Concussions: Watch Out for the imPACT

Editor's Note: Moved to the front page because, well, yeah, read the thing and tell me you don't come away impressed.

By: Max Esterhuizen

You are enduring the elements at a football game: the cold, the rain, and the high winds. None of it matters when you are watching your favorite team play a vicious match. Suddenly, there is a bone-rattling hit on the other teams player. You start cheering because of the ferocity of the hit. The other player doesn’t get up. Concern fills the stands. The player gets up with help, but appears confused and woozy. He just suffered a moderate concussion, which is a growing problem in today’s athletics.

Occurrence and Symptoms

A concussion can occur when trauma to the brain causes it to shake and rattle around inside of the skull. The loose definition of a concussion is that there is an apparent change in the state of the persons’ mental status. This change can be difficult to measure, as no two concussions are alike for any individual. The symptoms are not always easy to identify, but some of them are loss of consciousness, amnesia, severe headaches, disorientation, confusion or mental fogginess for mild to moderate concussions. For more serious concussions, serious mental degradation and not being able to handle stress are some of the symptoms. Additional symptoms are not universal, but also include hypersensitive senses, especially a reaction to moving lights and loud noises.

Recently, the doctors have gained the knowledge that a brain is still venerable even after the initial symptoms have gone away. A brain that has not healed completely is at an even higher risk of re-injury, and also at a higher risk of causing lasting problems to the patient. This has raised awareness about the issue of concussions and caused research about the identification of concussions to be taken more seriously, as having a concussion once does increase the likelihood of another concussion occurring.

Identification

There are a number of ways to identify if someone has a concussion. The medical field has used a number of techniques, many of which perform multiple functions. One of the most widely used methods is the imPACT test, which stands for Immediate Post-Concussion Assessment and Cognitive Testing. Doctors Mark Lovell and Joseph Maroon developed the imPACT test in the early 1990s as a way to measure head injuries. The test lasts approximately twenty minutes, and is for use with all ages that play contact sports. The test, which is designed for use before any contact sport conducted, judges the natural cognitive ability of the participant. The impact test judges individuals on their own terms, which is important because of how personalized concussions are – no two concussions are going to be the same for two individuals. So even though many people take the test, the results are only compared to what the individual taking it scores. The basic concept of the test is designed to compare a baseline score, which is what the person scores before there is any head trauma, to the score after there is suspected head trauma. After the test has been taken, the two scores are compared to each other and the level of brain deterioration can then be measured. The imPACT test judges many areas, including: measuring players’ symptoms, measuring verbal and visual memory, measuring the processing speed, and measuring reaction time. The imPACT test also assists in helping make difficult decisions regarding when a player may return to action.

Another method of testing for concussions is the relatively new idea of using a Functional MRI (F-MRI) to test the capabilities of the brain. This is a method that is gaining recognition from the medical field for being able to identify when a concussion has occurred and how severe the concussion is. An F-MRI is one of the few scans that can show brain activity and not just the innards of the skull. The F-MRI test is done after the concussion has occurred, and it basically tests the cognitive function of the brain at the time of the patient being concussed. The patient is given a set of tasks to do, and the brain activity is measured while these tasks are being performed . About a week after the known date of the concussion occurring, the F-MRI is done again, and the new brain activity is measured. According to a study done by the University of Pittsburgh, the patients who displayed the most hyperactivity at the time of their initial F-MRI took the longest to recover from their concussion. The study used the imPACT test as a method of trying to stimulate the patients’ brains. The two tests, when combined together, do paint a somewhat accurate picture of how long the recovery from a concussion will take.

There is a brand new method to identify concussions that was developed by the Army in 2010. Army Colonel Dallas Hack oversaw the research, and says, “[that] the blood test, which looks for unique proteins that spill into the blood stream from damaged brain cells .” Concussions, being able to be diagnosed by a simple and common blood test, help out doctors who can and have found it difficult to diagnose concussions. Having a concrete way to identify concussions helps prevent additional heard trauma while still recovering from a concussion. While the FDA has not yet cleared the test for use, it is still a huge milestone in the identification of concussions.

In-Game Identification

Concussion identification is all fine and dandy when able to test for it off the field, but concussions occur on the field. College programs are using numerous methods to identify concussions while on the field of play. There is the standard concussion test, which include a series of questions and other methods to check for the symptoms of a concussion. According to a source in CIB (Center for Injury Biomechanics), a method that is increasingly being used is that of a balance plate. A balance plate tests for inner ear balance, which might prevent for some concussions being misreported. Another common injury for football players that gives symptoms similar to a concussion is known as the stinger. It involves the nerves receiving a shock, and it manifests in the shoulder and in the arm. These two types of injuries are not severe, and for people with the athletic ability that is seen at the college level, also gotten over within minutes. By administering these tests, it gives the athlete time to recover, and because of the genetic make-up, sometimes head injuries are gotten over almost immediately. An example is the 2009 Chick-fil-a bowl that Virginia Tech played against Tennessee. Virginia Tech’s quarterback, Tyrod Taylor, experienced some head trauma in one of the opening plays of the game. He went to the sideline, but due to the television presence, the coaching staff could not give him the standard on-field concussion test. The medical staff worked on Tyrod Taylor’s shoulder, which is a symptom of the stinger, while buying time to give him a concussion test without the scrutiny that only giving a concussion test would have received. Virginia Tech offensive coordinator, Bryan Stinespring, also called down to test Taylor’s knowledge of the offensive playbook. Taylor passed all of the tests and was allowed to return to the field. Taylor went on to have an exceptional game, as the Hokies won 37-14.

The handling of this occurrence brings the question to mind: are colleges doing enough to protect the athletes? This issue also brings up the genetic difference between people: what might be a concussion to one individual might not be to an athlete, for example Virginia Tech’s David Wilson or Tyrod Taylor.

Genetic Make-Up

Just like how no two concussions are alike, neither are two people. Each person has the ability to handle concussions differently. This is due to a variety of factors, some of which cause the brain toughness to be built up from a young age. According to the source in CIB, these genetic factors are not completely understood yet, but the best example of such factors existing is that of one of the football players at Virginia Tech. David Wilson, a Virginia Tech running back, was playing in a game last year against fellow ACC team Wake Forest. David Wilson had a collision with one of the Wake Forest players that measured in at 225 G’s of force, which is an incredible amount of pressure being put on the human body. After the collision, David Wilson got right up and ran over the to the Virginia Tech huddle. The Wake Forest player, on the other hand, stayed down on the field and was removed from the game. He was later diagnosed with a concussion.

The genetic make-up does play a number of factors in who gets a concussion and who does not. What might be a concussion for one person might be nothing to another, which is the case for the “average” person and a high-level athlete, respectively. No one is precisely sure why some people are more susceptible to concussions, or for that matter how the neurons work in the brain. One thing is certain, however: no two people are alike when it comes to sustaining a concussion.

Reporting of Concussions

With the increased spotlight on concussions, the reporting of concussions has increased ten-fold. The reporting of concussions, or any form of brain injury for that matter, is also a sign of how cautious people are being when it comes to brain injuries. Concussion reporting at the high school level is one of the most interesting aspects of concussion reporting. Currently, in Virginia, there is a state law that might be passed that requires that if a concussion is reported at the high school level, the student-athlete must miss the next game and sit out at least a week and be cleared by a doctor before returning to action. This law presents multiple problems with it, however. The first is that due to the high-school students vying for an athletic scholarship, they may not want to admit to having a concussion and may continue to play through it. Secondly, with the decrease in the reporting of concussions, the lawmakers will think that their law has been a success, when in reality it has only further endangered the student-athletes by not reporting the concussion and continuing to play.

At Virginia Tech, there are about 5-10 concussions reported each year on the football team, but with the 50% under-reporting that goes on, it is more likely that 10-20 concussions occur each year a source at the CIB says. The same source also says that the use of the imPACT tests, while required, has had mixed results due to extenuating motives. Some of the athletes are tanking their initial imPACT test, which causes numerous effects later on. It means that the initial imPACT test results will show an abnormally low result, which means that the imPACT tests taken after the injury will be higher than the initial imPACT results, causing the medical staff to think that the athlete is not injured. The CIB source says that the instances of this happening are being dramatically reduced, as the medical staff has had their eyes opened.

Due to the inexact method of identifying a concussion, there are some standards for rating the impacts that could give a concussion. The CIB source said that some of the football players were saying that they had concussions to get out of practice, but said they would be ready by game day. Due to the Virginia Tech football players’ helmets being measured for impact, the CIB department was able to see the impacts that each player experienced, and were able to tell Coach Frank Beamer that the players did not experience an impact higher than that of a pillow hitting their helmet. The false reporting of concussion is a problem, as the symptoms are non-descript and inexact, and the increase spotlight on concussions has caused a very serious tone to be taken about head trauma.

Prevention – Looks Aren’t Everything

The prevention of a concussion is not an easy thing to tackle. The most basic form of protection that football players wear is the helmet, but even these vary. Each helmet has different factors that help make it either better or worse for protecting against a concussion. A lot of players prefer the less cumbersome helmets, which are not the greatest at protecting against head injuries. Some players also prefer helmets that look cooler than others, but the ones that look the best do not necessarily perform the best. A helmet that is made by Schutt, called the DNA Pro+ is a helmet that has increased protection against concussions, but it is not a helmet that passes the eye test of athletes. It is the helmet that Green Bay quarterback Aaron Rodgers had to switch to after sustaining concussions this past season; he was made fun of for having to wear the helmet. The Schutt helmet, however, has a padding system that absorbs impact better than the standard styrofoam inserts seen in conventional helmets . This helmet uses a compression-like system that either uses a combination of springs or bubbles that pop inwards when a hit is sustained. Other helmets, such as the standard Riddell helmet, use the standard styrofoam inserts, which does lessen the impact of the blow, but not as effectively as the DNA Pro+ helmet. The helmets that the Virginia Tech football team uses are standard Riddell helmets, which do not offer any extra protection against head injuries. However, not every player wears the same style of helmet. The helmets that the Virginia Tech football players wear all vary in how they lessen the impact of a blow.

Virginia Tech, the world’s leader in head research, has been doing numerous studies on the effectiveness of the football helmets used in both college and professional sports, with the focus being on football and baseball. Virginia Tech is releasing a safety rating of all the helmets, similar to that of car safety ratings, on the third of May, 2011 . There is a curtain behind the safety data that football helmets score, and the Federal Trade Commission wanted data to be available to everyone so that players and coaches will know which helmets offer the best protection . This will help everyone understand which helmets are better than others, hopefully reducing the amount of concussions in athletics.

Treatment

The treatment for concussion is a tricky subject, as there is no exact way to handle an athlete who receives a concussion. Ideally, the best way to handle a concussion is to remove all impact activities, increase sleep, and force healthy foods to be eaten. With a more severe concussion, all athletic activities should be halted, with only eating and sleeping being the allowed activities. Importantly, the sensitivity to light that is seen with some concussions means that no television or video games should be watched or played, regardless of the level of concussion sustained. Also, the use of cell phones while having a concussion should be limited, as any form of mental stimulation will slow the healing. The healing of a concussion can be compared to an ACL tear. You don’t want to run or walk on a torn ACL. The same is true for a concussion: you do not want to use your head while it is healing.

Concussions can cause lasting effects for some people, and these effects can last up to a year after the concussion is sustained. For up to a year after the concussion is sustained, the symptoms of headaches, lack of planning, short-term memory loss, problem solving, and information processing speed can come and go. While experiencing the post-concussion symptoms, it is important not to jolt the brain, as it is still undergoing the healing process.

Not allowing the brain to fully heal can cause devastating long-term effects on the patient. If the concussion is not allowed to fully heal before allowing the athlete, or any one for that matter, to return to their previous activities, it can cause Second Impact Syndrome, a term first used by Dr. Robert Harbough when a 19-year-old athlete died from sustaining a second impact while still recovering from the first concussion . While there is no exact time that is agreed upon for an athlete to return to the field, a combination of the tests use to identify a concussion can also be used to create a fuzzy time-table of return.

Is It Enough?

Concussion research is at an all-time high, and while there is no concrete definition of what a concussion is, there can still be precautions and proper treatment for suspected concussions. Many smaller colleges are taking very strict stances on concussions, and automatically pull the players out and give them adequate time to rest. The upper-echelon of college football does not have as strict of a stance, in part because the athletes themselves do not want to be pulled from a game, as these athletes are vying for that elusive NFL contract. It is the colleges responsibility, however, to ensure the safety of its athletes as to not let them put themselves in dangerous situations. Colleges have more experience and have a better perspective to advise the athletes on the proper way to handle a concussion. The increased genetic ability of the athletes does make this a hard decision, as the athletes may be perfectly fine after experiencing amounts of trauma that could cripple a normal human being. All in all, colleges are increasing their efforts to ensure the safety of its athletes so that they will not experience any long-term effects from their injuries.

Bibliography
Center, B. T. (n.d.). Sports-Related Concussions. Retrieved April 13, 2011, from Department of Neurological Surgery: http://www.neurosurgery.pitt.edu/trauma/concussion.html

Jonathan Cluett, M. (2003, August 5). Burner. Retrieved April 13, 2011, from Orthopedics: http://orthopedics.about.com/cs/sportsmedicine/g/burner.htm

Medicine, U. o. (2007, August 8). Sports Concussion Research Using Functional MRI Provides Insight.

Overview and Features of the imPACT Test. (2011). Retrieved April 13, 2011, from imPACT: http://impacttest.com/about/background

Schutt Sports - Football Helmets. (2011). Retrieved April 14, 2011, from Schutt Sports: http://www.schuttsports.com/aspx/Sport/ProductCatalog.aspx?id=108

Soon, Helmet Data at a Keystroke. (2011, April 1). Retrieved April 14, 2011, from Center for Injury Biomechanics: http://www.cib.vt.edu/news/archived_news/2011/news_01_09_2011.html

Zoroya, G. (2010, 10 15). Army finds simple blood test to identify mild brain trauma. Retrieved April 15, 2011, from USA Today: http://www.usatoday.com/yourlife/health/medical/2010-10-15-1Abrain15_ST_...

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Comments

This was an absolutely fantastic read. It's amusing, but not very surprising that David Wilson has one of the toughest noggins around. It's kind of amazing to realize that there are safer helmets out there like the DNA Pro+, but are overlooked because they don't pass the eye test. Do they cost more? Is there any indication that VT might use these in the future?

The helmets usually do cost a bit more (not sure exactly how much). Today is actually the day that VT is releasing the helmet ratings that I mentioned in the article. And from talking to the ICATS people, there is no indication that VT will be using these helmets unless it is on a player by player basis. I probably should have mentioned that in the article, but it's a little late for me to add that in now. What made me want to write on concussions is that I've had a decent amount of them (actually recently fully recovered from one I got last October...quite a bad one). And after finding out about David Wilson taking a 225g hit, it made me realize he really does eat Chick-fil-a on Sundays.

DANNY COALE ALL THE WAY TO THE THREE

Veterans Affairs

has been doing a lot of studies into TBI, or Traumatic Brain Injury's (which includes concussions) ever since the Golf War. What they were finding was that people who have suffered from Brain Injury displayed very similar symptoms to those who had PTSD (Post traumatic stress disorder). This caused concern because people were not getting disability from the military because they were wrongfully diagnosed. Last year they also found that persons who suffer from multiple TBI's are more likely to later in life get chronic traumatic Encephalomyopathy (which has similar symptoms to that of Lou Gehrig’s disease). Now the department of veteran affairs does in depth medical check outs with separating and retiring service members who have served in combat zones. Anyone who has suffered from

*Close proximity to a blast or explosion (IED, RPG, Land Mine, Grenade, etc.) ,
* Fragment wound or bullet wound above the shoulders
* Vehicular accident or crash (including aircraft, tank, personnel carrier, etc.)
* Fall
* Blow to the head
is now automatically screened. If you look into the Veterans Affairs studies they use deceased athletes to study the damage from multiple brain traumas. I think maybe these kids should stop worrying about how silly their helmet might look now and start worrying about how their body will handle the damage later. IMO, anything in Chicago Maroon and Burnt Orange with a VT on the side is going to look awesome regardless. Spend the money on the helmets, the parents would appreciate it!

"I don't know what a Hokie is, but God is one of them.' So I'm going with God. I'm going with Virginia Tech." Lee Corso Aug 23, 2000

http://www.thekeyplay.com

Who Is At Risk

Spending the extra money on helmets shouldn't even be optional in my opinion. The athletes want to play, the coaches want them to play, and the parents want them to play and be relatively safe. From personal experience, even though a helmet wouldn't have changed anything, it is better to have more attention be on concussions, that way they can be treated better. Schiffert Health Center here at VT does not have up-to-date information on concussions; and their information isn't even from the 21st century. They still grade concussions, and don't even say not to watch TV or play video games (or anything mentally stimulating, like using a cell phone or reading). So in my opinion, it isn't just the athletes that are at risk, but more so the general student population who do not have the kind of medical staff that the student-athletes have. I had to write the article with a slant towards the football team here because that was where most of the research was going, so it made it easier to interview people and find out exactly what was/is going on.

DANNY COALE ALL THE WAY TO THE THREE

good read

You never can tell what the effects will be. Being the Hockey fan from St Louis that I am (which is a bit unrelated) we had one of our best players get elbowed in the face in a game. He came back later in the game, scored a goal, and then missed the rest of the season (around 72 games). Here we are, about six months later, and he can't even get on the ice and skate because his symptoms are still terrible. And this was only his first concussion. Scary Stuff.

Logan 3:16

It is scary stuff, because the symptoms are never the same. I actually got a concussion (not my first, unsure as to what number it actually is, but was probably around my 3rd) and that is what spurred me to write the article. I got the concussion October 13th (just before the VT/Wake game) and was told I'd be okay to go to the game on the Saturday. Going to that game was probably the worst thing I could've done due to the noise, lights, and intensity of the game. It was in mid April when I fully regained the use of my brain again, which was around six months later, which is how long a serious concussion can take to heal.

DANNY COALE ALL THE WAY TO THE THREE

I was lucky. I played football in high school and never got a concussion (that I know of). I saw first hand the effects of concussions though. I played ball with a, who I'll leave unnamed, successful college QB and now backup professional QB. He suffered a concussion during a scrimmage and the bus ride home was both hilarious, because he believed everything, and scary because he couldn't remember anything.

It was in mid April when I fully regained the use of my brain again, which was around six months later, which is how long a serious concussion can take to heal.

Geeeeeez, glad your brain is all healed up.

The NCAA and BCS conferences are making money hand over fist. If they are going to continue to exploit these kids, at least make sure they're safe.

Thank you for the great read!

You are lucky that you did not get a concussion in high school (that's when the brain is at the most risk).

I agree that the big name conferences are making considerable money off of the athletes, but at the same time, the college athletes want to play through everything and anything in an attempt get that huge paycheck in the NFL. I think that the college players should want to use the better helmets first, that way they may not have to try and play through anything. There are problems on both sides.

DANNY COALE ALL THE WAY TO THE THREE

Virginia Tech announces football helmet ratings...

...for reducing concussion risk

http://www.vtnews.vt.edu/articles/2011/05/051011-engineering-helmetratin...

The information is based on a new evaluation methodology that incorporated eight years of data and analysis, quantifying head impact exposure and risk of concussion. The testing data showed that the overall best helmet currently available to the public is the Riddell Revolution Speed, which earned the only "5-star" rating. The next category includes five very good performing helmets that were all given a "4-star" rating: Schutt ION 4D, Schutt DNA Pro+, Xenith X1, Riddell Revolution, and Riddell Revolution IQ, according to Stefan Duma who directed the project.

...

Many of the 2010 Virginia Tech football team players used VSR4 helmets and had them through spring ball in April 2011. "Once we finalized the numbers, my first call was to our head team physician Gunnar Brolinson and our head team trainer Mike Goforth. We all agreed that we had to change out the helmets immediately," Duma said. "For the fall 2011 season, our players that had VSR4s will be in the Revolution Speed helmets."

To cover the cost of the new helmets, the School of Biomedical Engineering and Sciences agreed to pay for the newer and better performing helmets. "There is an appreciable cost associated with changing out approximately 40 helmets, but there is no question that we are going to do it," Duma said.