Computer test tackles guesswork on concussions

Sometimes athletes ignore the truth. Their drive to compete pushes them to keep playing, even when ailing.

But when an athlete suffers a concussion and returns to action prematurely, the consequences can be dire -- especially for school-age athletes who are more susceptible than adults to sudden death if they suffer a second head injury.

At least one public school in the state is taking the guesswork -- and the word of eager athletes -- out of the process of determining whether players have concussions and when they should be allowed back on an active roster. The Whitman-Hanson Regional School District is using computer-based neuropsychological testing to assess concussions and monitor the healing of students injured during games.

The emerging technology, technically called the Immediate Post-Concussion Assessment and Cognitive Test, is licensed for $400 a year from the University of Pittsburgh Medical Center. The software evaluates and documents various brain functions, including memory, processing speed and reaction time, as well as other symptoms related to a concussion. It also indicates when a player's brain activity has returned to normal.

The procedure has the injured players use computers to answer questions that document symptoms and test mental skills, such as whether they can recognize and remember words flashed for 750 milliseconds, whether they recall designs, can match numbers and symbols, and react quickly enough to identify colors as they are presented on the screen.

HealthSouth Braintree Rehabilitation Hospital is offering the testing through an athletic trainer that it provides to the school under contract. The hospital has also purchased its own system to allow other area school officials to bring in athletes for evaluation.

Last spring, when athletic trainer Scott Andrews brought the idea to Bob Bancroft, Whitman-Hanson director of athletics, Bancroft said he jumped at the chance to use something more than gut feelings to determine when to return a player to action.

''I've been a football coach for 35 years. Concussions are part of the game," Bancroft said. ''Something like this seems like a more exact way to make those decisions."

Whitman-Hanson is the only public school in Massachusetts that has the ImPACT system, according to Mark Lovell, director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program. The medical center is one of only two suppliers of this type of technology in the United States, according to Lovell, who also is the director of neuropsychological programs for the National Football League and the National Hockey League.

Lovell said he and his colleagues have been developing the software since the 1990s.

The technology allows a large number of athletes to undergo evaluations in a more efficient manner, he said.

In high school athletics nationwide, there are at least 60,000 concussions each year, with the largest percentage of those occurring in football, according to the medical center's data. Bancroft said that in his district there are at least three concussions a year. There likely are more that go unreported, he said.

A concussion happens when the brain is violently rocked inside the skull because of a blow to the head, neck, or upper body. Brain activity can be disturbed and symptoms include confusion, dizziness, disorientation, memory loss, and -- sometimes -- unconsciousness. Some of the physical effects may not show up on medical brain scans such as MRIs, and many mild concussions go undiagnosed, said University of Pittsburgh Medical Center officials.

If a high school athlete is hit hard in a game, the standard practice is to pull the player from the game and have the athletic trainer perform an evaluation on the spot. If there are no symptoms after 15 minutes, the player can return to the game. If there are symptoms, the player is kept out of the game and the testing system is used, said Andrews, who also is HealthSouth's supervisor of athletic training services. Athletes are also asked to see a doctor for treatment and medical clearance. The initial 1½-hour computer test is administered to students within 72 hours of the injury, and the results are given to their doctors. The athletes are retested after they say their symptoms are gone.

Sandy Coleman can be reached at sbcoleman@globe.com.