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Concussions: Using ImPACT in Schools to Measure Athletes' Post-Concussive Brain Function

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Thirty-eight million children between five and 18 play sports, and concussions make up 10 percent of their injuries. Of these concussed kids, one out of every four returns to the game before their injuries have fully healed, according to the Center for Injury and Research Policy.

We saw concussions become a mainstream concern this season after the NFL placed a ban on dangerous head hits. College, high school and youth sports have similarly adapted new rules regarding head injuries, concussion treatment and return to play.

But a persistent problem for coaches, schools, and even the NFL, is how to determine if a player has fully recovered from a concussion -- and at what point it's OK to send them back on the field.

Since each concussion is different, there is no established timetable that determines when it is safe for athletes to return to play. But because children's brains are still growing and developing, they face a longer recovery time and are more vulnerable to repeat injury than adults.

One tool available to assist doctors and coaches in managing these return-to-play decisions is ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a computerized exam that tests an athlete's brain function at the beginning of the season to establish their individual baseline.

If the child is injured during the season, they are administered the test again, which will indicate cognitive damage in such areas as memory, reaction time and processing speed.

When used properly, ImPACT can compare an athlete's post-concussive functioning to their own established baseline; which guide's the players, their families and doctors in knowing when the brain has fully recovered from a concussion.

Concussions are often invisible injuries and when athletes suffer multiple concussions, the symptoms linger for longer and longer periods of time, so conservative return to play decisions, protect the long-term health of the athlete.

A recent study of ex-pro athletes found that a new imaging technique coined the 'virtual biopsy' may help doctors diagnose chronic traumatic encephalopathy (CTE), a degenerative disease found in individuals who have suffered repeat head trauma and concussions.

For years it has been thought that repeat head trauma causes permanent brain damage in athletes but until now, the only test that could confirm this was an autopsy. These findings are an important step in proving the correlation between head injuries and brain damage.

The National Federation of State High School Associations (NFHS) took action to further protect students by passing new concussion rules that went into effect before the start of the 2010 school year. The revised rules say that any athlete exhibiting signs, symptoms, or behaviors consistent with a concussion will be immediately removed and forbidden to return to play until a medical professional signs off on them.

This rule replaces a previous one that only required students who lost consciousness to be removed from the game -- which was potentially harmful considering loss of consciousness only occurs in a small percentage of concussions.

NFHS and NFL aren't the only organizations tightening their stance on concussion treatment. The American Medical Association and American Academy of Neurology have also been vocal about the importance of proper concussion management -- specifically in children.

But while football seems to have been the catalyst needed to make these changes, parents and coaches need to remember that concussions and head injuries are a danger to more than just football players. Athletes competing in hockey, basketball, soccer, wrestling and cheerleading are just as susceptible to these types of head injuries.

While awareness level of concussions and their risks has been raised due to increased media attention, we still have a long way to go if we want to keep student athletes safe.

Despite our increased awareness, concussion rates continue to increase, which has left parents, coaches and doctors searching for a more effective way to keep their players safe during games and practice.

Relying on children to be open and honest with their doctors is one of the factors that lead to multiple injuries. Students often feel pressure to get back out on the field and will hide symptoms or play through the pain if it means being able to continue -- which is especially dangerous considering the difficulty involved in properly diagnosing a concussion and brain injuries.

But with the ImPACT program, doctors are able to get a clear answer on whether or not a child is healthy enough to return to the game.

Currently, despite being the most widely used test in the U.S., ImPACT is not currently used in many high school athletic programs. Budget restrictions mean that schools don't have the funds to offer this test to their athletes.

But I believe that as we continue to learn more about these injuries in developing children and the potential long-term impact of concussions and brain trauma, ImPACT will become a more widely used tool in schools.

Whether or not ImPACT is offered through your child's school, we urge parents to get their child tested independently before the start of the season.

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