He was once part of the problem, acknowledged Michael "Micky" Collins, director of UPMC's Sports Medicine Concussion Program.
"I played baseball in college," Mr. Collins told more than 100 school officials from around the state in a conference in Homestead Tuesday. "I'd lie, cheat and steal to get back on the field" after an injury.
Mr. Collins was the opening speaker at the first statewide conference on the "invisible injury" -- and how to help student athletes, and their teachers and coaches, cope with concussions and safely manage the condition afterward.
The conference was sponsored by the Allegheny Intermediate Unit and held at its central office on East Waterfront Drive.
It's difficult to judge the severity of a concussion from on-field symptoms or even to determine whether an athlete has suffered a concussion at all, Mr. Collins said.
"A lot of these symptoms won't manifest for two days, three days," he said.
Many student athletes are unaware they have suffered a concussion, and many who are aware lie about it. A study by McGill University indicated 60 percent of college soccer players suffered symptoms of a concussion during a season, but only 10 percent reported them at the time they suffered the concussion.
"The kids who say: 'I don't know' when you ask them when you had a concussion have the worst outcomes," Mr. Collins said.
For Mark Lovell, who preceded Micky Collins as director of the UPMC concussion program, and followed him on the podium Tuesday, this anecdote illustrates the scope of the problem:
Given the hypothetical choice between winning a gold medal at the Olympics and dying within five years or not winning a medal and living to a ripe old age, most athletes chose winning the medal and dying within five years, said Mr. Lovell, now the CEO of ImPACT Applications.
ImPACT (Immediate Post-concussion Assessment and Cognitive Testing) is the name of the computerized diagnostic test developed by Mr. Lovell, Joseph Maroon, chief neurosurgeon for the Pittsburgh Steelers, and Mr. Collins for determining the severity of a concussion, and the progress the athlete is making in recovering from it.
The lying begins early, Mr. Lovell said.
"I've had 5-year-old girls lie to me about their symptoms because they are afraid their mother won't let them go to the sleepover," he said.
Younger children who are not trying to deceive have difficulty describing symptoms of concussion, Mr. Lovell said. Because it is younger children, especially girls, who are most susceptible to concussion, it's vital for their parents, coaches and teachers to recognize the symptoms.
Among 10- and 11-year-olds, the chief symptom is being "tired and irritable," Mr. Collins said.
Among older children, "an athlete who reports an on-field symptom of dizziness is 6 1/2 times more likely to take more than a month to recover," he said. The average recovery time is 26.2 days.
Adolescent athletes base their perception of recovery from concussion on a remission of physical symptoms such as headache and nausea, but they often neglect subtle neuropsychiatric and sleep issues, UPMC researchers have found, according to research published last month in the journal Applied Neuropsychology: Child.
Students may feel better before their brains are fully back to speed, said neuropsychologist Jonathan French of the UPMC concussion program. They may look well and feel well before they are able to perform schoolwork at pre-concussion levels. Evaluation by "an appropriate medical professional" before they return to play is required under Pennsylvania's new Safety in Youth Sports Act (which goes into effect July 1).
Some teachers suspect students of faking problems with schoolwork, Mr. French said. "I wish we could give kids a bandage when they leave the clinic," so the "invisible injury" would be more visible, he said.
Following the UPMC experts were presentations on the new state law -- which also sets guidelines and training for coaches -- and on BrainSTEPs, a school re-entry program for children who have suffered traumatic brain injuries.
"This is excellent. It's important when a student is injured that they have an advocate at school" to inform teachers of the symptoms of concussions and how they can help students recover from them, said Bridgetta Devlin, who performs that role for the Pittsburgh Science and Technology Academy.
"This was very informative," said Charles Bellisario, who'll be the athletic director in the Deer Lakes School District this fall. "You don't realize how much is involved with concussions. It's been eye-opening."
Jack Kelly: firstname.lastname@example.org or 412-263-1476.