Brain test makes an impact on reporter

Staff WriterSeptember 1, 2009 

Last week, I joined about 3,000 Wake County high school athletes in taking the ImPACT test.

There is no passing or failing score, but in the aftermath of the test -- which establishes a baseline to evaluate a player's brain function -- I felt like I had been through a strenuous mental workout. It reminded me of the days of SATs and GMACs.

I grabbed a laptop computer at Carolina Family Practice and Sports Medicine in Cary and slowly worked my way through questions about my general health and previous concussions before getting down to the real work of taking the cognitive portion of the test.

The test measured word memory, design memory, matching symbols and colors, remembering sequences and reaction time.

I was overwhelmed. The test was not difficult, but it demanded concentration. The tests had surprising turns and twists, and in the aftermath I believed my cognitive process was completely tested.

A couple of times during the test, I recalled the old line, supposedly by former baseball pitcher Dizzy Dean, "They took a picture of my head and found nothing there."

My reaction was typical, said Janna Fonseca, the liaison between Wake County Schools and Carolina Family Practice and Sports Medicine.

"Imagine if you were taking the test and you were concussed and your brain wasn't quite at 100 percent," Fonseca said. "That would show up. This test is a tool, just a tool, but it is a good tool."

The baseline established by the test can help physicians know when an injury has healed enough for athletes to safely return to play. The computer test is not a panacea, but it is a good tool that can give a physician a more complete picture when used with other tests and observations.

I wish every high school athlete in the state could have the opportunity to be completely befuddled by the test like I was, but for now, testing every athlete is a dream.

Carolina Family Practice and Sports Medicine is providing free computer-based ImPACT tests to each Wake County public school. Athletes also can go to the Concussion Clinic at WakeMed in Raleigh on Tuesdays and Saturdays or to a concussion clinic at Carolina Family Practice.

Wake County seems on the verge of developing a model program, which is the dream of Dr. John Wooten, a pediatric neurologist with Raleigh Neurology Associates and medical director of the WakeMed Concussion Clinic.

"The dream is to keep young athletes safe and help them recover if they are injured," Wooten said. "But I hope we can learn some things about concussions, too."

In most school systems throughout the state, giving an Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) to all of the football players sounds like something for college and professional teams.

"We don't have anybody looking after us like that," Clayton football coach Gary Fowler said when asked about the ImPACT testing.

As a state, North Carolina still is struggling with the idea of having a certified athletic trainer at each high school, something health professionals say is the first step in protecting athletes.

Following the death last year of Jaquan Waller of Greenville Rose, which did not have a certified athletic trainer, there was a push to mandate having a certified athletic trainer at each school in the state. But in a tight budget year, the idea of the state providing funding for certified athletic trainers never gained traction.

"There is no substitute for having that trained professional on site," Fonseca said. "That is the first step."

Giving a cognitive test to every athlete who is susceptible to brain injury is reasonable. The cost is minimal, and the tests provide a tool to help assess a concussed player's healing. But one test in isolation does nothing.

"The athlete should be held out if he is still symptomatic," said Dr. Josh Bloom of Carolina Family Practice and Sports Medicine, who said symptoms can include vomiting, nausea, headaches, fogginess, lack of concentration, memory problems and personality changes. "But if he doesn't have any symptoms, the baseline test gives more insight."

Tests such as ImPACT are used along with tests that check balance and coordination to help assess the recovery of athletes after they no longer have symptoms.

The ImPACT test is made up of six modules that test areas such as memory and reaction time. There are no passing scores, but if an athlete scored in the 75th percentile in word memory when he was healthy and is now scoring in the 20th percentile, it could be an indication that the brain is not completely healed.

Bloom said he had seen a growing awareness of the dangers of concussions.

"I don't get as much push back," he said. "In football, you rarely have coaches, parents or players talking about being tough and being able to play with a concussion. We still have some work to do to get the word into soccer, cheerleading and other sports."

Parents, coaches and players are learning that being knocked silly is not "having your bell rung." There is nothing silly about a concussion, otherwise known as a traumatic brain injury.

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