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Injuries prompt athlete to become concussion-prevention advocate

Junior uses Concussion Awareness Day to share her story; ASU researchers taking transdisciplinary approach to issue

Woman holding volleyball

September 20, 2018

Six years ago, a doctor told Stephanie Cahill that she most likely wouldn’t graduate high school, and that college was definitely out of the question.

The grim news was delivered by a neurologist after Cahill received a severe concussion playing youth volleyball — a year after she suffered another blow to the head under the almost exact same circumstances.

Despite the double whammy, Cahill’s now a junior at Arizona State University, double-majoring in business law and psychology.

“Most people don’t see concussion as a serious injury,” said Cahill. “I’ve been struggling. Certain things have been hard. Reading is still hard. Memory is still hard. Comprehension is hard. … I still have very severe issues. I’ve had to fight my way back.”

To call it a fight might be an understatement. When Cahill was tested for concussion impact, she fell into the bottom 1 percent in the nation in terms of severity. The concussive blows she suffered at 14 forced her out of volleyball, cost her school time her junior year and pushed her to double up on summer school in order to graduate from Horizon High School in northeast Phoenix. She also hired a tutor to help her pass the SAT.

Cahill said there were also emotional aspects to deal with. She has wrestled with depression, anxiety and irritability, and she was less able to deal with stress than in the past. The biggest blow, however, was her loss of identity.

“Before the concussions I had always identified as an athlete because that’s who I was,” Cahill said. “When I lost that identity, I didn’t know what to do.”

Cahill hopes to use National Concussion Awareness Day on Sept. 21 to reach others who may be suffering from the same symptoms but don’t know where to turn.

“What’s motivating me to do this is that I don’t want other people in my situation to feel hopeless,” Cahill said. “I had a good support system, and I know a lot of other people don’t have that and are going it alone. I don’t want them to think they can’t recover.”

Long-term consequences

Mild traumatic brain injury, or concussion, is the most common type of traumatic brain injury, according to the American Congress of Rehabilitation Medicine. Along with impaired cognitive function, a concussion can cause an array of symptoms, most notably headaches, fatigue, depression, anxiety and irritability.

More recently the debate over sports safety has raged after reports that several former star football players — including Hall of Famers Junior Seau and Frank Gifford — had a degenerative brain disease with symptoms that may include depression, memory loss and suicidal thoughts.

Most research shows that concussions affect people differently. Most will have symptoms that last for a few days or a week. A more serious concussion can last for weeks, months or even longer, as in Cahill’s case.

“We’re starting to realize that there is a pretty significant portion of the population that will have long-term cognitive deficits, and that can be from a single concussion,” said Karen Gallagher, clinical associate professor and director of the Office for Veteran Health SolutionsThe Office for Veteran Health Solutions is an initiative based in the College of Health Solutions. “One concussion can have long-term consequences.”

A bump, blow or jolt to the head can cause the head and brain to move rapidly back and forth, said Gallagher, an Army veteran who spent years investigating how concussions affect service members transitioning into civilian and college life. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.

While some research shows that the young brain can be resilient, it may also be more susceptible to the chemical changes that occur in the brain after a concussion. These changes can often lead to a set of symptoms affecting a student’s cognitive, physical, emotional and sleep functions.

It can also severely impact a student’s schoolwork, Gallagher said. Cahill can attest to that; she has employed several new methods and techniques to get around her diminished cognitive skills. Because her reading comprehension is almost nil, Cahill listens to textbooks on tape. She also uses flashcards for memory and has doubled up on her study time in order to pass exams.

“All of this is through trial and error,” Cahill said. “My mind is being rewired, and it can be exhausting and overwhelming at times.”

Video by Deanna Dent/ASU Now

Advocacy and self-reporting

Cahill is unique in that she is actively seeking help. Many athletes, particularly male athletes, don’t do an adequate job in advocating for themselves, according to Michael Lavoie, a faculty associate at the College of Integrative Sciences and Arts and division chief for pediatric and neuropsychology at Phoenix Children’s Hospital.

“Just the other day I saw a male athlete who suffered a concussion last year in a helmet-to-helmet collision in football and didn’t tell anybody,” Lavoie said. “His grades declined and he was failing. No one could figure out why, and the school thought he might have a learning disability. He didn’t tell anyone because he thought he had to deal with it and tough it out.”

That kind of mentality has been pervasive in male athletes and coaches, Lavoie said. However, he said females generally do a much better job of self-reporting, which accounts for the rise in hospital admittances.

“Last year I called it ‘The Year of the Cheerleader,’ because every week I saw a new case from cheer and gymnastics,” Lavoie said.

Self-reporting plays a big part in concussion recovery and is the basis of a three-year study undertaken by the Hugh Downs School of Human Communication. The NCAA Mind Matters Challenge, a $7 million education and research challengeASU's portion of the study, “Socioecological influences on concussion reporting by NCAA Division 1 athletes in high-risk sports,” is a $400,000 grant., states that concussion among athletes is a growing concern with efforts underway to improve detection, diagnosis and treatment. And success is dependent on communication by athletes, because they often perceive concussive injuries to be of low immediacy.

“We are looking at the problem of concussion reporting on three levels: individual, group and team levels and the cultural narrative level,” said Steve Corman, director of the Center for Strategic Communication whose investigative team includes five ASU faculty members and several graduate students. “What we’re finding is that there are all of these narratives in popular culture that tell us that athletes are warriors; that they should play through the pain if they want to play in the big leagues.”

“This raises interesting philosophical questions about the fan’s responsibility and obligation. Is it moral to watch football? And if it’s immoral, then what can they do about it?”
— Shawn Klein, ASU sports ethicist

Corman said volleyball is considered a low-risk sport. The largest concussion rates were actually in men’s wrestling, men’s ice hockey, women’s ice hockey and men’s football. However, men’s football probably has the largest number of sports-related concussions due to the size of the teams, Corman said.

He said the research group is currently developing an intervention video to persuade athletes to think of concussions as a more immediate problem as well as teach the long-term impact it can have on their brains and mental health.

Sports fans could play a role in the cultural narrative of concussions, said Shawn Klein, a lecturer in the School of Historical, Philosophical and Religious Studies, who is also a sports ethicist.

“High-level elite colleges and professional teams will be driven by fans, and they are a driver of what goes on in sports,” Klein said. “Their presence is often why those institutions exist in the first place, and this raises interesting philosophical questions about the fan’s responsibility and obligation. Is it moral to watch football? And if it’s immoral, then what can they do about it?”

Klein said sports-related concussions can also be an opportunity for fans to gain a greater empathy for injured players, especially athletes in college and professional football.

“These players are not cogs in a machine on your fantasy football team but are human beings with real lives and wives, children, brothers and sisters,” Klein said. “Fans may come to a greater understanding that there are more important values beyond the game.”

Message for the masses

Karina Forbes Bohn, chief operating officer for ASU’s Global Sport Institute, whose goal is to examine issues impacting sports, said the institute is positioning itself to take an interdisciplinary look at sports-related topics such as concussions in the next year.

She said it will do that through a series of events, faculty cross talks and messaging on its multimedia website, which is in partnership with the Walter Cronkite School of Journalism and Mass Communication.

“We’ll take the research that we’ve done or aggregate research and translate it into useful information,” Bohn said. “We’ll do that through documentaries, podcasts, short-form articles, infographics and put it into a format where people will consume it.”

Cahill vowed she would do her part as well.

After she collects her two undergraduate degrees from ASU in May 2020, Cahill intends to enroll in law school so that eventually she can advocate for people with brain and mental health issues.

“They’re going to have issues with school and their scholastics, and they’re going to need someone to fight for them to stay in school. There’s also going to be issues getting jobs,” Cahill said. “I want to be sure their voices get heard.”

Top photo: Psychology and business law student Stephanie Cahill (pictured outside the Beus Center for Law and Society on ASU's Downtown Phoenix campus) focuses her activism on concussion, CTE (chronic traumatic encephalopathy) and mental illness after suffering a series of concussions as a high school volleyball player. Photo by Deanna Dent/ASUNow

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