11/29/2009 6:00:00 AM New testing rings a bell
VAHS brings computer program into concussion discussion
Concussions happen more often than we realize during contact sports such as hockey, football and soccer.
More than 400 athletes at Verona Area High School must take the ImPACT test before their sports begin to set a baseline for later testing if they get a concussion.
What is the ImPACT test?
The ImPACT test used in Verona Area High School takes about 20 minutes to complete on a standard PC with a mouse.
An athlete's first score on the test establishes a "baseline" that can be measured against later performances on the test. That would help clinicians diagnose a concussion or decide when the athlete has fully recovered.
After asking a set of personal questions - such as height, weight, sport and concussion history - the test includes a six-section "neuropsychological test" that measures such indicators as attention span, memory and reaction times. Later testing would include questions about current symptoms.
For example, in the "word discrimination" section, a list of 12 words appears briefly on the screen. After that, the athlete is given a list of 24 words and must click "yes" or "no" to indicate whether the word appeared on the original list of 12. This test evaluates verbal recognition and attention processes.
Another test, called "X's and O's," tests reaction time by having the athlete click the right or left button on the mouse depending on the color of a square that pops onto the screen.
That's followed by a "memory task," in which a large number of X's or O's appear on the screen for 1.5 seconds, but only three are colored yellow. After the letters disappear, the test-taker must remember where the yellow objects appeared.
The company that created the test says that all professional teams in the NFL, NHL and Major League Baseball use ImPACT, as do three branches of the U.S. military and more than 1,800 high schools and 700 colleges and universities.
When helmets collide on the football field, Verona Area High School is ready.
The same goes if wrestlers knock heads, a basketball player takes an elbow to the jaw or a soccer player crashes into a goal post.
This fall, VAHS began testing student-athletes in five sports using a software program known as ImPACT, or Immediate Post-concussion Assessment and Cognitive Testing.
Developed by a company in Pittsburgh, the test aims to address a growing concern for athletes at all levels - knowing when it's OK to return to action after suffering a concussion.
"More and more districts are going to this," VAHS athletic director Mark Kryka said. "This takes away any questions ... of whether an athlete is ready to play."
In general, diagnosing a concussion is pretty straightforward. But figuring out when athletes are fully recovered isn't so easy, and if they are sent back into a game too soon, another shot to the head could prove dangerous.
The ImPACT test is a 20-minute exam that measures such capacities as reaction times, memory and attention spans. The results provide a "baseline" score that doctors use to determine if an athlete's brain is functioning properly after a head injury, explained Stephanie Sinaise, the high school's athletic trainer.
In recent years, hundreds of schools nationwide - including nearly 70 in Wisconsin - have begun using the test, which is also common for most NFL and college football teams.
Verona started in August by testing roughly 220 football and men's soccer players, Sinaise said. This month, boys and girls basketball players, hockey and wrestling athletes are taking the test, and officials plan to test the girls soccer team before its season starts in March.
To test 400 athletes this year will cost VAHS about $500, which Kryka said is well worth it.
"We're very happy with it," he said. "In the long run, we thought it was better for (athletes') safety to do this."
In Dane County, McFarland, Sun Prairie, Edgewood, DeForest and Mt. Horeb schools are using ImPact, Sinaise said. And VAHS is also jumping on a national trend.
Concerns about the long-term effects of concussions are a hot topic this year in the NFL in particular, where there is mounting evidence linking multiple head injuries in players with brain disorders such as dementia and Alzheimer's.
Last month, Congress heard testimony on the issue from former NFL players and commissioner Roger Goodell. And just this week, NFL officials informed team doctors that each team will be required to supplement its medical staffs with an "independent neurologist or neurosurgeon" to help with concussions, according to FOX sports.
A New York Times story this week quoted an NFL players' union official as saying the union pushed for such a program in the hopes that it would spread to all levels of football.
The issue goes beyond professional sports or even football, said Eric Hilquist, a physician with Dean Health Systems in Madison who specializes in sports medicine. He spoke last month to the Oregon School Board, which is also considering using the ImPACT test for student athletes.
Concussions "are much more common than people realize," Hilquist said. He cited research showing that about 10 percent of athletes in contact sports suffer at least one concussion.
Most of those concussions are so-called "bell ringers" that don't involve a loss of consciousness, he said. Symptoms can include nausea, dizziness, confusion, headaches or trouble sleeping.
But those outward symptoms can disappear before the full effects of the concussion are gone, he added. For that reason, past methods of testing athletes didn't always work.
And that's scary, he said, because while a first concussion is serious, a second or third can be even worse - and easier to get.
"Their brain is much more susceptible to that second head injury, so it can be much lighter hit (that causes another concussion)," he told Oregon officials. "It can be more severe, require a longer recovery and can cause permanent damage to cognitive or mental functioning."
His colleague Deb Jenks, a former trainer for Oregon High School, said the ImPACT test also gives physicians a concrete reason to keep kids on the sidelines, even when they are itching to get back in the game.
"What our kids don't understand is that a 'bell-ringer' is a concussion," she said. "They are like, 'Oh, I just got my bell rung, no big deal.'
"It is, and they should not be let back into the game."
In an effort to "appear tough," some students will even lie to doctors about their symptoms, Hilquist said.
"But they can't fool a computer," he said.
Sinaise said Verona soccer and football players suffered about 15 concussions this fall, which she said is "about average" for a year. Recovery times vary depending on each athlete's symptoms, but Sinaise said that having the ImPACT test to gauge cognition is a boon for trainers and doctors.
"It definitely helps a lot," she said. "There have been times in my gut that I know kids aren't ready to go back, you can just kind of tell aren't themselves. ... Now we can say, 'Look your reaction time is not where it should be ... we need to be sure your brain is healthy."
Athletes need to be retested every two years, so next year, the high school will only test freshmen, she said. After that, the district will test freshmen and juniors every year.
