Title: Ahead of the Game and an image of Dr. Sebastianelli and Sam Slobounov

“Injured players will ask ... are you sure I can't go back in? When this happens, we have a minimum of fifteen minutes to assess whether symptoms start to clear.”

Dr. Wayne Sebastianelli, director of Sports Medicine at Penn State, can still remember a concussion he received while playing football at the University of Rochester in 1975.

“My head smashed into my opponent's helmet ... and the world turned dark. I opened my eyes and everything was in a grey fog,” he recalls. “It was a bad feeling—I'll never forget it.”

In those days, widespread understanding of traumatic head injury and its medical implications for athletes was very limited, Sebastianelli explains. So it wasn't surprising that his coach looked him over for five minutes, slapped him on the back, and cleared him to get back in the game.

Today, sports-related head trauma is deadly serious business.

Over 1.7 million people sustain traumatic brain injuries each year and 52,000 of these individuals are likely to die. Added to this, over 300,000 sports-related concussions occur annually, and the likelihood of suffering a concussion while playing a contact sport can be as high as 19% per year.

Dr. Wayne Sebastianelli (game day photo by Mark Selders)

Wayne Sebastianelli, M.D.,
Director of Sports Medicine at Penn State
Game day photo by Mark Selders

Ironically, it has become Sebastianelli's job (as Penn State's top trainer) to determine who will be held out of games involving hundreds of student athletes across the University from football, hockey, soccer, and basketball to volleyball, cheerleading and more.

Sports fans are well acquainted with Dr. Sebastianelli and his medical staff rushing out onto the field to examine the likes of Rob Bolden, Larry Johnson, Daryll Clark and other injured players in the heat of competition during the Lion's football games.

In these moments, trainers typically look for physical symptoms like blurred vision, nausea, memory loss, or slurred speech when diagnosing brain injury. However, a critical concern is also whether an athlete has had a previous concussion. A second impact coming within days of an initial blow, can cause cerebral edema and herniation, leading to collapse and even death within minutes. Trainers are also mindful that multiple concussions, over time, can result in long-term neurological deficits that can actually mimic advanced stage Parkinsons and Alzheimers diseases.

“There will always be some resistance in the heat of battle,” Sebastianelli says. “Injured players will ask ... are you sure I can't go back in? Those kinds of questions arise all the time. When this happens, we have a minimum of fifteen minutes to assess whether the symptoms start to clear,” he adds. “Coaching and training awareness is much improved from what it was 15-20 years ago and support for removing a concussed athlete has increased exponentially.”

In line with this, both the National Collegiate Athletic Association and the Big Ten Conference have posted guidelines that mandate all college athletes and coaches sign a concussion awareness form that requires they immediately report any symptoms of brain trauma. In addition, a number of states now mandate baseline concussion testing for every high school and college athlete in their districts.

“We're working to make it more socially acceptable for athletes to report concerns about themselves or their fellow team members and have instituted baseline cognitive testing both before and after a concussion takes place,” he adds. “This type of support is essential to saving lives—and athletic careers.”

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Virtual Reality
Penn State’s unique approach to Traumatic Brain Injury is shaking up traditional diagnostic methods.

Interestingly, some of the more acrobatic types of sports have been less covered in the press, but many of these can pose an even higher threat to athletes.

The Debate

With the recent influx of medical data on head trauma, the debate over concussion analysis and treatment has been gathering steam nation-wide.

NFL players like Terry Long, Andre Waters, and Justin Strzelczyk have raised the nation's awareness of the neurological changes that can destroy the minds of individuals who have been concussed multiple times. Long (a Pittsburgh Steelers Lineman) killed himself by drinking antifreeze at 45, Strzelczyk (also a Pittsburgh Steelers Lineman) died in a high-speed police chase at 36, and Waters (a Philadelphia Eagles defender) shot himself in the head at age 44.

Penn State cheerleaders

Photo by Annemarie Mountz

NFL hall of famers, quarterbacks, runningbacks, wide receivers and more have been lining up to donate their brains postmortem to further the understanding of Traumatic Encephalopathy—the name given to the type of degenerative neuro-dementia that can be caused by multiple blows to the head.

Last December, the NFL and its players association said they want to continue to encourage players to participate in these studies and pledged another $1 million or more to Center for the Study of Traumatic Encephalopathy headquartered in Boston.

Interestingly, some of the more acrobatic types of sports have been less covered in the press, but many of these can pose an even higher threat to athletes.

Lou Ann Kloss, Penn State's assistant cheerleading coach, emphasizes that cheerleading is an incredibly fast moving competitive sport today, involving highly skilled gymnastics that require students to be tossed in the air while simultaneously trusting that someone will always be there to catch them. “However, a common misconception is that fliers are at the greatest risk for concussions,” she adds. “In reality, the bases (or lifters) on the squad are the highest statistic for brain injury. Bases know if they don't catch the aerialist the effects will be devastating, so they sometimes get an elbow, knee, or foot to the head while trying to ensure the safety of a team member.”

A member of Kloss's squad, Craig Champi, has had seven concussions during the course of his sports career (in both high school and college), and was benched early this fall during the Temple game.

“For an athlete it's extremely frustrating, because I love being out there,” he states. “I do rugby, football, and wrestling, when I'm not cheerleading. But because of the multiple concussions I've sustained, I've been told I may not be able to play sports again. I just couldn't live with that.”

Frustration runs high for athletes of all types.

Penn State's star quarterback, Daryll Clark, who now plays for Canada's Calgary Stampeders, experienced his 3rd (and most severe) concussion during the Ohio State game in 2008. Pressure from fans was enormous—not only for him to get back into the Ohio game—but to play in the upcoming PSU-Iowa clash taking place the next week. Supporters doubted whether Penn State could win, without their first string quarterback to lead the team to victory.

“It was scary,” Clark remembers. “Concussions aren't fun and are tough to recover from ... so you focus on being able to carry the ball and remaining durable for the season. You don't want to be too nervous, where it takes away your game. Sometimes, you just have to live to fight another down.”

Champi adds that his goal right now is to continue to take Penn State's concussion tests until he gets a green light to get back into cheerleading and other athletics. “I'm hopeful,” he says, “that I'll eventually be cleared to do what I love to do.”

Daryll Clark makes a touchdown, Penn State vs. Ohio State, Nov. 7, 2009

"Concussions are a silent epidemic–because the brain can be terribly injured, and take years to recover, but no one will ever see this injury or think that anything is wrong."

Technical Transfusion

Photo by L. Reidar Jensen

There’s a Russian saying that “when you lose your mind, you have likely lost god’s good will.”

Elena and Sam Slobounov, who emigrated from Russia to the U.S. in 1989, both know what it's like to suffer trials of the body and mind, and they've used these trials to find a way to give back to humanity—and the world.

The Slobounov's have been partnering with Wayne Sebastianelli to design rehabilitative software for athletes at Penn State for over a decade. One of the crowning achievements of their work is a National Institute of Health funded Virtual Reality (VR) lab in Rec Hall, where Penn State athletes are tested for head injury.

Semyon (Sam) Slobounov, professor of Kinesiology

Semyon (Sam) Slobounov,
Professor of Kinesiology

Semyon (Sam) Slobounov, professor of Kinesiology, says that VR assessment is an enormous break through because it reveals cognitive changes that don't show up in typical medical diagnostic tests.

“To my knowledge, Penn State is unique in using VR to solve the brain injury epidemic,” he states. “Because of this work, national organizations such as the Department of Defense and the NFL are beginning to take interest.”

Penn State's approach to the growing concussion crisis is to administer baseline tests at the beginning of every season for high injury prone team members (such as basketball, football, soccer, hockey players and cheerleaders) to get a normal reading of the team members cognitive abilities. Slobounov's assistant, Katie Finelli, administers electroencephalogram (EEG), balance, memory, attention and reaction time tests. Several of these assessments involve virtual reality, and feature realistic 3D computer generated environments that enable the athlete to feel fully immersed in cyber-imagery.

The participant wears a special headset and stands on a platform in front of a 12' x 10' screen, then navigates with a joystick through a simulation of hallways and rooms, a 3D elevator, and more. If an athlete is injured he/she takes the same tests (post-concussion), so medical professionals have a basis for comparison.

According to Slobounov, it's essential the athlete doesn't return to play before they are fully recovered, because their reaction time could make them susceptible to new injuries. Also, multiple hits over time could lead to chronic headaches, clinical depression, Parkinson's Disease, Alzheimer's Disease, amnesia and other long term cognitive problems.

“When we see an injury during a game, such as someone's leg being twisted and broken, we immediately know that the injury will have a devastating impact on the athlete's life for years to come,” he states. “But concussions are a silent epidemic—because the brain can be terribly injured, and take years to recover, but no one will ever see this injury or think that anything is wrong.”

Slobounov's wife, Elena, a chief programmer of the cognitive VR assessment system, has firsthand experience with this type of cataclysmic event. In 1999, a truck came out of nowhere, side-swiping her in downtown State College ... and she temporarily blacked-out. When she came to—the world was no longer recognizable. Her short-term memory and sense of balance had been destroyed. When she tried to read, letters swam randomly in front of her eyes, when she tried to walk, the room tilted unexpectedly. For years afterward, she would trail a hand against the wall to keep upright, and struggled to remember a thought she had only moments earlier.

Fifteen years later, after a great deal of physical therapy, Elena says she may have finally regained 70% of her cognitive skills.

Sam, a world class Russian gymnast at sixteen, who later helped coach Olympic champion Greg Louganis in his twenties, knew what Elena was going through. He had suffered a concussion while riding a bike in Champaign, Illinois, in 1993, and never fully regained the hearing in his left ear. The concussion also led to a type of tinnitus, giving him permanent ringing in the ear.

“We are passionate about helping athletes, because we know the brutality of untreated concussions,” Elena says. “Athletes are competitive, and there is nothing more demoralizing than being taken out of a game. But preserving quality of life is even more important than competition.”

Sam adds, that (along with the college-related statistics) there is a growing body of evidence that indicates concussions are even more dangerous and take a higher toll on teenage athletes, who are more difficult to rehabilitate. Yet, high schools typically don't have athletic trainers or medical professionals at sports events due to the high costs—moreover, athletic equipment, like helmets, can be cheaply made and decades old.

“Our next step is to help pediatric concussion victims through new funding,” he states. “We have witnessed many higher ed institutions move from not even acknowledging concussions as injuries, to totally endorsing mandatory concussion baseline tests and mandating assessment. It's time to bring this same level of community involvement to our younger children. If ever there was a population that should have head injury scrutiny ... this is it.” ■

By Heather Herzog

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Title: Ahead of the Game and photograph of Dr. Sebastianelli and Sam Slobounov

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