Maggie Healey lay on the ground last September, hands wrapped around the soccer ball, hyped that she had blocked a goal and kept her team's lead, when an opponent's knee hit her temple, sending a sharp, shooting pain through her head.
The pain, incessant and throbbing, felt like someone repeatedly poking her in the head. It lasted for three weeks until doctors at Mount Washington Pediatric Hospital finally diagnosed it as a concussion. Once properly diagnosed, Maggie participated in six weeks of specialized physical and occupational therapy and got back on her feet.
Maggie, 12, now a seventh-grader at Parkville Middle School in Baltimore County, doesn't play soccer anymore because of her ordeal with the concussion. She has taken up volleyball instead.
As the new school year gets into full swing and the fall sports season begins, doctors are preparing for increased calls from parents and children who suffer head injuries.
Brain injuries in children "ebb and flow" with the school sports seasons, said Dr. Danielle Raines, the neuropsychologist who diagnosed Maggie. As a result, Raines and her colleagues hold workshops with social workers, coaches and parents around this time each year to teach them the symptoms of a possible concussion.
Doctors at Mount Washington Pediatric said they have already gotten several calls from parents after getting none in August.
In 2009, an estimated 248,418 children age 19 and younger were treated in emergency rooms for sports- and recreation-related injuries that included concussions, according to the latest Centers for Disease Control and Prevention statistics. Concussions are considered the most common type of traumatic brain injury and can refer to mild traumatic brain injury, mild head injury, minor head trauma or a mild brain injury.
In 2012, 706 Marylanders died as a result of a traumatic brain injury and 5,231 were hospitalized, according to the state Department of Health and Mental Hygiene's Core Violence and Injury Prevention Program incidence data cited in the 2014 annual report of the Maryland Traumatic Brain Injury Advisory Board. The board is made up of individuals with brain injuries, family members of people with such injuries, and state agency and service providers. State residents made 38,128 emergency room visits related to traumatic brain injuries, according to the report.
Football is the most common sport with concussion risk for males; for females, it's soccer, according to the Sports Concussion Institute.
The good news, doctors say, is the growing awareness about the risk. After years of pressure, the NFL recently acknowledged the long-term health problems such injuries can pose.
Now more parents and coaches are pulling students from play at the first sign of injury. By spotting injuries right away, parents can get kids into treatment more quickly and reduce the possibility of further damage.
The Maryland State Board of Education established a task force in 2012 to study whether the state is doing enough to reduce the number of concussions in student-athletes. The task force recommended that the state permanently adopt regulations requiring more training for coaches and physical education teachers, parental notification of concussions and further study of ways to limit such injuries. It also called for local school systems to develop policies to accommodate injured students academically.
Some parents are getting their kids baseline testing — or brain scans — before a concussion ever occurs. That way if a child ever suffers a brain injury, doctors can compare it to the healthy brain.
An injured brain needs to rest, both mentally and physically, to promote healing.
"Brain injury needs time to recover," said Dr. Charles Park, director of neurosurgery at Mercy Medical Center.
A concussion occurs when impact to the brain causes it to bounce around or twist in the skull. The impact of the brain hitting the skull stretches and damages the cells, creating chemical changes in the brain.
"Right after a concussion the brain is going chemically haywire," Raines said.
Signs and symptoms generally show up soon after the injury. However, the seriousness of the injury may not be apparent initially and some symptoms may not show up for hours or days. Parents should take children to the emergency room if symptoms persist.
When Raines first saw Maggie, she presented with classic concussion symptoms. She was lethargic and her thinking was slow. She couldn't remember the details of how she was hurt and continued to feel pain in her head.
"It was really frustrating not to be able to remember things and do all of the stuff I used to," Maggie said.
Raines performed a battery of tests to assess Maggie's writing, memory and recall skills, among other things. In one test, she was shown different designs and had to say whether she had seen the design before.
Treatment of concussions are very individualized, Raines said. Maggie's vestibular system, structures in the inner ear that contribute to balance and spatial orientation, were weakened. The injury made her feel dizzy often and gave her vision problems.
"Every person will be different, and depending on what the symptoms show, every treatment will be different," Raines said. "That's why the assessment is important."
Maggie's parents kept her out of school and prohibited her from playing sports after her injury, helping her brain to rest and heal.
At Mount Washington Pediatric, part of Maggie's treatment included therapy on a balance machine used by NASA astronauts after they return from a space mission. Maggie was harnessed to the machine and performed exercises that caused her body to move in ways that tested her balance.
Therapists had Maggie jump rope, run, and do squats and other exercises to build endurance and balance.
Maggie said she feels much better since being treated for her concussion. She is now cautious when doing some activities, such as jumping on the trampoline.
"I don't really feel the same as I did before the concussion, but I am glad to be better," Maggie said.
Her mother, Shawn Healey, is glad to see her daughter back to her normal self.
"You never want to see your child hurt," she said. "That is hard to watch."