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

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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.

"Unfortunately most of the policies have been about return to play, not returning to learning," Green said. "That piece is really new in the last few years."

The injured students she sees aren't even close to being able to concentrate in a classroom. Everything about school -- crowded hallways, lots of light and noise, bells ringing -- are the opposites of the only real treatment for a concussion: resting the head and eyes.

"These kids, they're not there, they're like a deer in the headlights," Green said of the injured students. "The fluorescent lights, the noise, the activity -- it's so much stimulation. (In the classroom) they hear the humming of the lights, the jingling of the students' bracelets, the rustling of papers, the people walking in the hallway. They have no filter. They are being stimulated constantly.

"It's devastating to these students. It's exhausting just sitting in the classroom," Green said.

At Thornton Academy, a local doctor looks at all the school's ImPACT test results and consults with trainers to implement best practices to minimize injury.

"It's a great tool," said Athletic Director Gary Stevens. "It gives our trainers data to make decisions, and sometimes data means you have to say no (to a player returning to play.) The more information you have, the more confident you can feel."


Berkner and Atkins said they hope that over the long term, they will collect and analyze enough data to be able to use it to loop back to coaches and trainers and develop best practices in either gear or play to prevent concussions in the first place.

For now, the focus is on education and treatment.

"That's all we have control over," Atkins said. "You're not going to tether kids to the couch. All you can control is how to treat it."

Some trends have become evident -- many football and field hockey players get injured, but a surprisingly high number of girls get injured in multiple sports. Neck strength is key to concussions, which may be a reason.

"The more we know, the more we ask questions," Berkner said. "We always talk about football, but women seen to be at higher risk and have a longer recovery rate."

Looking at 2010 Maine high school data, the researchers noted that of the top 10 sports with injuries, half were girls' teams. It appears to be related to neck strength, they said, but more research is needed.

The data show the highest number of post-injury reports was for boys' football -- 399 follow-up tests to 1294 baseline tests -- followed by girls' soccer, with 172 follow-up tests to 860 baseline tests. The remaining top 10 sports, in order, were boys' soccer, boys' lacrosse, girls' basketball, boys' ice hockey, girls' field hockey, girls' ice hockey, girls' softball and boys' basketball. Even cross-country skiers had post-injury tests, as did tennis players.

"We need to not focus just on football," Berkner said. "I don't think there's a sport yet that I've haven't seen a concussion. Maybe golf."

The concussion institute's other co-founder is Dr. William Heinz, an orthopedist at Orthopaedic Associates in Portland. He said using ImPACT results is particularly useful when trying to tell a parent or a patient that they need to rest the brain and not rush back to school or the field.

Parents who think their child is recovered are sometimes surprised.

"They think everything's fine, and then I show them he's at the fifth percentile reaction time," Heinz. "All of a sudden you see the light bulb go on in their eyes."

Heinz said the big battle is the culture change. It's drilled into players to give their all, and parents and coaches want to support and urge on a player. One day, he hopes they will be so successful in educating people about concussions that the culture will change.

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