SANFORD – “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’ve seen some kids with concussions, some lower grades than others, but we’ve seen our share of concussions,” said Sanford Athletic Director Gordie Salls. “We handle them with kid gloves.”

Many local schools, including Sanford and Massabesic high schools, are using a test known as the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) to help determine if a player can return to the field after a concussion.

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.

“It does motor skills, memory skills, reaction time, that kind of stuff,” said 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.

Salls said the Redskin athletic program has been using the ImPACT program with good results for quite some time.

“We were ahead of the curve on that,” Salls said. “We were one of the pilot schools (for the ImPACT program). All the kids at the high school, they get tested and we get a baseline on them. If they get a concussion, (we have the student) come back in after the concussion and take that same test, and if their baseline scores in all those areas are not up to where they should be from the first test, they can’t compete until they pass that test again.”

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.

Like all area schools, Salls said, the Sanford athletic staff handles concussions carefully, knowing that the long-term health of the athlete is far more important than getting back on the field quickly.

“We definitely do not let kids get anywhere near a field until they’ve been OK’d by the doctor and the trainer and they pass the ImPACT test,” said Salls.

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.”

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.

“Ultimately, the thing that makes it easy for us as coaches, is that if we are fortunate enough to have an athletic trainer, (knowing when it is safe for a player to return) is what they are trained to do, and you need to trust that they are going to use their expertise and make the right call,” said Massabesic High School football coach John Morin. “And really, when it is all said and done, when you have a trainer make that call, it does take it out of our hands.”

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, that can also be a leading cause of concussions – soccer.

“People want to think football gets all the concussions, but soccer has its share as well,” said Salls.

“Both boys and girls soccer have a lot of concussions,” agreed Hobgood. “A lot of times, kids go head to head when they’re trying to head the ball.”

In fact, the concern about soccer and concussions isn’t just limited to high school players. Scott Chretien, whose 11-year-old son Bailey plays youth soccer in Sanford, said he had some concerns about the risk of concussions in youth sports. While his family has been fortunate to escape a concussion, Chretien believes more needs to be done to educate parents and coaches about the risks.

“I believe more could be done to teach coaches and parents on the signs and what to do if there is head contact,” he said. “I am not aware of what literature or training is provided to coaches in various sports, but I feel that understanding the warning signs, what to do in certain situations and basically how to respond (to a concussion would be valuable knowledge).”

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 school officials say they are making sure that their players have the best helmets possible and that they are fitted correctly.

“Helmets don’t prevent concussions, but they’ve certainly done a lot in that direction to help with trying to minimize those (injuries),” Salls said.

“We have certainly upgraded the helmet that we are wearing,” said Morin. “In fact, all of our players are in the Schutt DNA now, which is one of the higher – and in some tests the highest – rated helmet right now.”

“We bring a guy in (for helmets) and he makes sure that every kid is snug as a whistle,” said Biddeford football coach Scott Descoteaux. “He came back a few weeks (into the preseason) and he made sure that everything was just right. The helmet fit is really important.”

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.

“A lot’s been done to improve helmets,” Hobgood said. “A lot has been done to teach the kids to not go head-to-head when they’re tackling, stuff like that. Our coaches do a really good job to make sure that kids have proper form (when they’re hitting) and that’s a big part of it.”

For his part, Descoteaux said he thinks that making sure kids know the ways to avoid putting themselves at risk for concussions is a key role for a coach at any level.

“The skills and the way you teach things is really important,” he said. “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.”

Even with all the safety precautions, it’s still hard for parents to watch their kids get hurt, but even with the risk, parents say that they feel that schools are doing everything they can to keep kids safe.

“You worry about all of the injuries – all of them,” said Amy Buckley, whose son, Dillon Tremblay, is a senior on the Massabesic football team. “Anything dealing with the head or the brain or the back is concerning. (But) Massabesic has a trainer on the field at all times, and she works very closely with the boys. I think they do quite a bit – they do a good job here.”

“I am very concerned about concussions,” agreed Wade Andrews, whose son Josh is a junior on the Mustangs. “As a past Pee Wee football coach and wrestling coach, that was one of the things that they told us to look for. You try to catch it if they’re dizzy, or if they have nausea, or if they are confused. I think the school is doing as much as they can.”

Lisa Coulombe, whose son Brandon also suits up for Massabesic, took a slightly different track when it came to concussions.

“I really don’t (worry that much),” she said. “I think that in this day in age, we worry about so much more than we used to, and I don’t think that (concussions) are really a factor. You have an injury that’s like a sprained ankle or something like that and the kids play with it. I do think the schools are doing enough with this new test, but I just don’t (think it’s that big a deal). In the old days they would have concussions and stuff and they still played football and they still played as hard. There are just so much more rules and regulations. I don’t know, I guess I am just an old-timer.”

While Coulombe isn’t sure about the new rules and regulations when it comes to concussions, Hobgood is glad that they are there. 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 also contributed to this report.