UW Health Sports Medicine Deploys New Online Test to Access Concussion Damages

MADISON - The helmets, or, worse, the unprotected heads, crash together with sickening force, and an athlete drops to the ground.

Maybe he gets back up, and maybe he doesn't. The scene plays out all too frequently across football and soccer fields in Wisconsin each fall. Doctors, coaches, athletes and parents are all well aware that concussions are a widespread concern in contact and collision sports.

While most athletes who suffer a concussion improve after a few days, a handful suffer more serious, long-term problems, especially in cases when they've had more than one head injury.

"As physicians, we know the bottom line is that nobody should go back to playing a collision sport, either practice or competition, unless they're completely symptom-free," says David Bernhardt, MD, a UW Health Sports Medicine physician who regularly tests concussions. "That means no headache, no dizziness, no memory loss, no problems with paying attention or focusing in school. The problem is that a lot of those things are subjective."

Physicians at the UW Health Sports Medicine Center are using a new tool that gives them a clearer way to determine when it's safe for an athlete to return to a sport after a concussion. Developed by neuropsychologists at the University of Pittsburgh,ImPACT is an online test – a series of questions and exercises that measure an athlete's baseline neurocognitive abilities, including visual memory, reaction time and impulse control. It takes an athlete about 20-25 minutes to complete, either in the clinic or from a home computer.

Doctors hope athletes will sign up to take the ImPACT test before the season begins. Then, if they suffer a head injury, they can re-take the test in the clinic setting, and doctors can compare the results to see if any serious neurocognitive damage has occurred.

"Assuming that the athlete has returned to baseline level, we'd have some objective measurement that it’s safe for them to go back," says Bernhardt.

Even if an athlete doesn't take the test before taking the field, ImPACT can give physicians important information about how an athlete is doing after a concussion.

At the professional level, concussions among athletes are getting more attention than ever. National Football League Commissioner Roger Goodell has instructed all NFL team physicians to pay particular attention to the injury this season.

Meanwhile, the list of former pro athletes who experience the long-term effects of multiple concussions continues to grow, including, most recently, former New York Jets receiver Wayne Chrebet and current Miami Dolphins quarterback Trent Green. In Wisconsin, most high schools have athletic trainers who work closely with athletes in most major sports to remind them of the risks and dangers of concussions. However, the thousands of young athletes playing in youth leagues and club sports don't enjoy that benefit. And when the pressure of the big game is on, experience has shown that some athletes may lie about or downplay the severity of their head injury so they can return to play.

"You have the clinician who's trying to do what's best for the patient and their brain. You have the athlete, who sees only that they have a game tomorrow against their biggest rival. Sometimes, those points of view are in conflict," says Bernhardt.

About 20 times a year, parents ask Bernhardt and his colleagues at UW Sports Medicine Clinic to convince their children not to return to play until they've recovered further.

Bernhardt cites a high-school soccer player and a straight-A student who recently suffered a concussion. Ten days later, his headaches and dizziness had disappeared, but he found that he was struggling to complete his college-level calculus homework as well as he normally could. Bernhardt's recommendation was emphatic: More recovery time was needed.

"The bottom line is that any concussion is an injury to the brain," says Bernhardt. "You don't want to risk your son or daughter going back to a contact or collision sport and possibly have cumulative injuries from going back too soon. They need to be completely symptom-free."