It was hot. It was humid. As the heat of August beamed down, the football players in their pads and cleats continued on with their drills.

Left. Right. Left.

For sophomore Cannon DeMoura, the day started out as a normal summer practice. Players ran the ball and they tackled. They began again. Repeat. DeMoura, a wide receiver and
tight end, ran in for a catch. Yet, after DeMoura took on numerous hits, he began to feel like something was off.

“I can’t stand up… I was getting too dizzy to like stand up and not fall down. I was starting to forget things,” Demora said. “I just knew something was wrong.”

Within moments of having these symptoms, DeMoura wobbled over to get medical attention because he understood the importance of meeting with the athletic trainers on staff at the high school.

“They immediately knew something was up because I’m pretty close to the trainers, and they’re like, this is not… him. So, they carted me back to the training room,” DeMoura said. “Then, I started throwing up a lot.”

From there, the trainers called the fire truck and the EMS. DeMoura was then transported to a local emergency room where he sought further medical treatment. He remained there for three hours while he underwent a CAT scan and was hooked up to numerous IVs. DeMoura was even tested for brain bleeding and any major brain trauma, which he was cleared of.

He was later diagnosed with a concussion.

“I was definitely really emotional,” DeMoura said. “Like, I was kinda just in shock, in disbelief. But after the first couple hours, it kinda settled down.”

Yet, DeMoura recounts that after his original diagnosis and as he began to recover from the sport that had left him with a concussion, his football coach continued to support both him and his recovery.

“He wasn’t very mad that I asked him to come out because he played in college. So, he obviously knows what a concussion is. He knows how serious it is,” DeMoura said.

According to Stacy Gray, a physical therapist for MUSC’s conclusion clinic, a concussion is in fact urgent for they can lead to long-lasting brain trauma.

“Anything that you feel like something just happened and you’re not feeling great, it’s definitely worth it to step out because you just continuing to play even less than 15 minutes prolongs your healing,” Gray said. “It’s that initial response that’s so important… stepping away from the activity, getting yourself checked out, making sure you didn’t have a concussion rather than playing through it.”

As part of her job, Gray deals with numerous concussion patients daily. However, in her 14 years of treating concussions, Gray has come to the realization that no two concussion patients are the same.

“There are different factors that go into the duration of healing,” Gray said. “Sometimes, if they’ve had other, you know, concerns, like maybe some anxiety at baseline or sometimes even female teenagers… can take a little bit longer… if you know they’ve had a previous injury that they haven’t quite healed from. There’s just different factors that can factor into a healing rate, and everyone is different.”

In order for patients to undergo a proper healing process, Gray works with other medical professionals within the concussion clinic. According to Gray, they have their own strict methodology for treating patients.

“It consists of our neurology provider doing an assessment that looks at any… what’s called red flags, like, anything concerning that they may need imaging or any neurological concerns. And then that neurology provider is also gonna be the person that if they do need medications,” Gray said.

From there, the patients are sent to a speech-language pathologist, or a speech therapist, who will conduct a cognitive assessment of the patient in order to ensure that there are no abnormalities in the brain.

“After a concussion, you could have some difficulties with attention and focus, and then a lot of times will then cause issues with memory,” Gray said. “So she’ll do some assessments for that, and if she finds any concern, she’ll usually give strategies to work on for school… Sometimes after a concussion, going back to school or fully participating in school can be difficult because of these difficulties with focused attention and some of the cognitive processes.”

After patients are evaluated by both the neurology provider and the speech-language pathologist, Gray begins to step in to help with the recovery identification process.

“I look at their ocular motor system, which is basically how your eyes move in your vestibular system, which tells your body where you are in space. And both of those systems can be affected by a concussion and can trigger symptoms,” Gray said. “And then I’ll look at their neck because a lot of times when you have a concussion, there’s a lot of force that happens to the neck, and be it when the head goes forward and backwards, the neck follows.”

Numerous other tests later, Gray, the speech-language pathologist, and the neurology provider discuss their findings. Based on what they have found as a trio, they will come up with a recovery plan for the patient. This may include any school accommodations or letters that the patient may need when they return to their day-to-day life.

Yet, for Mari Grossi, a pediatric neurologist who focuses on patients with epilepsy, concussion protocol looks a bit different, especially when dealing with children.

“To be able to recognize the changes, and then from there, you know, have a plan for them to recover,” Gross said. “But it’s very important because concussion can impact multiple areas especially the cognitive function, which can affect how the kids learn, how the kids… in the studies, how they are progressing in class, their memory… and also like headaches and balance problems.”

Similarly to Gray, Grossi notes that individual patients have differing recovery times based on how they were concussed and the severity of their injury.

“A concussion without any changes in the MRI, with no bleeding, with nothing, I had patients that took a very long time to recover. Especially with headaches that persisted for a long time. These kids were not able to go back to normal daily activities, especially because of the headache and the balance issues. I think these are the ones that are the most debilitating for them,” Grossi said.

However, according to Grossi, in order to mitigate the effects of concussion-related injuries, it is important to ensure that patients do not get a second or even third concussion following their initial diagnosis.

“There’s always this discussion: When should the kids go back to play, right? So, avoiding a second hit is very important,” Grossi said. “Because sometimes they’re still not fully recovered from that trauma and they are back training again. Then they have another hit.”