Austin Story doesn't remember the late-summer outing at a friend's lakefront home in New Jersey, or the rocks he climbed near a waterfall. Or how he lost his footing and, as his horrified mother looked on, fell about 50 feet.
The 14-year-old lay motionless with a traumatic brain injury as his father tried to get him off the rocks and find help.
Two months later, Austin is still being treated at the Kennedy Krieger Institute in Baltimore, though he has learned again to walk and talk. And his family is coming to grips with a grim statistic: Kids are the largest group among the 1.7 million Americans who suffer serious brain injuries each year.
Such injuries are receiving more attention lately, as the National Football League seeks to prevent concussions and the U.S. military struggles to cope with those wounded on the battlefield. Government officials say further efforts are underway to raise awareness on playing fields.
Austin's family hopes this accident furthers that cause — by promoting recognition, prevention and treatment — especially for the youngest victims.
"I have long feared that something like this could happen [to his child], even while I trusted it would not, or tried to prevent it, or tried not to worry about it, or struggled to let go at the same time," said Shane Story, Austin's father. "That's the challenge we live with."
Story, a lieutenant colonel in the Army Reserve stationed in Alexandria, Va., has served two tours in Iraq and has known fellow soldiers to suffer traumatic brain injuries. He believes injured service members, as well as pro athletes, are helping raise awareness. But Austin is a reminder that accidents can happen anywhere to anyone, he said.
Indeed, the U.S. Centers for Disease Control and Prevention say kids up to age 4 have the highest rate of emergency room visits for traumatic brain injuries — 1,256 per 100,000 people — and together with kids up to 14 make up about a third of the sufferers.
The number of cases seen annually from 2002 to 2006 in the nation's emergency rooms rose about 62 percent from the five previous years, according to data recently released. That pushed total annual cases to 1.7 million from 1.4 million.
Dr. Mark Faul, a behavioral scientist with the CDC, said officials there attribute the rise to awareness, not a spike in cases. And he agreed attention to the wars in Iraq and Afghanistan, as well as on playing fields, is helping.
Traumatic brain injury "is the signature injury associated with the wars and we suspect more people are going and getting themselves looked at," he said. "We believe there is more awareness. ... We don't know enough to say for sure."
Falls on and off the playing fields, he said, are the major causes of head injuries, ahead of car accidents. Faul and Kelly Sarmiento, director of communications in the CDC's division of injury response, said many states are starting to ban school kids from returning to games after they've been hit in the head. The CDC has helped "craft the thinking" and encourage lawmakers to take head injures seriously, from mild concussions to major blows such as Austin's.
They say long-term consequences for sufferers include problems with thinking, perception, language and emotions. Officials at the CDC and elsewhere are working on better science and educational outreach.
Austin is lucky, his doctors and therapists at Kennedy Krieger say. He was taken to the specialty hospital for children with brain and spinal disorders about two weeks after the accident.
The Prince William County, Va., teen had been airlifted to a hospital in New Jersey after his accident. He was diagnosed with an epidural hematoma, or a buildup of blood between the inside of the skull and the outer covering of the brain. Emergency surgery was necessary to stop the bleeding, and he could barely open an eye 24 hours later.
Today, it's hard for casual observers to tell that anything is wrong with him, though his parents say he is a slimmer 127 pounds, down from 144, and has a slight tremor in his hand. He doesn't remember the accident, or much of September for that matter. His short-term memory hasn't fully returned and words don't always come to him, though his parents are mindful that 14-year-olds aren't always the chattiest. He declares many things a simple "awesome."
Austin relearned to walk, talk and do everyday things at Kennedy Krieger. He's already completing sentences, texting friends and playing some of his favorite sport, lacrosse. He now holds a hospital record on the Wii video game in soccer's performance, a better performance than the one given by his beloved Dallas Cowboys' Tony Romo in a late October game. Austin called the quarterback's possibly season-ending collarbone break "depressing."
But not all kids do as well as Austin, who will soon transfer to an outpatient facility, where he'll continue therapy to improve his cognitive abilities. His parents hope he can return, probably next year, to his regular school, where he'd be a ninth-grader. He still may have some short-term memory issues and other problems, though his parents say they expect him, like his two older sisters, to go to college.
The family credits the fast action of rescue workers and the team at Kennedy Krieger with his recovery — and Shane Story hopes other families will take all head injuries seriously and seek immediate treatment.
Dr. Stacy Suskauer, director of Kennedy Krieger Brain Injury Program, said it becomes clearer in the first few weeks how well the children there will fare. She said it's apparent, however, that immediate care and early intervention and therapy benefit all of the injured children.
Researchers are working on improving treatment and ways to use magnetic resonance imaging (MRIs) to better evaluate the extent of damage and the length of time recovery might take, she said. "Those are always the first questions."
In the meantime, she said, use of helmets by kids on bikes and better protection for student athletes is crucial. She supports efforts in many schools to teach athletic trainers to identify symptoms of mild traumatic brain injury, or concussions, such as dizziness, blurred vision, confusion, ringing in the ears and mood changes.
Suskauer supports the many schools, including the University of Maryland and Howard County public schools, that are doing baseline testing of kids before an injury happens so they can tell when something is wrong.
"Our goal is to maximize the potential of these kids," she said of Kennedy Krieger patients, who include more than 13,000 children with neurologic injury or illness, as well as those with spinal cord injuries, behavior problems related to autism, feeding disorders and other maladies.
But she argues that not getting hurt in the first place is the ultimate goal. "Traumatic brain injury is the No. 1 cause of acquired disability among kids," she said. "Recovery is long and hard and not everyone does as well as Austin. ... Preventing injury would be huge."
In addition to the physical damage, the costs are high, about $56 billion a year, according to the National Institute of Neurological Disorders and Stroke .Those who survive may need physical, occupational and speech-language therapy, as well as psychiatric care and social support and care for the rest of their lives.
Shane Story says the family is thankful for church and friends, who are taking care of the family's house and dogs. And he's grateful for support at work, where he returned this week, and his health insurance. He still frets about the freedom Austin will soon crave.
"I survived my teens and early 20s and realized later in life how foolish young men can be," he said. "This is a reminder life can turn bad very quickly. ... We need to overcome the idea that there's something cool about getting back in the game after a blow to the head. We need more attention, more research and more seriousness."
Traumatic brain injury
•About 275,000 people are hospitalized annually because of one. The majority are treated and released from an emergency room.
•About 52,000 a year die from one.
•Children up to 14 years old make up the largest group of sufferers, making up a third of the total.
•Falls are the leading cause, ahead of car crashes.
•An estimated 10 percent to 20 percent of service members serving in Iraq and Afghanistan have sustained one.
Sources: Defense and Veterans Brain Injury Center, the CDC