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

(Continued from page 2)

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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.

"You know how they say friends don't let friends drive drunk? It should be, 'Friends don't let friends play concussed,'" he said.

Stevens agreed. At Thornton, he said, "we're concerned about the kid who is trying to hide something. With the testing, it's pretty easy to find out right away."


Policymakers have also taken note. According to an article this month in the Journal of Neurosurgery, 42 states and the District of Columbia have passed legislation to protect young athletes who have sustained a concussion. The earliest youth sport concussion law was enacted in just 2009 in Washington. Ohio's governor signed a bill into law this week.

Maine's new law requires every high school soon to develop a concussion management policy for determining when students can return to the playing field and the classroom by Jan. 1. While some schools in Maine already have such policies, under the law all school boards will have to follow similar protocols for diagnosing and treating head injuries as well as training coaches, athletic directors and other school personnel.

Heinz said he's concerned about implementing the new law, mainly because many schools are being asked to meet a difficult standard.

Specifically, it requires that a student be cleared by a doctor trained in concussion management before returning to school or the field. But for more rural districts, that may not be possible. There is also a need for a school official, likely a nurse, to manage the student's case -- but not all schools have their own nurse, or several schools may share one nurse, making it difficult to handle additional responsibilities.

Further, who should pay for the doctor's visit? The law applies down to kindergarten-age students, whereas organized sports teams tend to be in middle- and high-schools.

"Talk about chaos," Heinz said. "The law is being thrown at the schools, how does that help the schools?"

Green works closely with the institute and Heinz, and has also worked with the state to develop model concussion protocol. She, too, is worried about the implementation.

Green agreed, noting that a lone nurse might oversee multiple schools in some districts. The workload of diagnosis, management and follow-up of a concussion is very time-consuming. At her school, she has concussed students check in with her at least once, and frequently twice a day.

"This was done in good faith, but it's actually going to cause a significant amount of difficulty because of the way the legislation is written," Green said. "It's a huge commitment to do it right and to do it well. You need a lot of support."

Staff Writer Noel K. Gallagher can be contacted at 791-6387 or at:


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