On a recent Saturday morning, 15-year-old Eric Wagenlander woke with a question for his parents.
What, he wanted to know, was a hospital bracelet doing on his wrist?
"I immediately started crying," recalled his mother, Fannie Wagenlander of Mount Pleasant. "We knew that our boy was back."
Eric, a sophomore at Wando High School and a member of the Warriors varsity basketball team, had no memory of the previous 10 days.
He could not remember the fall he suffered during Wando's game against Ashley Ridge on Jan. 4, nor could he recall hitting the right side of his head on the court and suffering a concussion.
The ambulance ride to Medical University Hospital? Nothing. The EMS worker using a pair of scissors to slice off his uniform? No memory.
Same with the CAT scan and other tests, the visits from friends and teammates at home the next week, the three Wando games he attended to sit on the bench with his team. All were wiped from the memory banks.
"To me, it's like I was asleep for those 10 days," Eric said. "Waking up and having no idea what had gone on for 10 days - that's a weird feeling."
It's a scare more and more young athletes are encountering.
A recent study found that twice as many kids nationwide visited emergency rooms for concussions in 2005 than they had eight years earlier. Another study found a sharp increase in the incidence of traumatic brain injury among youths playing basketball.
Aleighsa Welch, a standout senior on the Goose Creek High girls' varsity basketball team, has a story similar to Eric Wagenlander's. She hit her head on the court during a game in December and suffered her second concussion in two years.
"For a few days, I was really distraught emotionally," said Welch, who has signed to play college basketball at South Carolina. "I was totally a different person, and my whole family knows it. I was irritable and an emotional wreck, feeling a lot of stress. It really affected me and my personality."
For parents of both players, waiting for their children to return to normal was the hardest part.
"It was the most traumatizing time of our lives," said Aleighsa's mother, Sharell Welch. "The physical part of it is bad enough, but the emotional part of it is the most devastating. It took a toll on us as her family as well as her."
On the Rise
An increasing number of families are facing similar challenges. An estimated 130,000 young people suffer concussions playing sports each year, and that number is on the rise.
A study published in the September 2010 issue of the journal Pediatrics found that the number of school-age children who visited emergency rooms for treatment of concussions in 2005 was more than twice what it had been in 1997. The study, titled "Emergency Department Visits For Concussions in Young Child Athletes" and conducted by researchers at Brown University, scrutinized more than 4 million ER visits.
Another study published in Pediatrics, titled "Basketball-Related Injuries in School-Aged Children and Adolescents 1997-2007," found an increase of 70 percent in the number of traumatic brain injuries suffered by children ages 5-19 playing basketball, even though overall basketball injuries had declined.
The researchers, from the Center for Injury Research and Policy in Columbus, Ohio, are not certain if the rise in concussions in basketball is due to increased awareness or more aggressive play on the court. Boys were more likely to suffer lacerations, fractures and dislocations while playing basketball, the study said, and girls led the way in traumatic brain injury and knee injuries.
Return to Play
The play on which Eric Wagenlander was injured was nothing dramatic, a typical charge-block play that occurs many times in a game. He never blacked out -- only about 10 percent of concussions result in a loss of consciousness.
"He's gotten hit harder, taken charges harder, run over kids harder," said his father, Steve. "It wasn't one of those where the crowd goes, 'Ooooh.' "
And yet Mark Buchman, the veteran head athletic trainer at Wando, immediately recognized one of the most profound reactions to a head injury he'd ever seen.
"He was pale white and had that glassy-eyed look," Buchman said. "He never lost consciousness, but he was very dazed and confused. He was nauseated and very slow. Usually, they start to get better after a few minutes. He did not, so we called the ambulance."
The Wagenlanders said Eric got first-rate care from Buchman and at the hospital, where he spent one night.
But care for a brain injury does not end when an athlete leaves the hospital, said Dr. Jason Madey of MUSC's Department of Neurology.
"Concussions are not just dings," Madey said. "They are serious and need to be managed appropriately by someone trained in sports medicine. We can't afford to risk our children in these situations. Second-impact syndrome can happen when athletes return to play too soon, and that's something that potentially can be fatal."
Awareness of the danger of concussions is increasing, as well. Many states have passed or are considering "return to play" laws, and the NFL banned "helmet-to-helmet" hits this season. Major League Baseball is considering a seven-day disabled list just for concussions. The Centers for Disease Control and Prevention has started a "Heads Up" campaign to raise awareness. Many sports leagues, universities and high schools are using the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) computer program to treat concussions.
Sharell Welch said there was a marked difference in how Aleighsa's most recent concussion was treated from her injury two years ago.
"I've seen the changes, and I welcome it," she said. "This time, they were much more careful. The first time, there were no tests or follow-ups once the doctor cleared her. This time, she had to take a series of computerized tests done by the trainer to see how symptomatic she was. The changes are definitely for the best."
But there's still work to be done. A 2009 study by the Center for Injury Research and Policy found that up to 40 percent of high school athletes who suffered concussions between 2005 and 2008 returned to action before their brains were fully healed.
That can be prevented by following a "return to play protocol," Madey said. The protocol is a five-step, supervised process that an athlete must complete, without showing symptoms, before he can get back in the game.
The process generally starts after an athlete is symptom-free for at least 24 hours. The protocol begins with light aerobic exercise and progresses through sport-specific exercise, non-contact training drills and full-contact practice before a return to games.
"But if at anytime an athlete develops symptoms, you have to return to the original state," Madey said. "It could take a week or months go get through."
And that can be difficult for a young athlete to accept. Eric Wagenlander is a key reserve on a Wando team enjoying one of its best seasons in years.
"It's tough to sit there and know you can't do anything," said Eric, who is now going through non-contact practice drills with his team. "It's not a fun thing to know this might be the best team I'll ever play on, and I can't play."
Welch is the best player on a Goose Creek team seeking a second consecutive state title. She missed seven games before returning to action.
"It was hard," she said. "I've never missed that many games for any reason. But I knew the risks of getting back on the court too fast. I knew it would be a long, drawn-out process, but it was worth it. I don't want to risk my whole career with another concussion."