I’m a general assignment and health reporter at the Keene Sentinel in Keene, N.H.

In December 2007, I returned from a two year Peace Corps assignment in Central Asia. Working as an English teacher at a local school in Turkmenistan, I was fortunate to live in the coastal town of Turkmenbashy, also known as Krasnovodsk, on the Caspian Sea. I studied Russian and Turkmen during my service. The experience and the amazing people I met there made a life-long impression on me and I hope to one day serve again in Peace Corps.

I graduated from Emerson College in Boston in 2005. I was a print journalism major and political science minor and pursued my interest in journalism through editorial positions on the school newspaper, The Berkeley Beacon, and internships with the Boston Globe and Casper Journal, a weekly community newspaper in my hometown, Casper, Wyo.

Thanks for taking a look at my blog and if you have questions, please feel free to contact me at casey.farrar@gmail.com.

Casey Farrar


Sudden Impact

A local program aims to assess student athletes before they are injured
Published Aug. 20, 2008 in the Keene Sentinel
By Casey Farrar
Sentinel Staff
Brows furrowed in concentration, a group of Keene High School football players sat in a computer lab last week watching a series of shapes and words flash across their computer screens.

Next came a set of questions testing their short- and long-term memory.

Training for the season had started, but this wasn’t a typical practice: Athletes on the football, soccer and spirit teams at Keene High School and Monadnock Regional High School this season are having their brain function tested as part of new program to assist athletic trainers and doctors when players suffer concussions.

The program, called ImPACT, or Immediate Post-concussion Assessment and Cognitive Testing, is one of the first of its kind — being used by more than 1,200 high schools, 300 colleges and universities and 30 professional football teams — to give doctors and trainers data about student athletes’ brain function before and after concussions.

And the information it has already provided has vastly changed the way doctors and trainers look at concussions in high school athletes.

Studies using the test, which was developed at the University of Pittsburgh, have shown that, unlike many other types of injuries, the younger an athlete is the longer it takes for his or her brain to bounce back from a head injury, according to Dr. Mark B. Silbey, director of the sports medicine department at Cheshire Medical Center/Dartmouth-Hitchcock Keene.

The aim of the project is to give doctors and trainers a more objective analysis of when it’s safe to send a young athlete back onto the field. Now local doctors and trainers hope to use the test as a tool for treatment of head injuries among Monadnock Region sports teams.

“When you put kids back on the field we now know that, especially in younger kids, it takes longer to recover,” Silbey said. “We’re only going to gather more data now, and the important thing is that these are objective numbers that can sometimes give us a better idea than subjective testing as to how the brain is recovering from trauma.”

This is the first season the hospital’s Sports Medicine Center has used the test.

Since 2004, the center has provided athletic trainers to Keene, Monadnock Regional, Fall Mountain Regional and Brattleboro Union high schools and Keene State College, the Keene Swamp Bats baseball team and the Monadnock Marauders football team.

Recently, it added Bellows Falls Union High School and Vermont Academy in Saxtons River, Vt., to its rolls.

While ImPACT testing is only being offered to Keene and Monadnock Regional high schools, with ice hockey, basketball and wrestling athletes also being tested before the winter season, Tate S. Erickson, sports medicine manager for the Sports Medicine Center, said if all goes well the center hopes to expand testing to more schools next year.

During the 2005-06 school year — the most recent statistics available — of the 4.2 million high school athletes across the country, nearly 760,000 were injured, according to a report by the U.S. Centers for Disease Control.

Nearly 15 percent, or about 100,000, of them suffered concussions, the report showed.

Last year, 54 student athletes from Keene, Monadnock Regional, Fall Mountain Regional and Brattleboro Union high schools suffered concussions, according to statistics from the Sports Medicine Center.

Concussions represented about 3 percent of the 1,610 injuries reported by athletes at the schools served last year by the center, but the severity of head injuries among high schoolers has only recently gained national attention.

“In the last two to three years it has become a national focus,” said R. Patrick Corbin, executive director of the N.H. Interscholastic Athletic Association. “The medical community didn’t ever pay as much attention as they should have to head injuries among kids, but now it has become a hot-button issue in New Hampshire and across the country.”

Part of what is behind the increased attention on the effects of concussion on high school athletes is the use of ImPACT testing, according to Erickson.

With more data available from the tests, doctors and trainers are better able to understand how the brain recovers, said Silbey, one of two doctors treating student athletes through the Sports Medicine Center.

A $2,500 grant from the Agnes M. Lindsay Trust in Manchester and a $1,000 gift from an anonymous donor paid for the ImPACT testing, according to Donna M. Dubuc, director of development at the hospital.

Erickson, who oversees the eight athletic trainers that work in the six schools in the region, said the pilot testing programs at Keene and Monadnock Regional high schools will complement the traditional assessments that trainers, doctors and coaches use when an athlete suffers a concussion.

Before the start of the season, athletes will take a baseline exam, which rates their reaction time and memory, over the Internet.

In one portion of the test, blue and red dots flash intermittently on the screen. Students have to push the letter “P” on their keyboard when they see red and “Q” when they see blue. It is a test of reaction time.

Immediately following that, they are asked to recall a list of words they saw in an earlier portion of the exam — testing long-term memory.

If an athlete suffers a moderate or severe concussion — classified as a concussion with symptoms lasting more than 15 minutes or if an athlete loses consciousness — he or she will retake the test a day after the injury. The test will give doctors and trainers an idea of how badly brain function has been affected and helps to determine when an athlete is ready to return to the field, Erickson said.

But as trainers and doctors at the Sports Medicine Center analyze the tests over the next year, Erickson said the schools will continue to use the usual standards to determine when an athlete can return to play.

Typically, an athlete who suffers a mild concussion — with symptoms including dizziness, double vision and headache lasting less than 15 minutes — are out of sports for one week, Erickson said.

These athletes won’t be retested using ImPACT, unless a trainer or doctor recommends it, while athletes suffering moderate concussions will be out up to two weeks from the time their symptoms subside, according to Erickson.

Severe concussions, defined by an athlete losing consciousness, will mean an automatic two-week break from sports, and possibly longer depending on an athlete’s recovery time, Erickson said.

Erickson said while some teams and schools have decided to send athletes back to the field once their test results are within 10 percent of baseline, others have taken a more conservative 5 percent approach.

Because the program is new at the Sports Medicine Center, clinicians have yet to determine the level of function they will use to mark an athlete’s safe return to play, according to Erickson.

Because concussions cause swelling in the brain, doctors and trainers are concerned with athletes returning to play too quickly.

If the brain is still swollen and is injured again, it can trigger permanent damage including aneurysms, or bleeding in the brain, which can lead to death, Erickson said.

Since symptoms of concussion, which include headache, nausea, confusion, irritability, sleep disturbances, fatigue and memory loss, commonly have been self-reported, doctors have had to rely on an athlete’s own judgment of their symptoms.

“When a kid comes in and says their symptoms are gone, we can test them with ImPACT and see if their brain function has recovered,” Erickson said. “Everybody’s different in terms of how they will recover, but I believe the trends will be consistent with the traditional standards.”

Corbin, from the state high school athletic association, said the objective testing can be important in discouraging athletes from returning too quickly.

“Teenagers all think they’re invincible,” Corbin said. “It’s important to play in that game and you get banged in the head, your eyes are crossed, but you’ll be okay.”

A recent study involving ImPACT pointed out that while self-reported symptoms generally subsided in four days, tests showed memory decline lasted at least seven days after injury, according to Erickson.

Parental pressure can also push student athletes back onto the field too soon, according to Corbin.

“One of the biggest problems is parents who are so concerned about Susie or Johnny playing in that championship game, and fighting the whole mentality that a student getting their bell rung is okay,” Corbin said. “It boggles my mind, as a parent, to see parents putting kids back out.”

Erickson said he also has seen athletes pushed back into playing by overzealous parents, but trainers and doctors can now use ImPACT score reports to show solid data about the concussion.

“It’s not there to replace traditional testing, but it’s a great tool and we’re hoping, based on the results of the pilot group, to expand this to other schools,” Erickson said.

Casey Farrar can be reached at 352-1234, extension 1435, or cfarrar@keenesentinel.com.

Richshaw Redemption: Keene man peddaling for his life

Published Aug. 10, 2008 in the Keene Sentinel
By Casey Farrar
Sentinel Staff
Published: Sunday, August 10, 2008
April 10 is a date filled with significance for 40-year-old Richard R. Rice.

It’s his birthday, the date on which his mother died four years ago and, this year, became the date that he started his own business — a bicycle taxi service in downtown Keene.

But more than a month ago, Rice thought his dream of running his own business was vanishing.

A letter from the Keene City Clerk’s office informed him he’d have to shut down his fleet of rickshaws — three-wheeled bicycles with a seat in the back for passengers — because it didn’t meet city transportation codes.

“I was getting really discouraged and thinking I’d just give up, but so many people were encouraging me to keep going that I couldn’t just walk away,” Rice said.

Becoming licensed posed a challenge not only for Rice, but for city officials as well.

Aside from a horse-drawn carriage business that opened in Keene last year, this was the first time the city has had a non-motorized taxi service, according to Deputy City Clerk William S. Dow.

“We did some research and were able to acquire a lot of information through the Internet,” Dow said. “Apparently they’re pretty popular in other places and we determined what he’d be required to do, mostly safety concerns.”

Rice had to find a company that would insure his rickshaws and sank his life savings into paying for the insurance and safety measures including slow-moving vehicle placards on the back, lights, bright safety vests for drivers and helmets for passengers under 16 years old.

This weekend, four of his six rickshaws returned to the streets.

“I finally succeeded at something and I did it myself,” Rice said. “That’s an adrenaline rush.”

It’s not the first time Rice has faced an uphill battle.

Since losing his mother four years ago, he lost his job as a truck driver, became homeless and has suffered from depression.

Then last March, Rice’s friend showed him two rickshaw bicycles he owned. Rice took one out for a spin and the idea for his business, Richsaw Taxi, began to form.

“I was just out riding it around because it’s really fun to use,” Rice said. “And people kept coming up and asking me for a ride. Then someone said, ‘You should start a business with this.’”

The idea seemed to be the answer to Rice’s dream of owning his own business.

After an Internet search unearthed four rickshaw taxis for sale in Key West, Fla., Rice decided to go for it.

“I didn’t know if I could do it, but I decided to give it a shot,” Rice said. “I had the rickshaws shipped up here and I just started riding around.”

Students from Keene State College soon became his largest customer base.

On weekends when college was in session, Rice said he was riding as much as 35 to 40 miles a night, shuttling students from downtown bars to their homes.

“That was part of the reason that I wanted to do this,” Rice said. “I saw a lot of the college kids downtown drinking and walking or driving back at night and that’s dangerous.”

Rice said meeting the challenges he’s faced so far have built his confidence and he’s lost more than 100 pounds from being on the bikes, sometimes more than 12 hours a day.

He still doesn’t have a place of his own, but he’s looking, and expects to have a home soon.

And now that he’s on a roll, Rice is full of plans for Richsaw Taxi.

Since mileage-based fees would be difficult to calculate on the rickshaws, Rice said he set a standard $5 rate for rides. He can also wait for people while they shop.

He plans to put advertising for local businesses on the sides of his rickshaws, hopes to expand service to local shopping centers around Keene and has had inquiries about providing transportation for weddings and birthday parties.

“I hope that it’s going to turn into something really nice for Keene,” Rice said. “I want to give rides to elderly people who need to go shopping or people who want to go for a scenic ride. I can take people out on the bike paths and around town.”

Rice has four drivers working for him right now, and said if all goes well he may consider expanding the business to Portsmouth or Concord.

“The best part is being able to ride past the gas stations and know I never have to stop there,” Rice said.

And while rickshaws are more popular in tropical climates, where they can run year-round, Rice said he may try to keep a couple of the taxis running in the winter, especially for special occasions.

More than anything, he’s just glad to be doing something he loves, Rice said.

“I really enjoy it,” Rice said. “If I wasn’t having as much fun, I’d probably have given up by now. But I want to see where it goes.”

Casey Farrar can be reached at 352-1234, extension 1435, or cfarrar@keenesentinel.com.