CONCUSSIONS
School district uses software to assess effects of head injuries
By JESSICA ADLER
What would you do if you smacked into the concrete wall of a gymnasium, lost
consciousness for a bit and woke up with a horrible headache?
Jackie Stanzione, a 17-year-old senior at Pequannock Township High School
did what many die-hard athletes might. She played down her injury and
returned to softball practice the following day.
"It's not that I didn't think it was serious when I told my mom what
happened," Stanzione said of her injury, which occurred in April. "I was
just foggy-feeling. And I wasn't really saying things I didn't think were
important."
When it comes to concussions, what exactly qualifies as "important" is
sometimes a gray area.
"There's a lot of misunderstanding, not only in the medical field but in the
public," says Dr. Gerald Tramontano, a clinical neuropsychologist with the
Pathways Behavioral Unit at Preakness Healthcare Center and clinical
director of the NeuroRehab Institute in Mt. Arlington.
According to researchers, mild and moderate concussions aren't getting
enough attention, leaving certain patients at risk for resonating effects.
Concerned about such risks for its students, the Pequannock Township School
District is taking a proactive step - incorporating technology used by
professional athletic associations including the National Football League -
in order to ensure their safety.
Beginning this fall, the district will mandate that an ImpactTest be given
all middle- and high-school athletes participating in contact sports. It is
one of only nine districts in New Jersey to adopt the technology, along with
five universities, including Princeton and Rutgers. The computer-based test
evaluates reaction time and memory in order to ensure that competitors fully
recover before returning to play.
When Stanzione awakened after her concussion, she found herself on the
gymnasium bleachers, an ice pack in hand. She had a booming headache and
when she stood up, she said, she blacked out. But Stanzione is an
experienced athlete. She plays first base and outfield for the school
softball team and a traveling summer league team, and she also plays field
hockey. She is not a complainer.
When she got home after practice, Stanzione told her mother she was
exhausted, took two ibuprofen and went straight to bed.
In the morning, her headache persisted, but she went to school anyway. She
felt nauseous and her vision was blurred, but it was the very beginning of
the softball season and Stanzione wanted to "make a good impression." She
attended tryouts that afternoon.
Eventually, she had to sit it out, unable to focus on the ball.
It was at that point that Stanzione and her parents decided to visit a
hospital emergency room, where a CT scan revealed nothing out of the
ordinary, no bleeding or bruising. Doctors told Stanzione she could return
to practice the following day.
According to Dr. Joseph Feldman, chariman of the emergency trauma department
at Hackensack University Medical Center, that was the wrong advice. Athletes
who suffer a concussion should be advised to follow up with a physician or a
specialist before returning to play, he said.
Tramontano agrees. Even non-athletes, he said, need to be careful after
experiencing a concussion. Depending on the severity of the injury and the
patient's medical history, he says, symptoms such as lethargy, lack of focus
and depression might last months, not just a few hours or days. Tramontano,
who specializes in rehabilitative therapies for patients with lasting
neurological damage, says that an appropriate treatment usually can be
devised, and effects eventually subside.
Those with a prior history of neurological disorders, such as a learning
disability or a family history of such disorders, are at increased risk for
slow recovery, Tramontano said. Another major risk factor, especially for
athletes, is repeated concussions.
"Once you get a couple, he said, "you're more vulnerable."
The jury is still out on whether sustaining repeated concussions can lead to
irreversible damage. Some researchers point to memory loss and impaired
motor-skill function in boxers as evidence that permanent harm is possible.
One thing that's certain, Tramontano said, is that the shorter the time
between multiple concussions, the greater the potential for damage. Recovery
time can be exponentially extended if someone undergoes a head injury
without fully recovering from a prior concussion, he said.
University of Pittsburgh medical researchers had this in mind when they
developed the ImpactTest.
Administered to athletes in the National Hockey League, the NFL,
championship auto racing and other professional associations, the 20-minute
exam is designed to ensure that competitors fully recover before returning
to play. Subjects are asked to complete tasks such as clicking on the left
mouse button as quickly as possible when a circle appears, and on the right
button as quickly as possible when a square appears. Annual licensing fee
incurred by the district for the software: $450.
"An MRI or a CT scan is not going to pick up on a concussion when there's no
bleeding or swelling," said Dr. Mickey Collins, the director of the sports
concussion program at the University of Pittsburgh Medical Center. "By doing
a program like this, you're able to qualify the injury."
Athletes take the ImpactTest prior to the season. Then, in the event of a
concussion, they take the test again. Post-injury brain function should
return to within 95 percent or higher of the baseline score before returning
to competition, Collins said.
"The mentality of athletes is that the last thing they'll do is report their
injuries," said Collins. "Everyone wants to get back to play. This test
allows us to better objectify things."
Until April, the ImpactTest was used on a pilot basis in the Pequannock
Township School District. On a rainy day during the fall field hockey
season, Stanzione was one of the students who took it.
Even though her CT Scan revealed no evidence of damage, Dr. Paul Ostergaard,
her family physician and Pequannock Township School District doctor, advised
that Stanzione retake the test.
Her score revealed that she was at 72 percent of her normal brain function.
"We all have the same pressure; keep the kid out or let them play,"
Ostergaard said, referring to the role of athletic trainers and team
physicians. "Sometimes a student will downplay symptoms. The nice part about
the test is that it shows that something is going on."
Ostergaard estimates an average of five concussions a year among Pequannock
District athletes. The school has used the test in a dozen or fewer cases
thus far. Stanzione's was the most severe.
For her, it was useful beyond the softball field.
When she had to tell teachers that her academic performance might be
hindered for a while, "the test kind of showed I wasn't lying," she said.
After taking the ImpactTest every five to seven days for a few weeks,
Stanzione returned to about 98 percent of her baseline. She attended every
practice and game while she was injured, until finally, she could return to
play.
At first, Stanzione says, she could still feel some effects of the
concussion; it was difficult to determine the direction and spin of fly
balls. After just a few days, though, she was back to her old self, batting
fifth in the lineup and playing the field.
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