Keeping track of concussions

As athletes at Hammond High School in Columbia, Md., headed off to games and practices after school on a recent Friday, junior varsity lacrosse player Jake Rotter strolled to an empty computer lab to once again square off against his stiffest adversary: himself.

Rotter sustained a concussion during the junior varsity football season, experienced lingering headaches that prompted him to leave the wrestling team and then endured another concussion playing lacrosse this spring.

In previous years, the school's athletic trainer and Rotter's doctor would have monitored his symptoms -- if there were obvious signs, which is not always the case -- and made a determination about when he could return to action.

Now, Howard County schools make quantifiable decisions with the ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, program, a tool to help track recovery from concussions. The program, developed by Mark Lovell at the University of Pittsburgh Medical Center, is used by professional sports teams, colleges and hundreds of high schools in the United States.

Howard County began using it this school year, and it is free to students, with parental permission.

Here's how it works: Before the season, an athlete takes the computerized ImPACT test, which, in part, measures memory and reaction time after the athlete is shown a series of words, designs, patterns and symbols. It takes about 25 minutes. There is no particular score for which to strive; each athlete's results provide a baseline of information.

"It definitely tests you," Rotter said.

If the athlete experiences a head injury, he or she retakes the test to see how results compare with the baseline reading. Is there a lapse in memory? Reaction time? Some other decline in performance? If the retest results fall markedly short of baseline numbers, the athlete probably will be deemed not ready to play, being told to sit out until the ImPACT scores are close to pre-concussion results.

The ImPACT test findings remove some of the guesswork about whether an athlete is fit to resume play, and the graphic representation of results makes it easy to explain to athletes and their parents why the athlete might or might not be fully recovered from a head injury.

"There's a real gap in the knowledge of this injury," said Gerry Gioia, director of neuropsychology and director of the Safe Concussion Outcome, Recovery and Education Program at Children's National Medical Center in Washington. "What happens is families and kids are getting lots of different messages about whether they can go back to play or not, and many times it's not based on any objective or systematic data."

The cost of the program is $9,000 for the software, about $750 for each of Howard County's 12 high schools. But for school systems without certified athletic trainers, administering and interpreting the tests could be a problem. Howard has a trainer.

Oh, and don't try to lowball your initial ImPACT test. Not only could it be hazardous to your health, it could be embarrassing. Gioia said the test has indicators that expose sandbaggers.

"I feel like (the ImPACT test) is holding me back a little bit," Rotter said, "but I'm also glad it exists. Because if it didn't exist, I'd be back on the field and getting another concussion and be in a worse state."

AP-NY-04-23-08 0900EDT