In his 38 years as a trainer, Phil Mateja can tell when a student athlete needs to come out of the game after a blow to the head.
“I’ve been around long enough; I know when somebody’s not right,” says Mateja, the athletic trainer for Brewer High School.
Making the right call on whether to pull an athlete who might be suffering from a concussion out of the game is vital, as mounting scientific evidence suggests that improperly-treated concussions can lead to long-term mental and physical health problems.
But making that call also can be difficult, especially in the heat of the moment. There are few coaches or medical attendants in the state with as many years of experience as Mateja. Often, a coach or attendant doesn’t know a student well enough to be familiar with that student’s normal reaction time to questions. And many times, a student wants to play and will readily agree he or she is fit for active duty, says Dr. Kendra Bryant, a Rockland neuropsychologist.
“Ninety-nine percent of the people I see want desperately to get back to playing,” Bryant says.
That’s why some 60 Maine school systems have adopted a standardized, computerized testing system, known as the ImPACT test, to detect the neurological effects of concussions in student athletes. Advocates for such standardized concussion management say the test safeguards neurological health by helping better determine the optimum time athletes need to fully heal.
The ImPACT program, which can be run on any ordinary PC or Mac, consists of a battery of questions to test a concussion patient’s memory and cognitive functions. The patient first enters his or her medical data on the computer and then uses the mouse to navigate through tests to recall words or shapes from lists and match colors to numbers. The program records the student’s answers and then generates a score of the student’s cognitive functioning.
Every student who participates in a school sport takes the test as a baseline at the beginning of the sports season. If the student suffers a concussion, the student takes the test again and the two tests are compared. If the second test shows neurological impairment in comparison to the first, the student must take time to heal before playing again. Students retake the test until their performance matches or exceeds their baseline performance; only then are they allowed to go back into the game.
“It’s a great diagnostic tool,” Mateja says. “The kids can’t cheat.”
The drive to find a better way to diagnose and manage concussions reflects a growing understanding that such head injuries can have long-term effects on neurological and physical health. Boston University scientists have found that repeated concussions have led to higher incidences of dementia and other neurological disorders in professional hockey and football players. This national conversation is changing the standard of care for student athletes across the country, says Dr. Paul Berkner, president of the Maine Concussion Management Initiative and director of health services at Colby College
“The concept of getting dinged or getting your bell rung is no longer acceptable,” Berkner says.
The effort to standardize concussion treatment was spearheaded by a handful of doctors throughout the state before it was brought under the umbrella of the Maine Concussion Management Initiative through Colby College. The program began offering information about concussions to medical providers and coaches, as well as grants to help schools initially pay the annual $500 fee to use the diagnostic program.
To understand the importance of precaution around a concussion, it’s helpful to understand exactly what’s happening after the injury.
The brain needs fuel, in the form of glucose, to operate. When a brain suffers a blow, its metabolism gets shaken up and its fuel supply gets disrupted. At the same time, the body restricts blood flow to the brain; it’s blood that carries the glucose. This means the brain is starving for the glucose it needs at the time when it needs it most. Because of this scarcity of glucose, the brain is more susceptible to injury in the period shortly after a concussion.
Treating concussions can be tricky because symptoms are not always obvious, even to the patient suffering the concussion. Without a baseline testing of brain function, it is often impossible for trainers, coaches, and doctors to analyze a student athlete’s neurological function, even days after the blow. And a concussion can continue even after all the symptoms have disappeared.
“They might start to feel fine, but when you test them, they might show impairment,” Bryant says.
The only proven way to heal from a concussion is rest from physical activity and, in some cases, mental activity. With rest, in most cases, the brain can heal itself and normal activity can resume. But sometimes, even with rest, the brain remains more vulnerable to future concussions. According to Berkner, it then becomes necessary to advise a student to retire from sports or risk permanent neurological damage.
Adoption of the ImPACT test is just one way in which doctors, nurses, and school personnel are trying to reduce the amount of concussions that occur in scholastic sports. The Maine Interscholastic Athletic Administrators Association (MIAA) has adopted a new policy to ensure that every coach knows how to spot and initially treat a possible concussion. For the 2011-2012 school year, all coaches will be required to view a video about concussions. It’ll be just another requirement for coaching, like CPR and First Aid certification, says Bunky Dow, athletic director for the Mount Desert Island High School and MIAA associate executive director. The goal is to make sure a student isn’t accidentally rushed back when he or she still might be suffering from a concussion.
“If you’re not up to par, you’re not back on the field,” says Dow.
While it is important that concussions are being taken more seriously than before, it’s also important to avoid creating undue anxiety, says Bryant. She treated one student athlete who recovered well from a single concussion but became quite anxious about the possibility of experiencing another. In this case, the computerized testing was helpful to demonstrate that the student was fully recovered.
While there are no guarantees when it comes to the brain, the vast majority of student athletes will avoid any long-term, ill effects from concussions if the proper precautions are taken.
“It’s a manageable condition; we just need to manage it,” says Bryant.
