WESTBROOK – “Getting your bell rung” and ”getting dinged” are two common euphemisms used in sports for hard blows to the head that lead to concussions.

For years, concussions weren’t seen as major injuries – in fact, players from the pros all the way down to high school were told to just “shake it off” and get back into the game.

But medical science has shown just how devastating concussions – which are defined as a traumatic brain injury that alters the way the brain functions – can be, with long-term effects that can lead to serious problems. As a result, the attitude toward concussions has changed across the board from the hard-hitting pros of the National Football League to the playing fields of Maine. Now, local schools and sports leagues have implemented programs to educate young athletes about the severity of concussions and to make sure that a player doesn’t take the field until the injury is fully healed.

The change in attitude toward concussions is even evident in the virtual world. In the latest edition of the globally popular Madden NFL video game from EA Sports, virtually concussed players have to take a break. At a conference earlier this year, EA Sports president Peter Moore announced that in “Madden 12,” which was released this week, players who received concussions in the video game would have to sit out the rest of the game and the game’s announcers would talk about the head injuries.

While the hopes of the video game designers and the NFL, which worked with EA Sports on the development of the game, was that the change would serve as a teaching tool for younger players on the seriousness of concussions, the fact is that concussion awareness starts at an early age, and local schools are doing everything in their power to ensure the safety and health of their athletes.

“(We are) trying to create a culture where kids are willing to be outgoing about their symptoms, to be open and honest with (the coaching staff) and the trainers,” Westbrook High School football coach Jeff Guerette said. “Because kids kind of have the tendency to want to play through concussions, or to shake it off and say ‘I’m fine.’ (We are) just trying to create that culture where kids understand the importance of being open and honest about their symptoms so that they can stay safe.”

According to the Mayo Clinic, the brain is cushioned from everyday jolts and bumps by the fluid that it floats in inside the skull. A violent blow to the head and neck or upper body can cause the brain to slide back and forth forcefully against the inner wall of the skull, causing a concussion.

Typical symptoms of a concussion can include headache, temporary loss of consciousness, confusion, amnesia, dizziness, a ringing in the ears, nausea or vomiting, slurred speech and fatigue.

According to the U.S. Department of Health and Human Services Centers for Disease Control and Prevention, parents who suspect their child has a concussion should keep the player off the field, seek medical attention right away, make sure that the player knows that it isn’t safe to play with a concussion and talk to the coaches and the school’s medical staff.

While football seems to be the poster sport when the subject of concussions comes up, and for good reason, there is another sport, traditionally known as a non-contact sport, which can also be a leading cause of concussions – soccer.

With players flying up and down the field and leaping to hit the ball with their heads, the inherent risks for concussions in soccer become obvious from the sidelines, but in the heat of the game, players don’t think about getting a concussion.

The problem isn’t limited just to high school soccer, coaches and parents in youth soccer leagues are also concerned with keeping players safe.

“I am (concerned), especially since at times concussions can be very difficult to recognize,” said Greg Post, who coaches youth soccer in Westbrook. “I feel that persons getting into coaching youth sports should be required to take a concussion-specific course as part of their certification. Grouping a 10-minute discussion on concussions into a larger class curriculum provides very little benefit. And a refresher course should have to be repeated each year.”

“Any type of brain injury, especially to a growing developing brain is a serious concern for any coach or parent,” added Eric Peterson, the coach of the Bonny Eagle U13B youth soccer team. “Repeated concussions at any age can lead to long term medical problems so there is certainly a concern whenever there is a potential concussion.”

“I believe more is being done now with both awareness and prevention with respect to concussions in youth sports,” added Peterson. “Better helmets for football, hockey, biking, skateboarding, and motocross have helped prevent concussions as our younger athletes continue to get bigger, stronger, and more competitive at younger ages. Soccer is another story in my opinion. The head in soccer is a huge part of the game as athletes move into U12 and above. Most soccer head injuries involve head to head (or other body part) or head to ground contact or a ball striking someone’s head while not in a good technical ‘purposeful’ heading position.”

While soccer and all sports carry an inherent chance for a concussion, the fact remains that with its full-speed contact and the impact of tackles, football players are at a high risk for head injuries.

Since it covers the head, the helmet is the obvious focus when it comes to preventing concussions in football players. And local schools say they are making sure that their players have the best helmets possible and that they are fitted correctly.

“We really put a point of emphasis on our equipment,” Guerette said. “This year, the school and our football boosters bought us 30 new Riddell Revolution/Speed helmets. In studies, they test out very good in terms of providing kids with safe helmets. We try and use the best equipment we can.”

But a top-of-the-line helmet isn’t going to prevent 100 percent of concussions; the best equipment needs to be combined with proper form to work correctly. Coaches work with their players to make sure they aren’t leading with their head when tackling and avoiding helmet-to-helmet contact.

“There’s probably four or five different things that we do (to prevent concussions),” Guerette said. “The first thing is we try to teach kids to block and tackle the right way. You don’t want your head and your helmet as a weapon. You want to have your eyes up and see what you’re hitting. You don’t ever want to lead with your head.”

“The skills and the way you teach things is really important,” added Biddeford High School football coach Scott Descoteaux. “Any adult these days that is coaching this game who is not paying attention to concussions I don’t think is doing their kids a justice. You have got to be very, very detailed in how you teach the mechanics of blocking and tackling especially – that is where you see the majority of concussions.

Guerette said that in Westbrook, as is the case with most other schools, if a player suffers a head injury, they can’t come back to play unless they are cleared by a doctor, and coaches always err on the side of caution when it comes to concussed athletes. “The rule of thumb is, ‘when in doubt, sit them out’,” he said. “Because concussions are treatable and most of them don’t end up being super serious. The things that are really scary are having someone out there playing with a concussion or having someone out there that has a concussion that hasn’t fully healed and then their subject to that second impact syndrome when you’re talking about serious consequences.”

And even when a doctor clears a player, that doesn’t mean that they are going to play in a game right away, they need to work themselves back into game action through a gradual series of progressions.

“If (a kid) gets cleared on a Thursday by a doctor, they’re not playing Friday night,” Guerette said. “They have to go through a progression of jogging and stretching on day one, if no symptoms return, they can ramp it up a little bit, then if no symptoms return then maybe by the third or fourth day (the player returns to practice). Then they can return to full contact. But if at any time, those symptoms come back when a player is going through that progression, then they have to go back to the start.”

But all of the preventative measures in the world can’t stop 100 percent of concussions, and schools are being proactive in finding ways to determine the severity of head injuries and when an injured player has healed enough to return to action.

Many local schools, including Westbrook and Bonny Eagle high schools, are using a test known as the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) to monitor players.

Developed in 2002, ImPACT is a computer test developed to help trainers and doctors evaluate an athlete’s recovery following a concussion. Before the season, each athlete is given a baseline test.

“We’ve been using the ImPACT test,” Guerette said. “That’s a great tool for the athletic trainer. You couple the test with the physical exam and you get a pretty clear idea of where a kid is in terms of how their brain is.”

“It does motor skills, memory skills, reaction time, that kind of stuff,” described Jessie Hobgood, Sanford High School athletic trainer. “Rather than basing a kid’s performance after a concussion off an average of kids, it’s basing it off their baseline.”

Once a baseline is established, the test can be administered again to see if the results have changed.

Having tests such as the ImPACT and trainers watching the kids makes it simpler for coaches to know when it is safe for a player to return to action.

And while no test is foolproof, Hobgood said, the ImPACT test is designed to watch for players trying to manipulate the results, either at the baseline test or after an injury. “Ultimately, the kid has to go through me and the coach before they can get back on the field, but there’s every now and then there’s a kid who tries to not take it or mess (the test) up (on purpose),” she said. “But the program has a built-in filter for that. If the test is obviously messed up, it has a red flag, so the kid has to take it again.”

Hobgood said that as hard as it is for a young player to be told they can’t play the sport they love because of a concussion, it’s the right thing to do. Because players who play with a concussion are at greater risk for a second one, and that is where the real problems can start.

“If a kid is not totally better and they get another concussion on top of the first one, it’s called post-concussion syndrome and it can be catastrophic,” she said. “There’s physical damage to the brain, bruising every now and then to the brain after the concussion, and if you get another one on top, there’s a high risk for bleeds in the brain … it could result in death. It’s a nasty, nasty injury.”

Staffers Emory Rounds and Jason Scott contributed to this report.