When you think about concussion injuries what comes to mind? Is it the crack of a pro football player getting tackled? It might be a major league catcher getting rammed into at home plate. How about a soccer player heading the ball? All these things may cause a concussion but what also can is a hip check during a hockey match or a wrestler getting taken down and don’t forget the cheerleader who gets knocked to the ground while trying to catch their flying teammate. Concussion injures occur across a wide range of sports and a wide range of activities within those sports. It also occurs at all levels of play including pop-warner football. I go into great detail about concussion injuries during our Concussion RouletteTM workshop so if you want all the facts give us a call and we can schedule that talk for your next sports boosters meeting or team meeting.
I want to hit on one big factor that I feel is being mishandled in concussion injuries today; this is the testing that is being done. To highlight this I am going to point you to this article in the Wall Street Journal dated April 19,2017. It is an article about a high school football player, 17 years of age, who died after suffering a second concussion approximately one month after his first concussion. Yes, death is a consequence of having a second concussion too soon before your brain heals from a previous one. In fact 18 high school athletes died from second concussion syndrome last year. Not a big number compared to the total amount of high school athletes but this should be something we have a handle on to keep the number at zero. At the heart of this WSJ article is the most common test used to determine a concussion and when to return to play. It is the test that this 17 year old, 4.0 gpa high school kid from Washington state took and passed, because he passed it he was allowed to return to play. If you have a high school kid it is probably the same test they took to gather baseline data and would be tested with again to determine an injury and when to return to play.
This is the ImPACT test. This is a cognitive test that was developed in the 1990’s and is marketed as the most widely used and scientifically validated concussion management test. While this is the most widely used computerized test it has flaws, as the WSJ article shows. Studies on concussion injury and brain science have rapidly evolved since 1990 and this test has not evolved with the times. I suggest you read this WSJ article and this ESPN article heck even Slate has an article about how problematic ImPACT really is. Another problem is that kids are smart, they understand if they sandbag their baseline ImPACT it can be easier to return to play. With a lowered baseline it is easier to get back to that baseline score post injury and get cleared to play. The WSJ article includes comments by a professor of neurosurgery and neurology with the University of Wisconsin and who is one of the three primary researchers with the CARE Consortium. The CARE Consortium is doing some great work in the concussion field. This Dr. McCrea is very critical of the ImPACT test especially in light of the most current research on the brain and brain injuries. He believes that concussion testing should include physical and functional testing, something that ImPACT cannot do.
The biggest takeaway I hope you get from this post is that the ImPACT test should not be solely relied upon to measure your young athlete, solely used to determine an injury, and then solely used to determine when to return to play. It is clear that ImPACT is failing some athletes, and there are better tests out there. We actually offer testing for concussion injuries. Our test is FDA approved, approved in Canada, approved by 18 countries in the EU, and approved in Austraila. It involves a physical evaluation including balance and reaction time. The developers are working on adding another visual tracking component right now (as of April 2017.) This test provides a clear objective score out of 100 which we use, in conjunction with other clinical findings, to determine if an injury occurred and when the best time to return to play may be. If you are interested in getting your athlete tested, or want to take the test yourself, give us a call we can set that up.
When we talk about concussion getting an objective baseline test done is the key to keeping your athlete safe. You should be relying on an exam which offers better results than one developed in the early 1990’s prior to our expanded knowledge of this injury. If you want to learn more about concussions give us a call, we give talks on concussion injuries regularly and would be happy to speak to your group.