Fourth concussion tipping point for GFU-bound player
Sami Howard's last concussion, captured by a student videographer, looks bad. But it's the sound — something like a dropped bowling ball — that turned the crowd's cheers into a low moan and then near-silence.
The five-second video shows the 17-year-old in the No. 11 jersey wrestling for a basketball and then suddenly going down, her blond ponytail whipping around as the back of her head slams the hardwood court with a stomach-churning thud.
"You can see me laying there, not moving," says Howard, who grew up in Gresham and attended Columbia Christian's High School in east Portland. "I'm going to have headaches for the rest of my life."
The clip of Howard's fourth concussion is undeniably dramatic. But her story of athletic injury, impaired academic performance and eventual recovery is not unusual.
Since Howard was the only senior on her school's basketball team, her classmates at Columbia Christian joked that the final home game of the 2017 season — billed as "Senior Night" — should really be called "Sami Night."
The Knights were losing badly on that February evening to the Knappa Loggers, another 2A-ranked varsity team in the Oregon School Activities Association.
While Howard describes herself as a sweet person, she's different on the court.
"I'd be diving on the floor. I would bruise after every game," says Howard, who started playing hoops in preschool. "I threw everything into the sport, because I loved it so much."
The 6-foot-2-inch player, who'd already committed to playing college ball for George Fox University in Newberg, expected a few "war wounds" after every game, but the stakes felt especially high that night. So at the start of the second quarter, when she and an opposing player each grabbed for a rebound under the basket, Howard hung on, trying to yank the ball away as the ref signaled a jump ball and whistled the play dead.
Both girls went down, Howard falling backward with no way to brace for the impact. Her head slammed onto the court and she briefly lost consciousness as teammates rushed to her side.
The Knights ended up losing, 51-14. Howard doesn't remember. She spent the evening in Legacy Emanuel Medical Center getting a CAT scan for what doctors later classified as a severe concussion.
The repercussions were huge. Howard dropped her college-level algebra class during her final high school semester while attending medical appointments four times a week.
For Sami's mother, Karen Howard, it was the tipping point.
"I would tell her in the doctor's office, 'You need to seriously think about stopping,'" recalls the 53-year-old, who herself was a high school athlete. "You could very well become my special-needs child, bottom line, or die from it."
Despite the promise made to George Fox, Howard and her parents decided she had to stay sidelined. Permanently.
Off the bench
From a perch in the library at Concordia College a year later, Howard isn't selling a sob story.
The business major works part time for her school's athletic department as a game-day management aide, setting up concessions and compiling stats for the men's basketball team, just six miles from her old high school gym. Ever the competitor, the hardest part, she says, is not being allowed to cheer while sitting on the bench.
In many ways, Howard's concussion experience is a story of successful intervention.
Knights coach John Roady hustled his player off the court after the injury, aware that Howard had suffered a concussion during a basketball game in her sophomore year. Repeat injuries, Roady knew, can be especially severe.
From the bleachers, Karen Howard watched as Sami let a water bottle slide from her fingers while sitting on a chair reserved for the players. She knew something was wrong.
She took Sami to Legacy Emanuel Medical Center at halftime, and later would make sure her middle child spent the necessary hours with a neurologist and undergoing physical, occupational and speech therapy. Those tests showed Sami's short-term memory had dropped significantly below baseline. Progress was slow, but it happened.
Staff at Columbia Christian accommodated Howard's needs. The student center lounge was open if she needed to lie down during the middle of the day, and her mom was ready to pick her up when she couldn't find any relief.
Howard describes listening to hours of audio of the TV show "Grey's Anatomy" — the colors and motion made it too difficult to watch the video. Karen Howard remembers the sunglasses and earplugs her daughter needed to block out the world.
Even on a good day, Howard would come home from high school, nap for four hours, wake up for dinner, then sleep for another eight.
Doctors no longer try to keep patients who suffer concussions awake, because the brain needs rest in order to heal.
At the time, Howard was suffering debilitating headaches once or twice a week. She now takes a daily medication for migraines, which can strike once a month or once a week.
"It fluctuates," Howard says. "They've just become a part of me: headaches and being forgetful."
Her short-term memory is not what it used to be. With less than a month until the end of the school year, Howard is still looking up room numbers and double-checking her schedule.
"Little things like that I just don't retain right now," she says.
Howard says she's met a lot of college athletes who have suffered concussions.
"I'm surprised their parents and their doctors are allowing them to continue," she says.
The daughter of two prep basketball players, Howard started playing sports in school as a fourth-grade student. She suffered her first concussion the summer before sixth grade during volleyball practice, when she ducked under a net to snag a ball and smacked her head on an equipment cart. Then a minor car accident in 2014 inflicted whiplash and a second concussion during Howard's freshman year.
The third concussion came on the basketball court in 2015, during district playoffs. She fell while playing underneath the basket.
Karen Howard says that in all three sports concussions, the coaches were good about following the state law and pulling her daughter out of the game and giving her time to heal.
Coaches "respected the rule that you have to fully recover," she says. "But you can't wear a helmet."
Neither mother nor daughter say they have any regrets. Sami is planning a concentration in sports management. When she finishes school, she'd like to be a coach.
Free concussion baseline testing for teens available at medical center in Newberg
Because concussions can occur without warning in any sport, prior action can be taken to aid in the healing process after they occur. Providence Newberg Medical Center is playing its part in this process by offering ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) screenings this month to kids ages 12 to 18.
While testing after a concussion is important for long-term health, prescreening provides valuable information for medical professionals. A child's baseline thought processes and reflexes when they are healthy can be stored and later compared to their test results if they are injured.
"ImPACT is a computerized neurocognitive test battery that is used to assess sequencing/attention, word memory, visual memory and reaction time," Jenna Vernon, clinical supervisor at Providence Rehabilitation and Services, said. "There are six modules that assess the listed domains."
The test takes 25 to 30 minutes to complete, she added.
When it comes to return-to-play decisions, ImPACT testing can still be helpful even without the ability to compare the athlete's score to normative data.
"The ImPACT test is not meant to screen or prevent mental health issues or impairments," she said. "Its main objective is being able to test and compare specific components of cognition at baseline and post-concussion."
Essentially, the function of ImPACT is to measure an athlete's symptoms. Measurements include verbal and visual memory, processing speed and reaction time down to 1/100th of a second. Once these measurements are attained, a comprehensive report of test results is created that provides reliable baseline test information. It further assists clinicians and athlete trainers with return-to-play decisions.
If multiple tests are taken throughout the course of an athlete's career, the data will automatically be stored and compiled so developmental and injury-induced mental changes can be accounted for.
"We are moving toward advocating for all athletes starting at age 12 and higher to take (the ImPACT test) so if a concussion is sustained we can compare their baseline testing to post-concussion testing," Vernon said. "This is a tool we can use whether through specific concussion rehabilitation, athletic training at a high school or return to sport/activity to gauge if the athlete or adolescent is back to their baseline and assess change of symptoms (headache, dizziness, fatigue, blurry vision, etc.) while taking the test."
She added that ImPACT has gained use since its release in 2002 due to local and statewide sports organizations allying with national organizations such as NASCAR, as well as soccer and hockey teams. As Oregon works to increase concussion awareness, all or most high schools will require athletes to complete the ImPACT testing prior to playing a sport and annually thereafter to track developmental changes and maintain mental health.