PROVIDENCE, R.I. – Rhode Island student athletes are hitting the playing field this season with a new set of rules on what happens when they get a concussion. A new state law requires players to leave the playing field after they're hit in the head.
It also will help Rhode Island become the first state in the nation with detailed statewide data on the impact of brain injuries.
It's a Friday night at Cranston stadium and Cranston West's football team is up against Barrington. The game's not going well. Cranston West fumbles a snap when it's close to the end zone, and Barrington takes advantage of the mistake to score its second touchdown.
At some point during the action, Cody Nadaeu gets hit.
Nadaeu sits on the sidelines squirting water into his mouth. He stares blankly as his parents stand behind him, gathering his things to go to Hasbro children's hospital. Michael Hayden, the team doctor, says he didn't see the play, but it's pretty obvious what happened to Nadeau.
"When he came over to the sidelines he just said he didn't know what was going on," Hayden says. "He didn't know the score, and I asked him a few other questions and he just wasn't oriented to where he was. And that's the hallmark of a concussion."
It's the varsity team's first concussion of the season, and their first real test of the Rhode Island's new concussion law. Mike Traficante, the athletic director for the Cranston public school system, says, "We'll see how the process works in a hurry now."
He says after Cody Nadaeu goes to the hospital, he'll have to ease back into football.
"He'll have to go one week where he's asymptomatic," Traficante says. "Then after one week, when he's asymptomatic of the concussion symptoms, the second week he can start to light exercise. The third week, more strenuous exercise and we'll go from there."
This gradual return to the game is part of a new state law that requires a doctor's permission before athletes can go back to the field. It's all a part of an effort to prevent the more severe consequences that can occur when players get a second or a third concussion before they've healed from the first. Even a mild second impact can cause brain swelling and in rare cases, death.
And that's what motivated Dr. Elizabeth Jacobs to lobby lawmakers to pass the bill. As an emergency room doctor at Hasbro Children's Hospital, she's seen firsthand a direct correlation between sports seasons and concussion seasons.
"We always know the day that football season starts because the kids begin rolling the door with their football helmets on," Jacobs says. "We also know the day that ice hockey season starts because of the same scenario, jut with an ice hockey helmet on instead of a football helmet on."
Jacobs says identifying students with brain injuries is one thing. Helping them heal is another.
"We do a great job in the emergency department for screening for head injuries like bleeds and skull fractures," she says. "Nobody really knows what to do with the kids after they get a normal cat scan."
That's why this year students can go to specialized concussion follow up clinics at six different locations in the state. There, doctors can monitor students' progress as well as collect useful data about head injuries in Rhode Island using a simple computer test.
Elizabeth Connolan with the brain injury association of Rhode Island has traveled all over the state administering what's called the IMPACT test. It's a pretty basic computer program- words and images flash across the screen to test student's memory and reaction time.
The tests are supposed to be difficult, but students don't have to worry about failing. The initial score just provides a good measure of how the brain usually functions. When students get a concussion, they take the test again.
Nick James is a left guard on Cranston West's freshman team. Football players, like James, are taking the test first because they're at the highest risk for concussions. The goal is to eventually offer the test to every student athlete in the state. When an athlete's score matches his pre-concussion performance, he can start playing again.
James says the test was confusing, so that means it's probably a good way to measure the effects of a concussion. But not everyone is on board with the IMPACT test.
James's coach Steve Stoehr needed some convincing it was worth his time.
"Well, I have a hundred kids on my team," Stoehr says. "To get a hundred kids in a library on 20 computers? That's a lot of practice time gone."
Rhode Island's concussion law doesn't require the IMPACT test, it just recommends it, so testing is up to each individual school. So far, 27 schools have been tested and 19 have not. Stoehr says he takes concussions seriously, and always keeps his athletes off the field after they've been hit in the head, but the impact tests and the new law sometimes feel like overkill.
Elizabeth Conollan with the Brain Injury Association of Rhode Island says she thinks once students and coaches see the impact test at work they'll understand why it's useful.
"Because there definitely are children who were sent back to play too soon, who either parents didn't know or coaches didn't know or teachers didn't know that they didn't need more rest," Conollan says. "So, kids were playing with concussions. So that's why you need the law."
In general, it's difficult to quantify the severity of a concussion, but the test scores offer a clear comparison of a student's brain before and after.
Researchers including Dr. Elizabeth Jacobs from Hasbro Children's Hospital say the results are a useful tool for learning more about the causes and treatment of concussions.
As for Cody Nadaeu, the football player who got hit in the head, he visited Dr. Jacobs in her office for a post impact test. She says he's healing well and will probably be ready to play by next week.