Ending the Guessing Game in Concussion Recovery

Hammond High trainer Tim Happel helps Jake Rotter, left, a JV lacrosse player, prepare to take the ImPACT test, which helps monitor the effects of concussions.
Hammond High trainer Tim Happel helps Jake Rotter, left, a JV lacrosse player, prepare to take the ImPACT test, which helps monitor the effects of concussions. (By Marvin Joseph -- The Washington Post)
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By Preston Williams
Thursday, April 17, 2008

As Hammond High School athletes headed off to games and practices after school 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 JV 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 and some other Washington area schools can make quantifiable decisions with the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) program, a tool to help track recovery from concussions.

Howard 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 his memory and reaction time after being 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 retakes the test to see how his results compare with his baseline reading. Is there a lapse in memory? Reaction time? Some other decline in performance?

If his retest results fall markedly short of his baseline numbers, he probably will be deemed not ready to play. The athlete will continue to sit out until his ImPACT scores are close to his 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.

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. According to http://www.impacttest.com, the only Washington area school systems to use it are Howard and Fairfax counties, with other individual schools using it, as well.

"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 (SCORE) Program at Children's National Medical Center in the District. "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."

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