High School Football Receives Concussion Protocol Tools Before It Was Cool

Concussion protocol and prevention hit a fever pitch between 2013-2016 as professional leagues sought to create better best-practices and defend lawsuits.

In 2006, West Virginia University medical students were working with high school football teams using high-tech concussion protocol tools developed by the University of Pittsburgh Medical Center.

Here’s that story as it appeared in The [Martinsburg, W.Va.] Journal on Nov. 7, 2006:

ImPACTing football: WVU medical students conduct study on concussions

By Charles Schelle / Journal Staff Writer

MARTINSBURG — Athletes know the drill after they get their noggin hit: “What’s the score? How many fingers am I holding up?” If players answer correctly, they might get back to action.

But those questions do not hold up, nor do many tools to diagnose concussions, according to a recent study by medical students at the Eastern Division of the WVU Health Sciences Center and Dr. Konrad Nau, family medicine chairman.

“Concussions are one of the more common sports injuries after a sprain ankle, and the management of concussions have undergone a lot of change recently,” Nau says in a telephone interview from a Las Vegas conference.

Nau and a group of medical students at the Eastern Division in Martinsburg offer several local high school football teams and Shepherd University football, a service to help better manage concussion recovery with software called the ImPACT Test, which stands for Immediate Post-Concussion Assessment and Neurocognitive Testing .

“We need a better tool,” Nau says about managing concussion recovery in general.

The test was developed by University of Pittsburgh Medical Center (UPMC) and is used by concussed Pittsburgh Steelers quarterback Ben Roethlisberger. Several National Football League teams use the technology, including Roethlisberger’s Steelers, as well as the National Hockey League, National Collegiate Athletic Association and hundreds of high schools across the United States and Canada.

Locally, medical students at the Eastern Division volunteered to be sideline physicians for concussions at Hedgesville, Jefferson and Martinsburg high schools and Shepherd University football teams.

ImPACT studies by UPMC found that CAT scans, MRIs and other imaging provide little scientific- data when diagnosing and managing concussions. Studies also found that current concussion guidelines are often misused and misinterpreted, which could lead to a player returning to play before he has fully recovered from his concussion, according to the test’s Web site http://www.impacttest.com.

The Eastern Division studies concussions in football because men’s football has the highest concussion rate in sports, Nau says.

Medical student Vishal Thakral, assigned to Martinsburg High, says it’s important to prevent effects from a second concussion when the first one has not healed.

“The long-term effects of concussion without the appropriate amount of time will delay what they do academically, what they do socially,” Thakral says, who studies neurology. “It is both to improve their excellence on the field at being able to play 100 percent at their level as well as off the field.”

Panhandle participation

Medical students wait on the sidelines of Jefferson, Hedgesville and Martinsburg high schools and Shepherd until a player collides into something with his head. This season, one player at the schools had a concussion.

Nick Denne, who wants to go into pediatrics, is assigned to Hedgesville High School’s team where the concussed player attends.

Denne says he was not at the game against Sherando, so he met the player Monday after theSaturday game to perform the ImPACT Test. The player underwent a CAT scan after the game, he says (which Nau says is not necessary).

“Everything cleared out at the hospital so he came back, and he was having a lot of symptoms, headache, irritability, eating, sleeping at night,” Denne says.

Athletes enter their birth date, age, gender and other information to be submitted into a database for research data. Then they answer questions to measure memory, reaction time, color matching, word discrimination and about their symptoms. Athletes’ results are compared to an ImPACT test they completed prior to the season, which is referred to as the baseline. The test takes about 30 to 40 minutes to complete.

The questions don’t take much effort to answer, Thakral says, so the test has a built-in feature to see if the student clicks buttons just to get through the test.

“A lot of it is mundane tasks, like they’ll have a red circle and a blue square. And every time it comes up you either have to hit the left button or the right button, and doing that for 10 minutes, a lot of kids’ attention spans usually run out of time,” he says.

The athlete’s results matched his baseline test, which surprised Denne.

“I spoke to him briefly before the test, and he didn’t look like himself,” he says. “You could tell he was in pain; you could tell he was having headaches, and you could tell the bright lights in this room actually bothered him.”

The doctors decided to hold out the player for a week instead of allowing him to return, Denne says.

Denne doesn’t see the results of the ImPACT Test as a drawback because the test did what it was suppose to do, he says.

“It’s a two-fold test — it’s not just their scoring on their test. If they’re still having symptoms, there’s no point in risking any future neurological development,” he says.

If Denne was on the sideline when the concussion occurred, he would have performed an ImPACT Sideline Concussion Assessment on the player. The assessment lists symptoms for the physician to check off, exercises the player must perform and ask questions for memory, amnesia and concentration. The players must read numbers in backward order and recite words or a phrase, for example.

Overall, concussion management has came a long way over the years.

“Five or 10 years ago, you have a concussion, you give it a degree — mild, moderate or severe— and then there’s a length of time that usually a student goes out for,” Thakral says. “Now it’s more directed to the injury itself, to the student, to the athletes itself, instead of having a general timeline.”

Mounting results

This is the third year that the Eastern Division has used the ImPACT test, and Nau says he has not run into any coach who participated with the program who argued with the results.

Nau and another set of medical students completed a survey of all West Virginia high school team physicians and athletic trainers at schools who had a football program about concussion management .

“Trainers and sideline physicians across our state realize that physical exam and CAT scans for the report of the patient are not reliable, they don’t give a high degree of reliability to go back and play,” he says.

“(A) majority of physicians who completed this, agree that the physical examination does not reveal enough information to evaluate concussions,” he says.

In the same survey, physicians and trainers had high confidence in standardized neuropsychological tests, similar to the ImPACT Test, though many have not used it, he says.

The study will be submitted to West Virginia Medical Journal for publication, he says.

Nau hopes more schools will learn about the ImPACT test in West Virginia and want to use it. Right now, the community service project is free to these schools because of grant money and assistance form the Eastern Area Health Education Center.

The ImPACT software, which can be loaded on any Windows-based computer, costs $500, something that is affordable for schools when broken down to a per-athlete cost, Nau says. The agreement allows a school to use it for all sports for one year and has to be purchased by individual schools and not a school system.

“We’re hoping that after we complete this after a couple years we can give it to schools and community for free,” Nau says.

—Staff writer Charles Schelle can be reached at 263-8931, ext. 135, or cschelle@journal-news.net

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