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. (By Marvin Joseph -- The Washington Post)
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To learn more about the ImPACT program, and to take the test ourselves, we caught up with Rotter, 16, and Hammond athletic trainer Tim Happel on Friday when Rotter was retaking the test for the second time since sustaining a concussion late last month.

Rotter first got concussed in first grade in a bike accident at Lake Elkhorn. He lost his short-term memory for a few days. A person who sustains a concussion can be more vulnerable to concussion than those who have not sustained such an injury.

"Oh, another butterfly gave you a concussion?" a buddy said to Rotter recently, jokingly suggesting that the middle linebacker-offensive lineman and lacrosse defender, known for his physical playing style, is soft.

When Rotter, who is enrolled in honors courses, is concussed, he suffers from headaches and a lack of concentration. "It feels like you have a haze over you, a fog, kind of," he said, adding that his grade-point average dipped from about a 3.57 to a 2.71 in the fall when he had trouble focusing after his football concussion.

"He's in all really, really intense classes, so concussions have much more effect there than on the field," his mother, Julie, said.

Rotter could tell when he took the first retest April 2 that he was not particularly sharp. He noticed further improvement Friday afternoon, taking it for a second time since his lacrosse concussion. But before clearing him to play, Happel wanted to consult with Gioia, who helped develop the concussion treatment program for Howard schools. (Gioia's children play sports at Mount Hebron High.)

"It seemed like I could remember the shapes a lot easier," Rotter said after his second retest. "I was a lot faster, it felt like. It was a pretty obvious difference."

Mike Williams, coordinator of athletics for Howard schools, said that the county's dozen high schools have tested an average of about 200 athletes each. With the program becoming more established, he expects that number to grow to 400 or more next school year.

"They used to say after two days you could return" from a concussion, Williams said. "Then it went to a week. Now research shows that with high school students, their brains are still developing, and a sustained concussion in a high school student can impact their learning and development for a lifetime. When we saw that, that's what really sold us. It's not a perfect science, but it's the best thing out there."

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

For athletes itching to get back on the field, the ImPACT test can be friend or foe: friend if it raises no red flags, which might result in getting back sooner, or foe if the athlete feels fine -- or is downplaying symptoms, which is common -- but falls short of baseline benchmarks when retaking the test.

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."

Varsity Letter is a weekly column about high school sports in the Washington area. E-mail Preston atwilliamsp@washpost.com.