Think of the brain inside an athlete’s head as an egg yolk within a shell.
When the eggshell is bounced or broken, the egg yolk usually isn’t quite the same.
When an athlete makes violent head-to-head contact with a rival, or falls and hits the ground hard, the brain may move within the skull and set off a number of internal chemical changes, making it difficult for the brain to operate at normal efficiency.
What often results is a concussion, but because all the activity takes place beneath the skull and isn’t subject to an immediate diagnosis, it remains a somewhat mysterious injury despite its prevalence.
An estimated 1.4 million concussions per year are sustained in sports- and recreation-related activities. Updated estimates by the Sports Concussion Institute suggest that 10 percent of high school athletes will suffer a concussion each year from their participation in contact sports, with female athletes more susceptible to the in-jury than males.
Yet concussions aren’t readily apparent to anyone at first glance. They can’t be detected on an MRI or CT scan, and 90 percent of concussions do not involve a loss of consciousness.
And many athletes of all ages are reluctant to admit to such an injury during the middle of a competition.
Yet talk to experts in the field, and they feel significant strides in demystifying the concussion are being made.
“There’s been a lot of progress in the last 10 years in understanding concussions and how to treat them,” said Mickey Collins, Ph.D., a nationally renowned sports concussion clinician and researcher based at the University of Pittsburgh Medical Center.
“Now we’re looking at something we can manage, and by doing proper management it allows proper recovery to occur.”
Collins, a 1987 graduate of Hermon High School and former baseball player who competed for the University of Southern Maine in the 1989 NCAA Div. III College World Series, has worked with numerous professional sports organizations and with individual athletes of all ages.
But among his current focuses is one of the most vulnerable populations for concussions — the high school student athlete. Research has shown that high school athletes — particularly those in such sports as football, wrestling, soccer, basketball, cheering and lacrosse — are more vulnerable to concussions than older athletes and may take longer to recover.
“The outcomes vary from a couple of days to a week or a year to some kids not recovering fully,” said Collins. “Forty percent of high school kids get better within a week, for 60 percent of the kids it’s two weeks and for 80 percent of the kids it’s three weeks.
“But that means for one out of five kids the recovery period is more than three weeks.”
One crucial element of proper concussion management is a timely diagnosis, and a program co-founded about a decade ago by Collins and colleagues Dr. Mark Lovell and Dr. Joseph Maroon has been introduced in approximately 30 Maine high schools in an effort to aid that process.
ImPACT — Immediate Post-Concussion Assessment and Cognitive Testing — is a computerized neurocognitive testing program that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages.
Maine is one of the first states to use the test, dating back nearly a decade to when the ImPACT program was used at Bonny Eagle High School in Standish as a pilot project.
“We developed ImPACT to put the brain to work,” said Collins. “It’s a stress test for brains.”
The 30-minute test involves the student-athlete first providing demographic information, then being tested in a variety of categories that measure reaction time, processing speed, memory and attention.
The test can be used as a baseline measurement to be compared with similar testing done in the aftermath of a concussion, and that can be used in conjunction with a clinical evaluation and symptom measurement to help determine when the injured athlete can return to the field of play while minimizing the possibility of a second concussion.
If an athlete has not taken the baseline test, a post-concussion test may be taken and compared to peer-group results as part of the management process.
“The test itself is a tool,” said John Ryan, longtime athletic trainer at Bangor High School, where the ImPACT test has been administered to student-athletes in several sports during the current school year. “It’s not a be-all and end-all, it just provides a baseline measurement.”
Bangor and the other high schools statewide — totaling some 4,000 student-athletes who have been tested — have access to the ImPACT program through the efforts of the Maine Concussion Management Institute.
That organization, made up of physicians, parents, athletic trainers, neuropsychologists, teachers and other professionals, raised $15,000 to make the ImPACT program available to the participating Maine schools free of charge, and is continuing to raise funds in hopes of expanding that effort next fall.
“Our ultimate goal is to provide baseline testing for all high school athletes in Maine,” said Dr. Paul Berkner, director of medical services at Colby College in Waterville and president of the MCMI.
Berkner has utilized ImPACT at Colby for the past three years, and says the program not only has helped in the management of specific cases but also has helped enlighten the college’s student-athletes about the injury and its dangers.
“The athletes are much more aware about concussions now,” he said. “And it’s changed the way I manage concussions.”
The MCMI also is dedicated to educating those involved in the health care of student-athletes about concussion management and testing programs such as ImPACT. A conference for medical providers is scheduled for Jan. 29 at Colby College, and a similar conference specifically designed for coaches is slated for March 6 at a location yet to be determined.
“The No. 1 priority is to get this testing into every high school in Maine,” said Ryan, a member of MCMI’s executive committee, “and to get physicians involved, to get school nurses involved and to get the coaches involved.”
Collins said Maine is “ahead of the curve” in its concussion management and testing efforts, a status that soon could put the MCMI in line for a boost from the federal government.
Legislation introduced in the U.S. Senate last month would establish a five-year grant program, authorized at $5 million for the first year, to be distributed to states to implement proven concussion management strategies for school-sponsored sports and fund schools’ implementation of baseline and post-concussion neuropsy-chological testing technologies.
“Our high schoolers playing in the state football championships, and all of our children playing school sports, should be able to focus on achieving their goals on the field without worrying about a concussion that can affect them off the field,” said bill sponsor Sen. Robert Menendez (D-N.J.) in a press release.
In the meantime, the effort to demystify concussions will continue, through expanding baseline testing to more Maine high schools and advancing the dialogue among student-athletes and those who take care of them.
“It’s a continual education process,” said Ryan.
For more information on the Maine Concussion Management Institute or to donate to its ImPACT fundraising efforts, access its Web site at www.colby.edu/concussionmanagement.