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Eds: This is the first of four Cronkite News stories on concussions in Arizona high school sports.

By NICOLE VASQUEZ
Cronkite News

MESA – Bike. Peach. Umbrella.

Skyline High freshman lineman Noah Barta struggled to remember those words after he was blindsided on a kickoff return during a September 2015 game against Westwood.

On the sidelines, Mike Coutts, Skyline’s athletic trainer, took Noah’s helmet away, barring any chance of him playing another snap. In one of his concussion protocol tests, Coutts asked Noah to repeat the three words he gave him.

“I have no idea what you’re talking about,” Noah told Coutts.

From the stands, his mother, Brenda, watched. As a speech pathologist for Skyline, she was all too familiar with the protocol her son was undergoing.

“I could see Noah was getting really agitated, which isn’t like him,” she said. “Talking with coaches, he was throwing his hands up in the air, storming away then walking back. That’s when I finally came down from the stands and to the sidelines to listen what was going on.”

Noah is one of a growing number of Arizona athletes to report a concussion. According to Barrow Neurological Institute’s survey, one in three high school senior athletes reported sustaining concussions in the last year.

Noah doesn’t remember the hit that sidelined him. His friends showed him a clip on Hudl.com afterwards.

“I was on kick return and I was going back,” Noah said. “The kid was right there, he just blew me up from the front. It doesn’t look that bad on video, but it felt bad.”

He had clearly sustained a concussion. Typical symptoms include headaches, dizziness, blurry vision, mood changes and difficulty in remembering, concentrating and making decisions. But unlike his professional or collegiate counterparts, high school-age heads heal at a different pace.

Dr. Kristina Wilson, who specializes in pediatrics and sports concussions at Phoenix Children’s Hospital, said that it takes longer for youths to recover with their brains still developing.

That fact is supported by a Journal of the American Medical Association Pediatrics survey conducted in May that discovered high school football players are more likely to suffer more symptoms than older athletes; 15 percent of players did not return to play for at least 30 days following the concussion.

“Many times we tell parents it’s better to get hurt when you’re younger because you’ll recover a lot faster,” Wilson said. “Head injuries are the exact opposite. It can take a week longer than kids who are even just five years older.”

It’s why Wilson said concussion awareness and education play a factor in reaching those at-risk younger players. The Barrow survey found 79 percent of high school athletes immediately told their coach they had a problem.

“The mentality used to be, ‘You need to be tough,’ or, ‘If you get hurt or injured, you’re weak,’” Wilson said. “What we’ve seen instead from schools in the Valley, coaches and trainers are creating a much more supportive environment as far as head injury goes. We see a lot more kids coming forward now.”

Thanks to the relationship between the Arizona Interscholastic Association and Barrow, more than 250,000 athletes have completed concussion education through the Brainbook, an online course that teaches athletes what concussion symptoms to look out for.

AIA bylaws require athletes to complete the Brainbook online course before they can practice or compete.

As a result, 61 percent of all high school athletes are more aware of the symptoms and dangers of concussions than they were a few years ago, according to Barrow’s 2016 concussion survey.

“We try to work with coaches, parents and the kids themselves to create protection for them but then not also over-regulate them,” said AIA Assistant Executive Director David Hines.

Coaches and parents aren’t allowed to make return-to-play decisions. The AIA provides officials trained with the concussion protocol, making Arizona one of the only states to do so.

If officials suspect a player shows concussion-like symptoms, they can take him or her out of the game to be checked.

But only qualified medical officials can provide the ticket back to the field.

In August, the organization announced it will provide concussion insurance for its athletes for the 2016-2017 school year.

The intent, Hines said, is to eliminate the chance that parents without insurance won’t allow their kids to be seen because they’re concerned they can’t afford treatment.

At the time of his protocol testing, Noah couldn’t understand the reason why Coutts flashed a light to check his pupils and asked him to count backwards from 100 by threes.

“I’ll ask questions like: ‘What did you have for breakfast this morning? What’s the score of the game, without looking?’,” Coutts said. “Usually by that time we’ve had five, six minutes go by and I’ll ask: ‘What were those three things that I asked you to remember?’ If I see anything, any physical symptoms, if there is any difficulty remembering – those are all red flags and then that kid gets removed from the field.”

It was halftime when Noah was escorted to the locker room by his father, Chad, and Skyline athletic director Greg Schultz.

He went to his locker to grab his belongings. But all he could do was stare at the lock.

“I have no idea what my combination is,” he told them.

Schultz and his father could only console him. It was the first moment Noah realized he wouldn’t be going back on the field anytime soon.

“I think it’s one of those moments when the emotions take over,” Brenda Barta said. “Tears came, he just looked at them like, ‘What’s going on with me?’ I think that’s when it hit him, at that moment when he just stood there, staring at his locker, he realized that OK, there’s something wrong here.”

During the car ride to the hospital, the game remained on Noah’s mind. He continued to ask what the score was and when he could go back and play. It’s the only part of that night he remembers.

“At that point he didn’t realize the game was over,” his mother said.

For two days, Noah stayed home from school. The next three weeks, his routine changed. There were weekly visits with his pediatrician.

Then, drop-ins to see Coutts for ImPACT baseline testing that became a school routine. The computerized test consists of numbers, shapes and squiggly lines to check cognitive function, memory and reaction time.

The access to ImPACT is free due to the Barrow Concussion Network, a program that offers statewide concussion research and consultation to all AIA member schools.

Along with the rest of Skyline’s athletes, Noah took the test at the beginning of the school year to get an initial score. Coutts then compares that number to the results post-concussion.

Once his pre- and post-concussion numbers matched, it meant Noah would be closer to suiting-up again.

In his first weeks of recovery, the noises of school – the bell, the laughter of his friends, the lessons – all aggravated his symptoms.

Noah plays the cello. But he couldn’t stand to be in orchestra class. He sat in his mom’s office during that hour instead.

He still went to his first homecoming dance with his friends. But his parents had to pick him up early because the blaring buzz of the bass was too much for him.

“I guess I was proud of myself because I can get really emotional,” Brenda said. “I stayed pretty calm through the whole thing. But in the back of my head, when this started carrying on and he had headaches for a couple weeks, I did start having the typical feelings of, ‘Is this worth it?’ Even though this is something that he loves, is this worth it?’”

Wilson said she expects 85 percent of concussion victims to recover. After 30 days, they enter the prolonged recovery phase.

That’s when Wilson talks with the parents.

“We will recommend to the family that we don’t think it’s the best interest to go back,” she said. “Or we really think they need to take a year off of sports or recreational activities that put them at a higher risk to get a head injury, until we have time to reconsider.”

Noah saw his doctor close to the prolonged recovery stage.

“On our last check up the doctor said, ‘If you get another concussion, within a year, I will shut you down from sports, I won’t clear you again,’” Brenda said. “He’d have to go through a specialist.”

For an athlete like Noah, who begged to go back to the game, it’s not an easy chat to have.

“They tell me that they’re ready to go back, that they’re recovered 100 percent,” Wilson said. “I try to break it down to tangible things that they can understand in the moment and say, imagine how you felt several weeks ago when you couldn’t get out of your bed or go to school because the headaches we’re so horrible. Imagine if that never went away. That’s the risk you run.”

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Seventy-nine percent of high school athletes reported sustaining a concussion to their coaches, according to a Barrow Neurological Institute survey. (Photo by Jeanna Berg/Cronkite News)