A local program aims to assess student athletes before they are injured
Published Aug. 20, 2008 in the Keene Sentinel
By Casey Farrar
Next came a set of questions testing their short- and long-term memory.
Training for the season had started, but this wasn’t a typical practice: Athletes on the football, soccer and spirit teams at Keene High School and Monadnock Regional High School this season are having their brain function tested as part of new program to assist athletic trainers and doctors when players suffer concussions.
The program, called ImPACT, or Immediate Post-concussion Assessment and Cognitive Testing, is one of the first of its kind — being used by more than 1,200 high schools, 300 colleges and universities and 30 professional football teams — to give doctors and trainers data about student athletes’ brain function before and after concussions.
And the information it has already provided has vastly changed the way doctors and trainers look at concussions in high school athletes.
Studies using the test, which was developed at the University of Pittsburgh, have shown that, unlike many other types of injuries, the younger an athlete is the longer it takes for his or her brain to bounce back from a head injury, according to Dr. Mark B. Silbey, director of the sports medicine department at Cheshire Medical Center/Dartmouth-Hitchcock Keene.
The aim of the project is to give doctors and trainers a more objective analysis of when it’s safe to send a young athlete back onto the field. Now local doctors and trainers hope to use the test as a tool for treatment of head injuries among Monadnock Region sports teams.
“When you put kids back on the field we now know that, especially in younger kids, it takes longer to recover,” Silbey said. “We’re only going to gather more data now, and the important thing is that these are objective numbers that can sometimes give us a better idea than subjective testing as to how the brain is recovering from trauma.”
This is the first season the hospital’s Sports Medicine Center has used the test.
Since 2004, the center has provided athletic trainers to Keene, Monadnock Regional, Fall Mountain Regional and Brattleboro Union high schools and Keene State College, the Keene Swamp Bats baseball team and the Monadnock Marauders football team.
Recently, it added Bellows Falls Union High School and Vermont Academy in Saxtons River, Vt., to its rolls.
While ImPACT testing is only being offered to Keene and Monadnock Regional high schools, with ice hockey, basketball and wrestling athletes also being tested before the winter season, Tate S. Erickson, sports medicine manager for the Sports Medicine Center, said if all goes well the center hopes to expand testing to more schools next year.
During the 2005-06 school year — the most recent statistics available — of the 4.2 million high school athletes across the country, nearly 760,000 were injured, according to a report by the U.S. Centers for Disease Control.
Nearly 15 percent, or about 100,000, of them suffered concussions, the report showed.
Last year, 54 student athletes from Keene, Monadnock Regional, Fall Mountain Regional and Brattleboro Union high schools suffered concussions, according to statistics from the Sports Medicine Center.
Concussions represented about 3 percent of the 1,610 injuries reported by athletes at the schools served last year by the center, but the severity of head injuries among high schoolers has only recently gained national attention.
“In the last two to three years it has become a national focus,” said R. Patrick Corbin, executive director of the N.H. Interscholastic Athletic Association. “The medical community didn’t ever pay as much attention as they should have to head injuries among kids, but now it has become a hot-button issue in New Hampshire and across the country.”
Part of what is behind the increased attention on the effects of concussion on high school athletes is the use of ImPACT testing, according to Erickson.
With more data available from the tests, doctors and trainers are better able to understand how the brain recovers, said Silbey, one of two doctors treating student athletes through the Sports Medicine Center.
A $2,500 grant from the Agnes M. Lindsay Trust in Manchester and a $1,000 gift from an anonymous donor paid for the ImPACT testing, according to Donna M. Dubuc, director of development at the hospital.
Erickson, who oversees the eight athletic trainers that work in the six schools in the region, said the pilot testing programs at Keene and Monadnock Regional high schools will complement the traditional assessments that trainers, doctors and coaches use when an athlete suffers a concussion.
Before the start of the season, athletes will take a baseline exam, which rates their reaction time and memory, over the Internet.
In one portion of the test, blue and red dots flash intermittently on the screen. Students have to push the letter “P” on their keyboard when they see red and “Q” when they see blue. It is a test of reaction time.
Immediately following that, they are asked to recall a list of words they saw in an earlier portion of the exam — testing long-term memory.
If an athlete suffers a moderate or severe concussion — classified as a concussion with symptoms lasting more than 15 minutes or if an athlete loses consciousness — he or she will retake the test a day after the injury. The test will give doctors and trainers an idea of how badly brain function has been affected and helps to determine when an athlete is ready to return to the field, Erickson said.
But as trainers and doctors at the Sports Medicine Center analyze the tests over the next year, Erickson said the schools will continue to use the usual standards to determine when an athlete can return to play.
Typically, an athlete who suffers a mild concussion — with symptoms including dizziness, double vision and headache lasting less than 15 minutes — are out of sports for one week, Erickson said.
These athletes won’t be retested using ImPACT, unless a trainer or doctor recommends it, while athletes suffering moderate concussions will be out up to two weeks from the time their symptoms subside, according to Erickson.
Severe concussions, defined by an athlete losing consciousness, will mean an automatic two-week break from sports, and possibly longer depending on an athlete’s recovery time, Erickson said.
Erickson said while some teams and schools have decided to send athletes back to the field once their test results are within 10 percent of baseline, others have taken a more conservative 5 percent approach.
Because the program is new at the Sports Medicine Center, clinicians have yet to determine the level of function they will use to mark an athlete’s safe return to play, according to Erickson.
Because concussions cause swelling in the brain, doctors and trainers are concerned with athletes returning to play too quickly.
If the brain is still swollen and is injured again, it can trigger permanent damage including aneurysms, or bleeding in the brain, which can lead to death, Erickson said.
Since symptoms of concussion, which include headache, nausea, confusion, irritability, sleep disturbances, fatigue and memory loss, commonly have been self-reported, doctors have had to rely on an athlete’s own judgment of their symptoms.
“When a kid comes in and says their symptoms are gone, we can test them with ImPACT and see if their brain function has recovered,” Erickson said. “Everybody’s different in terms of how they will recover, but I believe the trends will be consistent with the traditional standards.”
Corbin, from the state high school athletic association, said the objective testing can be important in discouraging athletes from returning too quickly.
“Teenagers all think they’re invincible,” Corbin said. “It’s important to play in that game and you get banged in the head, your eyes are crossed, but you’ll be okay.”
A recent study involving ImPACT pointed out that while self-reported symptoms generally subsided in four days, tests showed memory decline lasted at least seven days after injury, according to Erickson.
Parental pressure can also push student athletes back onto the field too soon, according to Corbin.
“One of the biggest problems is parents who are so concerned about Susie or Johnny playing in that championship game, and fighting the whole mentality that a student getting their bell rung is okay,” Corbin said. “It boggles my mind, as a parent, to see parents putting kids back out.”
Erickson said he also has seen athletes pushed back into playing by overzealous parents, but trainers and doctors can now use ImPACT score reports to show solid data about the concussion.
“It’s not there to replace traditional testing, but it’s a great tool and we’re hoping, based on the results of the pilot group, to expand this to other schools,” Erickson said.
Casey Farrar can be reached at 352-1234, extension 1435, or firstname.lastname@example.org.