Doctors say she suffers from post-concussive syndrome and seems to have impaired brain function.
"She is the poster child for the long-term effects of a concussion," her mother, Wendy Lindsay, said recently.
Concussions, which are traumatic brain injuries, are particularly dangerous for adolescents. They can cause brain damage, severe learning disabilities and in some cases death if not treated promptly.
Adolescents are more susceptible to concussions than adults and take longer to recover, according to Dr. Mick Koester, the director of the National Federation of State High School Associations'Sports Advisory Committee.
Most of the 62,000 high school athletes who have a concussion each year recover within a couple of weeks with rest. A recent study at UNC-Chapel Hill indicates 95 percent of high school athletes who receive concussions recover in a month or less if the injury is treated properly.
But having "your bell rung," or being knocked unconscious or dizzy, is not something that can be shaken off. During congressional hearings last month, the Government Accountability Office, which testified about the dangers of concussions on high school athletes, told lawmakers that head injuries can have long-term consequences in the classroom.
About 80 percent of high school concussion victims say their learning abilities were impaired in the weeks after the injury, according to recent studies.
"Academics usually are impacted," said Dr. Kevin Guskiewicz of UNC. "The academic effects can last longer than the physical effects."
The only treatment is rest.
Guskiewicz, one of the leading authorities on the injury, said athletes with head injuries need more than physical rest. They need to limit their time working on computers and watching television.
"The brain needs to rest," Guskiewicz said.
If athletes return to physical activities before the brain is healed, the results can be disastrous.
In 2008, Jaquan Waller, a Greenville Rose football player, received a concussion on a Wednesday in practice and played in a football game two days later.
He died of what is known as second impact syndrome, which occurs when someone who has not healed from a concussion suffers a second one.
The N.C. High School Athletic Association requires any participant who has been diagnosed with a concussion to file a return-to-play form signed by a physician before participating in practices or games. The athlete needs to be free of concussion symptoms and should be gradually returned to activity. If any of the symptoms return, the athlete needs to be held out of participation. The organization has recommended that all high schools have certified athletic trainers, but a lack of funding has prevented many schools from filling these positions.
There is no group that tracks the number of concussions among athletes on the state or county level.
End of a dream
In hindsight, Ashley might have returned to play too soon.
Her skills in softball, which she and her family thought would earn her a college scholarship and allow her to pursue her dream of coaching or working in sports medicine, are of no use now. Doctors say the risks are too great for her to play athletics again.
"Softball was half my life," Ashley said. "It is really hitting me that my life has changed."
She suffered her first concussion at a softball practice with her N.C. Challengers club team. The squad was doing a rapid catch-and-throw drill, and Ashley was playing first. She was still looking at the second baseman, who had bobbled a catch, when a throw from third base hit her above her left eye.
She was knocked unconscious, which is atypical of most concussions. Only about 10 percent of concussion victims are rendered unconscious.
Despite the injury, she played in a game for Holly Springs Middle School the next day and was hit in the head again when a struck ball bounced off the ground and hit her on the right side of her face. She stayed in the game after the blow, left for awhile after feeling dizzy, but returned to finish the game.
Holly Springs Middle School Principal Brian Pittman said school personnel are not allowed to discuss students' health.
Bobby Guthrie, the Wake County athletic director, said the trainers and coaches at middle schools and high schools cannot be expected to know about injuries sustained in activities apart from the school.
"These coaches and athletic trainers have no way of knowing what happened at the club team practice or game," Guthrie said.
After the middle school game, Lindsay went to the emergency room, and the fractures and concussion from the day before were found.
Her doctors told her not to play again until she had no concussion symptoms, which included severe headaches.
The headaches eventually became less frequent, and she wanted to play, so on a near-100 degree day in July she told her club coach she was ready to take the field and returned to the Raleigh Walnut Creek Softball Complex with her team.
"We thought she was well," Wendy Lindsay said.
Instead, Ashley had a severe headache, vomiting, fatigue, and attention and concentration problems. She went to the emergency room, where she was diagnosed with post concussive syndrome because she had not recovered from the April concussion.
"If I could do it over, I wouldn't have played in July," she said. "I was supposed to wait until I didn't have any symptoms, and I didn't quite get there."
Despite continuing to have some headaches, she played a couple of times again in the fall with her club team, although she had not been released to play by her neurologist, according to a recent neurological report.
She was released this spring by her family doctor to play at Holly Springs High School and filed the state high school association's return-to-play form. But she was hit in the head during warm-ups at a junior varsity practice March 23 and suffered another concussion. She stayed in bed for the next four days with severe headaches.
She hasn't played softball since, but she suffered a third concussion when she fell from a golf cart last month.
Her doctors tell her that her athletic career is over.
"It seems so final now," she said. "Before, it had always been, wait until you get better. Now, it is that it is too dangerous for me to play again.
"But if I could, I would play again today."
Guskiewicz cautions that high school athletes many times aren't reliable in assessing their symptoms.
"A 15-, 16-, 17-year-old athlete who wants to play will not be truthful about their symptoms about 50 percent of the time," Guskiewicz said. "That is why it is so important for us to get baseline testing on all of our high school athletes before there is an injury. The tests can help us evaluate how well the brain has healed."
The baseline tests would include physical (balance, reaction times, etc.) and neurological (memory, thinking skills) exams. The results would be an indication of how well the brain has healed when compared to the same tests after a concussion.
Baseline tests were done on most Wake County Public Schools high school athletes last year, but the testing isn't done on a statewide basis. Even if baseline testing were mandatory for high school athletes, something Guskiewicz emphatically believes is necessary, it would not have helped Ashley, who was in middle school when she suffered her first sport-related concussion.
Academic fallout
Diagnosing concussions is important not only from an athletic perspective, but also from an academic standpoint.
Michelle Pelton, a former student athlete at Fall River, Mass., testified last month before the U.S. House Committee on Education and Labor that she received five concussions. She eventually had to be home-schooled, and she is not expected to play athletics again.
"I had headaches, lack of concentration, mood swings, depression, and I just did not care about anything," Pelton testified during the congressional hearings on concussions.
Ashley can relate. She fears her teachers think her academic troubles are a result of a lack of desire or indifference.
"I wish I could show them a picture or something and prove there is something wrong with my brain," she said.
A recent neurological exam indicated she has an impairment in sustained attention, new learning and executive skills. Executive skills include the ability to start and stop actions, to anticipate outcomes and make adaptations, and to plan ahead. The results are commensurate with post concussive syndrome of mild to moderate severity, according to her neurological report.
Lindsay's academic achievement has fallen since her initial injury. She was a B and C student at Holly Springs Middle as a seventh-grader. Her grades plummeted in the spring of 2009 after the injury. She struggled to pass her work at Holly Springs High Schools.
"Her headaches are so bad that it is hard for her to go to school," said Wendy Lindsay. "Concentrating and staying focused seems to bring on the headaches. She only has been able to go to school for a full day a few times."
Ashley said she has trouble concentrating. When she studies for tests, her mind wanders, she has difficulty understanding, and her head hurts. She has a particularly difficult time watching overhead projections.
"I hate I've had such a miserable year in school," she said. "The freshman year is so important academically, and I'm going to have to work harder to pull up my grade point average. But I'm not going to give up."
Dr. Gerard A. Gioia, chief of the Division of Pediatric Neuropathy at the Children's National Center in Washington, said during the recent congressional hearings that schools need to be aware of what students can tolerate in terms of reading, mathematics and concentration after a brain injury. The classroom, he said, is "where the kids spend most of their recovery time, not on the field."
Meanwhile, Ashley is trying to deal with the aftermath of her injuries.
"I'm trying to stay focused on Ashley," Wendy Lindsay said. "It is hard for her. Her life was softball. Now she is not only dealing with [not] playing, but with the headaches and other problems."
Ashley plans to transfer to Fuquay-Varina High School this fall. She will have an individual educational plan that she hopes will help her academically. She and her mother echo the concussion message of the Centers for Disease Control and Prevention: "When in doubt, sit it out."
Ashley knows her athletic dreams are at an end. Her recovery is just beginning.
