Program determines if high school athletes have concussions

By BOB MASSEY

Feeling Fit Correspondent

The problem with a sports-related concussion is that a spot diagnosis is often subjective. After all, you can't see brain damage.

The coaches do a great job in stressing the need for athletes to get evaluated if they think they've sustained a concussion, Hoke said. But that alone is not enough. Many athletes tend to put pressure on themselves to stay in the game and not let their teammates down -- in spite of potential injury.

That's why Hoke, the athletic trainer for Charlotte High School, was so excited by a program he saw at a state conference in April -- ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Among its customers are numerous professional teams across a variety of sports, as well as collegiate and high school sports organizations.

With the potential dangers of undiagnosed concussion, Hoke sees the ImPACT program as a godsend.

Head games

The system was developed by two doctors in the early 1990s, and it has become a standard tool to detect concussion in athletes from age 10 and up. On the company's client list are two dozen pro football teams, all National Hockey League and Major League Baseball teams, seven pro basketball teams, and numerous other athletic organizations -- including pro auto racing, rugby, soccer and even Cirque du Soleil.

The program costs $500 to test up to 300 athletes, but sponsorship for the first year is covered by Dick's Sporting Goods, a national chain with a location in Fort Myers.

The test, a software program administered on a computer, uses a series of cognitive assessments -- such as memory and matching exercises, reaction time, speed, concentration -- that are completed prior to the start of the sports season. This serves as the athlete's baseline.

Hoke described ImPACT as a noninvasive test in a video game-type format. It takes about 15 to 20 minutes to complete.

"The ImPACT test is essentially a preseason physical of the brain," he said. "If an athlete is believed to have suffered a head injury during competition, ImPACT is used to determine the severity of the head injury, and when the injury has fully healed."

An athlete involved in an impact affecting the head in which concussion is suspected is required to retake the test. The results are then matched against the earlier baseline results.

"We've already used it," Hoke said. "We had an athlete in football take a hit to the head. We compared his test results to his baseline and it was much lower. That gave us some objective evidence to sit this kid out, so you're not just going based on the kid's symptoms, or him saying, 'I just have a headache and my cognitive ability is fine.'"

In the event the test results show evidence of a potential concussion, the data is given to a local doctor for evaluation -- and can be shared with the athlete's family doctor.

Both pre- and post-injury test data is given to a local doctor to help evaluate the injury. The information gathered can also be shared with a family doctor. The test data will enable these health professionals to determine when return to play is appropriate and safe for the injured athlete.

The test, however, is only the first step in the process.

Getting clearance

According to James Vernon, athletic director at Port Charlotte High School, there is a strict protocol for an athlete with a head injury.

"Let's say a kid is dizzy or has a headache," he said. "They immediately see the trainer. What the trainer will do is he'll try to diagnose them. No matter what, after a hit, he'll keep them out of practice that day. But if he thinks they have a concussion -- they have the symptoms -- after he does his test, he will immediately send them to the doctor. Until the doctor signs them off, they can't do anything at practice."

Vernon explained that, even after a doctor's release, the athlete must follow a four-step process before being allowed back into a full-contact situation.

The first day, athletes are allowed only light exercise, such as walking or swimming. On the second and third days, they can advance to sport-specific drills that increase in intensity. On the fourth day, they participate in a full-contact practice -- but are evaluated by the school trainer. If all looks good, the athlete is sent back to the doctor for final clearance.

"We've been doing this for a while now," Vernon said, "but the state has stepped in and made it mandatory, so now everybody's doing that. That's the same procedure we've been following anyway."

The high school athletic staff said the ImPACT test is invaluable in the process because it is the first line of defense to determine whether a player has a concussion.

"What's good about the test is that it's objective," Hoke said. "I'm glad we got our hands on it."