Concussion Screening

high school football players, one tackling the other

Acutely, concussion is characterized by headache, nausea, vomiting and transient alteration in level of consciousness in the wake an impact. 

Chronically, sufferers may experience permanent memory loss, poor concentration and resultant job-related disability. 

In rare cases, frequent concussive or sub-concussive impacts may result in CTE or chronic traumatic encephalopathy, the well-described syndrome of many former NFL players and the subject of much legal controversy.

“JUST GET BACK IN THE GAME KID.”

That was the mindset of yesteryear. Those days no longer exist. Parents, I’m talking to you. We had little knowledge of the ramifications of our decisions to send children back out on the playing field post-head injury. But as with anything, good judgment comes from experience, and experience from bad judgment, or in these cases ignorance.

We now know that yesterday’s “tough it out” strategies, while building character, affect the biologic essence of that responsible for one’s character:  the stuff between your ears, the most complex computer known to man, your brain.  Do everything in your power therefore, should you choose to participate in impact sports, to protect it.

BUT FIRST ESTABLISH A BASELINE.

Prior to engaging in any sport or physical, give strong consideration to a pre-competition (baseline) concussion screening. Why? For the simple reason that cognitive screening “after the fact” may not reveal a deviation from an established “normal,” yet the result may be a deviation from your previously established normal. Due to the high sensitivity of the computerized testing, even subtle deviations may be identified. Yet these changes may be a sign of something more sinister, underlying damage to the brain, clinically unapparent to even the most astute physician.  

xrray of normal brain and one that has had a series of severe conussionsPhoto courtesy of ESPN.com

And therein lies the problem. Prior to the advent of computerized testing, children and adolescents were returned to play based solely upon clinical examination findings. Minute neuropsychological aberrancies however (suggestive of brain pathology) remained undiscovered on standard neurological examination. Consequence? An early return-to-play recommendation for a patient with a potentially susceptible brain. Remember, your brain is particularly vulnerable to the effects of a second impact in the wake of the first. Prevention of a second impact therefore is critical, particularly in children with developing brains. In the pediatric population, this may be the difference between life and death. Awareness of even the subtlest signs of concussion therefore is paramount.  Baseline screenings make sense now, right? Protect yourself and your children with imPACT testing.

Dr. Osborn recommends not only baseline imPACT screenings, but also annual testing for athletes even in the absence of interval “injury.” Why? Same reason. The effects of repeated sub-concussive impacts, lurking under the clinical radar, may be teased out by sensitive testing. Remember, you do not need to lose consciousness to have sustained a concussion. Read that least sentence again.

(We will figure out how to make the "IM" in "IMPACT" lowercase)

imPACT TESTING FAQ’s

1. How long does imPACT testing take? 

Office-based imPACT testing takes approximately 30 minutes start to finish. “Sideline” testing (if available) is a 5-minute, mobile version of imPACT that may assist coaching staff in assessment and triage of the concussed athlete.

2. Aside from the obvious implication, what does “imPACT” stand for?

imPACT is an acronym for Immediate Post-concussion Assessment and Cognitive Testing.

3. In that context, when should an athlete undergo testing after a suspected concussion?

Within the first 48-72 hours post-impact. It is imperative that Dr. Osborn or another qualified imPACT provider be notified even after the most mild head injury if a concussion is suspected by a coach or family member. That said, an initial evaluation should be performed in a local ER if any if the following symptoms are present:

  • Severe, intensifying headache.
  • Two or more bouts of vomiting.
  • Post-impact seizure.
  • Confusion or strange behavior.
  • Altered level of consciousness (i.e., increasing drowsiness).
  • Weakness on one side of the body.
  • Visual problems.
  • Blood, or clear fluid, leaking from the nose or ear.
  • Unusual breathing patterns.

Failure to recognize and react to these symptoms early could prove fatal. And while sports injuries contribute to fatalities infrequently, the leading cause of death from sports-related injuries is traumatic brain injury (TBI).

4. Six weeks after a cycling accident my imPACT test revealed a significant deviation from baseline. Now what?

Your imPACT results are suggestive of ongoing brain dysfunction as a result of the head injury.  The degree of expected recovery is unpredictable with current technology.  Regardless, return to play should be delayed for now and the imPACT test repeated in 2 to 4 weeks (to allow for brain recovery).  

5. Will imPACT prevent concussions?

No! Despite advances in equipment and the advent of evaluation procedures like imPACT, concussions will continue to occur. Helmet technology, while reducing impact forces, cannot eliminate the to and fro movement of the brain within the skull. Telemetry monitors, while potentially predictive are certainly not protective either. ImPACT will allow properly trained professionals to track the cognitive status of the athlete and help prevent premature return to play.

USE YOUR BRAIN. GET TESTED NOW.

Simply contact the office and schedule a baseline testing session. Your results will be archived for comparative purposes should you sustain a head injury at a later date. It has been said that the devil lies in the details. Nowadays, the devil lies in the data. Standard neurological exams are far less sensitive to the subtle effects of concussive and sub-concussive impacts than are testing modalities incorporated into imPACT. No, technology is not supplanting the human element. It’s simply making us smarter and facilitating the care of our most important asset. And we all know what that is…