Neurocognitive tests key to assessing concussions

By Jennifer C. Yates

Associated Press

Published: Saturday, Nov. 20 2010 9:52 a.m. MST

A concussion occurs when the brain is shaken, causing a cellular disruption that can't be detected on a brain scan or X-ray. Symptoms, which often aren't present for a day or two after a hit, can include headaches and memory and coordination problems.

In the past, athletes who suffered a hit to the head might have been sidelined for the rest of the game, or worse put back in after sitting out a play or two to "shake it off," Lovell and Maroon said. Doctors now understand that there may be catastrophic consequences if a person has repeated concussions before getting a chance to heal. And the only way to do that is through physical and mental rest.

Although 300,000 sports-related concussions are diagnosed every year in the U.S., the American College of Sports Medicine estimates that about 85 percent go undetected, putting the athletes at risk of suffering even more severe injuries.

With the increased attention given to concussions over the past few years, doctors said they've seen more kinds of tests and products on the market that claim to diagnose or even prevent concussions. Lovell said the mouthpieces, ear pieces and helmets are great for research purposes, but they can't tell if someone has been injured or if they should be playing.

And no two brains react the same to a hit, so there isn't a one-size-fits-all treatment.

At UPMC's Sports Medicine Concussion Program, Lovell and other doctors see about 10,000 patients a year.

One of them was 13-year-old Logan Stork, who was hit from behind and forced into the boards face first during a hockey tournament a few days earlier.

"All I remember is going down on the ice and getting taken off the ice on a stretcher," Logan said. He spent five hours in the hospital, and then watched the rest of the tournament from the bench.

Logan had had a concussion before, so his parents wanted to take every precaution. Fortunately, Lovell said that Logan's good ImPACT score and his complaints of a stiff neck probably indicated a neck strain and not a concussion.

"The bottom line is we don't want anyone to go back while they are still having symptoms," Lovell said.

In the room across the hall, Lovell was seeing Luke Kusler for his follow-up visit. Luke's ImPACT scores were higher than a month ago, but still not back to normal. The teen also had trouble balancing when Lovell had him stand on a foam-like square in the exam room with one leg up and his eyes closed.

Even so, Luke wants to get back in the game — any game — and asked when he could start conditioning for baseball.

Lovell cautioned the teen that he wasn't ready.

"If we treat this well, you are going to be able to play again," Lovell said. "If we rush you back too soon, that's when the real trouble starts."

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