James Limperos quickly realized that going back to the game so soon after the hit he took was the wrong choice.
Despite his trainer's advice that he sit out for awhile, the former Warren G. Harding High School center offensive lineman said he returned to play sooner than he should have.
"That was a mistake," the 18-year-old recalled recently. "I got sick, ended up spitting up blood. I had this pressure in my head, this heaviness, and I couldn't bend over without getting dizzy or sick."
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James Limperos, 18, of Warren, said he has suffered multiple concussions during his lifetime and is a proponent of raising awareness about traumatic brain injuries among student athletes.
Limperos, who graduated from Warren City Schools in the spring, did what some health experts and lawmakers insist is an all-too-common practice among student athletes: returning to play too soon after taking a hit to the head, and at times, while suffering with a traumatic brain injury such as a concussion.
The Centers for Disease Control and Prevention report that each year U.S. emergency departments treat an estimated 173,285 sports and recreation-related traumatic brain injuries, including concussions, among children and adolescents, from birth to 19 years of age.
"The problem is that people just don't always see the seriousness of the injury," said State Rep. Sean O'Brien, D-Brookfield. "That's why it's so important to raise awareness, to get parents and coaches to understand what a TBI is, the symptoms as well as consequences and what can happen if you get back into a game too quick. It's risky and can be very serious because it can cause even more, sometimes serious, injury."
For that reason O'Brien, along with State Rep. Michael Stinziano, D-Columbus, last year introduced House Bill 143 on Youth Sports Injuries. The bill addresses concussions / traumatic brain injuries, or TBIs. O'Brien said the legislation is designed to teach young athletes and their parents the dangers of concussions. The measure, endorsed by the Ohio Athletic Trainers' Association and the Brain Injury Association of Ohio, has passed through the House and is pending in the Senate; however, O'Brien said he expects to see similar support.
"This isn't a partisan issue," he said. "This a very important legislation for Ohio and most lawmakers, regardless of party, are receptive to it and to getting it moving. It's about helping Ohio's youth."
O'Brien said the legislation is part of a national trend to protect young athletes from sports-related brain injuries. To date, 31 states and the nation's capital have passed student athlete concussion prevention laws similar to HB 143 and 11 more states have similar bills pending.
The bill calls for the removal of a student athlete from practice or competition if the student is exhibiting signs, symptoms or behaviors consistent with having a concussion or head injury.
It also adds a referee of a youth sports organization to the list of persons required to remove a student athlete from practice or competition.
If the bill is enacted, O'Brien said student athletes and their parents would be educated about the effects of concussions and players would be allowed to return to competition only after being cleared by a licensed health care provider.
"The key to limiting the number of concussions our young athletes suffer and reducing their impact is awareness," he said. "HB 143 will educate coaches and parents and will lead to better treatment and increase the likelihood of a successful recovery."
O'Brien said his interest in raising awareness increased as he became more aware of national statistics.
"It's an effort to see what we can do to prevent kids, especially younger kids, from risking serious injury, and in some case life-lasting injuries,'" O'Brien said. "Studies have shown that a young child with a TBI that doesn't seek medical attention can run the risk of further injury just by returning to play too soon. They need to give their bodies time to heal. It's just not worth the risk."
Some educators, coaches and athletic trainers in area school districts are trying to be proactive. For example, Paul Trina, athletic director at Warren City Schools, said his coaches and trainers are studying techniques they can use to better identify a possible concussion.
This year Warren has instituted policies to guard against student injuries. For example, Trina said his team is using ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a computerized evaluation system that helps coaches and trainers determine whether it's safe for an athlete to return to play after a head injury.
Trina said trainers are learning how to use the 20-minute test, developed in the early 1990s by doctors Mark Lovell and Joseph Maroon, to measure player symptoms, verbal and visual memory, processing speed and reaction time. It also helps clinicians and athletic trainers make return-to-play decisions, Trina said.
The test measures multiple aspects of cognitive functioning in athletes, including: attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving and reaction time.
Phil Annarella, Austintown Fitch head football coach, said the problem is no more prevalent than it has been in the past.
"If anything, things have gotten better and (sports) are safer than they've ever been," he said. "Now we have more awareness, better, safer equipment, specially made, new-style football helmets," he said. "Football, for example, is a very physical sport and you always run a risk of injury. But if there's any doubt, any question at all, we do not play the kids. They sit out. If a trainer says they stay out, they stay out."
Annarella said sports information and injury education efforts have advanced tremendously since he started coaching 40 years ago.
"Things have gone in such a positive direction, and I think everyone is better educated," he said. "You have to be smart about it."
Likewise, Trina said it's better not to take any chances or unnecessary risks.
"It's always better to error on the side of caution when it comes to injury, especially something that could cause even more harm if not addressed right away," he added.
Trina emphasized that student athletes and their parents should make sure they express their concerns and any symptoms the youth is experiencing to a coach or trainer.
Limperos said he supports O'Brien's attempts to bring attention to the issue. If there's one piece of advice he'd offer young athletes, it's that they shouldn't underestimate the impact of any sports-related injury regardless of how insignificant it appears, he stressed.
"All it takes is one bad hit and it could affect the rest of your life," Limperos said. "It could end up so many bad ways. It's just not worth it. I'm fortunate it wasn't worse than it was. But I learned something from it. You shouldn't take those kind of chances, no matter how bad you want to be in the game."