By Dr. Mark Hudak
Dealing with concussions in athletes has been a challenging task for many years. A concussion is a traumatic injury that causes altered function of the brain for some time after the injury. Until recently, very little science has been used to determine when it is safe to return athletes to contact and collision sports safely.
There are chemical changes that occur in the brain that can last from several days to several weeks after the injury. Returning to activity too quickly can lead to more severe and potentially life-threatening consequences if a second injury occurs before the brain has had a chance to heal. It has also been determined that young developing brains are more susceptible to permanent injury than adult brains.
In the past, most physicians used concussion-grading scales that were based on educated guesses as to when it was safe to allow athletes back on the playing field. In the past decade, however, more information about brain function and recovery from injury has become available. The use of neuro-cognitive computerized testing is making it much easier and safer for physicians to asses when an athlete’s brain function has returned to normal before exposing him or her to further risk of trauma.
At Mercy Medical Center Sports Medicine in Canton, Ohio, the ImPACT concussion assessment program is being used to assist in making better decisions as to when to return athletes safely to their sport. This computerized neuro-cognitive tool allows for assessment of an athlete’s reaction time and ability to concentrate and looks at both short-term and long-term memory function.
Utilizing the ImPACT program, it is beneficial to get a baseline on all athletes involved in higher-risk sports prior to the start of their seasons. Football, soccer, basketball, hockey and wrestling are obvious high-risk sports, but gymnastics, competition cheerleading, baseball, softball and lacrosse are also at-risk sports.
High school athletes should be baseline-tested in their freshman and junior years since their brains are still developing significantly. College athletes only need to be tested in their freshman year as their brain development is mostly complete. Once a baseline has been established, it allows for a comparison of an athlete’s mental ability to his/her baseline if the player suffers a concussion during practice or games.
The diagnosis of a concussion is not made using ImPACT testing. Concussions are diagnosed by clinical signs and symptoms that occur at the time of or after an injury. An athlete does not have to lose consciousness to have a concussion. Some of the symptoms of a concussion may include confusion, headache, dizziness, blurry vision and memory problems. Some signs of concussion may include vomiting, loss of balance and emotional outbursts. Any time a concussion is suspected, the athlete must be immediately removed from play and should not return until he or she has been evaluated by an athletic trainer or physician. If the diagnosis of concussion is made, the athlete should not return to participation until formally evaluated by a physician.
The ImPACT test is most useful when performed after the athlete’s symptoms have improved significantly and a determination as to whether or not he or she can return to play is desired. If the athlete is able to perform close to his/her baseline, a progressive return-to-play protocol will be started. This consists of a stepwise increase in non-contact exercises for a few days. If the athlete is able to progress through this protocol, he or she will be released to full contact activity.
It is important to realize that the athlete’s score on the ImPACT test is not the only determining factor for a return to activity, but is just one component of the decision-making process. A combination of resolving symptoms, a normal physical exam and return to baseline on ImPACT testing makes it much easier to determine when it is safe for student-athletes to return to sports while minimizing the risk of further injury.
It should be noted that the concussion management process is not a “one-size-fits-all” scenario. Coaches and school administrators should consider teaming with local sports medical providers, legal counsel and coaching staff to establish procedures that best serve their student athletes.
NOTE: For additional information concerning the ImPACT assessment program, visit the website: http://www.impacttest.com.
Following is an example of how useful the ImPact program has been.
I had a middle school athlete, who had not been baseline tested, suffer a head injury during a football practice on October 23, 2010. He hit his head on the ground and experienced a headache, dizziness, fatigue, memory loss and light sensitivity. I saw him two days later and he was still very symptomatic. His headache went away, and he was seen four days after the injury. He still had some dizziness, light sensitivity and concentration problems. He was ImPact tested that day and his composite scores were all extremely low. He returned one week later and his scores were worse despite having significant improvement in his symptoms. He was seen again in five days at which time his symptoms were completely resolved and his scores improved dramatically (see composite score chart below). Without the ImPact testing, have may have been allowed to return to full contact activity on November 3, but it was obvious that his brain function was not recovered at that point. The risk of severe injury would have been much higher had he been back on the field at that time.
ABOUT THE AUTHOR:
Dr. Mark Hudak is starting his third year as medical director of Mercy Medical Sports Medicine in Canton, Ohio. He was the team physician for Kent State University for 15 years along with serving in the same capacity with Malone University in Canton. He is a member of the American College of Sports Medicine, the American Medical Society for Sports Medicine and the American Academy of Family Physicians.