December 25, 2012

Concussion diagnosis, management put to the test

A neurocognitive exam may enable Maine schools to better determine when an injured athlete may resume competition.

By Noel K. Gallagher
Staff Writer

WATERVILLE - Here are a few outdated notions: Playing through the pain. Getting your bell rung on the field. Sucking it up. Taking one for the team.

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Thornton Academy soccer team members take tests at the Saco school to provide a baseline for athletes who suffer an injury resulting in a concussion.

2009 Press Herald File


The ImPACT test, which measures the brain’s reaction time, processing speed and verbal and visual memory, was developed by Dr. Mark Lovell and Maine native Michael “Mickey” Collins, at the University of Pittsburgh in the 1990s. It is used by Major League Baseball, the National Football League, the National Hockey League, Major League Soccer, and colleges and high schools. More than 2 million people have passed through the ImPACT program, making it the most widely used concussion evaluation system in the country.

These age-old sporting cliches -- used as a rallying cry to "buck up" an injured player -- are being tossed aside as coaches, parents and student athletes themselves learn more about concussions and the serious damage they can do to a growing child's brain.

In Maine, the leading edge of concussion education is in Waterville, at the Maine Concussion Management Institute.

The group -- a coalition of Colby educators, local doctors, athletic trainers, neuropsychologists and other professionals -- is focused on providing Maine high schools with access to the latest in concussion diagnosis and management tools. In the past year, they have been heavily involved in briefing legislators and creating concussion protocol plans for schools, something all Maine K-12 schools will have to have starting Jan. 1, 2013 under legislation passed earlier this year.

Concussion management is tricky. First of all, it has been difficult in the past to even tell whether a player has been injured. A concussion doesn't show up on an MRI or a CAT scan. Yet research shows that 10 percent of athletes get concussions.

"It's hard to manage this injury in an effective way, but we are doing some amazing stuff," said Dr. Paul Berkner, who co-founded the program.

When the institute was launched three years ago, it started aggressively promoting the ImPACT test, a computerized neurocognitive exam that helps determine when athletes who have suffered a concussion can resume physical activity. ImPACT, which stands for Immediate Post-Concussion Assessment and Cognitive Testing, is considered the best way to gauge whether a student has been concussed and the severity of the brain injury.

Student athletes take a computerized test that serves as a baseline. If they are injured they get tested again for any measurable change in their response times or critical thinking skills. An injured student might take the ImPACT test repeatedly during recovery, as health care workers determine whether the student's response times have returned to their baseline norm.

The institute team thinks its work is paying off. More kids are getting tested, school nurses, coaches and athletic directors are working together to help injured students, and parents and students are better informed about concussions. Their primary interest is in getting every high school in the state to use the ImPACT testing program.

"There's definitely more students coming forward and they're being checked out," said Dr. Joseph Atkins, the concussion institute's treasurer and dean and psychology professor at Colby.

"We're not anti-sport ... we just want to make sure they're managed properly," said Atkins, who coached high school football in New York state in the 1980s.

Today, 82 high schools participate in the program, about half of the state's high schools. About 20,000 baseline tests and 8,000 post-concussion tests have been conducted.

Not only can participating schools access the ImPACT testing resources, but program officials will go to the school to train coaches, talk to the students and serve as a resource for ongoing concussion issues.

The institute was founded in 2009, funded with a grant from Colby College's Goldfarb Center for Public Affairs and Civic Engagement. Today, it is self-sustaining through fees; schools pay $500 a year to participate.

One of the most important aspects of the institute, said one local school nurse, is that the ImPACT test helps schools determine when an injured student is cognitively able to do anything -- including go to class, not just get back in uniform.

It's been an overlooked aspect of concussion management, said Cape Elizabeth High School nurse Tatiana Green.

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