Test could keep injured athletes from returning too soon

Laguna Beach High School athletic officials have another tool to gauge whether an athlete is ready to return to the game after a hit to the head.

For the first time, students in all sports, including dance team members, will take a computer test to assess mental capabilities such as concentration, memory and reaction time. Each athlete will receive a baseline reading, which can then be used to compare test results following a concussion.

Laguna Beach High trainer Ron Holaday helped test about 260 athletes before the fall sports season. He said athletes in winter and spring sports will also be tested before their seasons unless they took the test for a fall sport. About 500 to 600 athletes will take the test.

Players need only take the baseline test once, and it can be used throughout their high school careers, Holaday said. Laguna Beach Unified School District nurse Pam Mjad also administers the tests, a district release said.

Following a head injury, athletes answer a series of questions on the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a test used by multiple organizations, including Major League Baseball, the National Hockey League, the National Football League and more than 7,400 high schools, according to ImPACT's website.

Laguna Beach High athletic director Mike Churchill first heard about the test in March from Kathy Smith-Coakley, a certified trainer who has a son on Laguna's varsity football team and owns COASTherapy in Huntington Beach, he said. The program costs a one-time charge of nearly $2,000, and was donated, he said.

In the Newport-Mesa Unified School District, all four high schools are using the ImPACT test, said Mike Zimmerman, Newport Harbor High athletic director.

One ImPACT test exercise requires the student to remember the words flashed on a screen, or to identify which squiggly lined designs appeared.

Other test sections ask athletes to rate their dizziness, nausea, fatigue or headache on a scale of 1 to 6, with 6 being the most severe.

Holaday sends test results to David Kruse, a certified sports medicine physician, who gauges whether an athlete can return to play. State law and the rules of the California Interscholastic Federation — the high school sports governing body — require that an athlete be cleared by a physician trained in concussion management, Kruse said in an email.

Kruse, who consults with a school's athletic training staff, looks for four criteria to determine when an athlete may return to play.

His requirements include "having a consistent symptom-free status, tolerating all school activities successfully without symptoms and to their normal ability, completing a graded return to physical activity per standard concussion protocols, and having an ImPACT [test reading] that is back to baseline," Kruse said.

While the test provides helpful information for trainers, doctors and coaches, it does not measure the severity or degree of a concussion, Kruse said.

"Updated concussion guidelines no longer promote 'grading,' or determining the 'degree' of the concussion," he said. "ImPACT assessments are not performed until an athlete has become symptom-free. ImPACT is not used to diagnosis concussions; it is used to help us assess whether an athlete has recovered from their concussion event."

If determining when a player can return sounds difficult, even diagnosing a concussion can be a challenge.

Ninety-percent of most diagnosed concussions do not involve a loss of consciousness, according to ImPACT's website.

"Sometimes you don't realize a kid has a concussion until the next day," Holaday said. "In football, a kid may have five to eight hits to the head in a game. They may not be the hardest hits and the person may not feel any symptoms that night. Adrenaline masks a lot of things," including pain.

Laguna Beach High School football coach Corey Brown relies on insight from coaches and players to determine whether to remove a player from a game or practice.

"If a kid acts funky, not himself, or if he gets up slow — these are all signs we look at," Brown said. "You want to get the kid out as soon as you can" in those situations.

Concussions are also common among soccer and basketball players, but they can happen to any athlete, Holaday said.

A couple of years ago, a cross-country runner suffered a head injury when a construction worker swung a board and hit the person in the head, Holaday said. In doubles tennis, two players could be moving toward the ball and collide into one another, he said.

"Let's be safe and [test] everyone; there's no harm in that," Holaday said.

Newport Harbor officials started testing athletes using ImPACT three years ago, beginning with football, boys and girls soccer and boys and girls water polo, Zimmerman said.

"The hope is identifying other sports where it's most likely a kid could have a concussion and test them," Zimmerman said.

He said it is important to not put "a kid at risk by participating again when a concussion could be a factor."

The ImPACT test is one part of a larger approach Laguna has taken to address sports injuries, both before and after they occur, said Smith-Coakley, whose clinic treats the U.S. women's water polo team.

For this season, Laguna purchased new football helmets with padding that is not directly connected to the helmet's shell, Brown said.

"It's like a bonnet ... or shocks on your car," Brown said. "If you take a hit to the helmet, the helmet moves," not the head.

Communication between trainers, doctors and parents is critical, Smith-Coakley said.

"Laguna has physicians volunteering on a consulting basis [for all sports] to speak to the athletic trainer via cellphone or by text," Smith-Coakley said. "There's full communication if something happens on the field."

Younger athletes are particularly vulnerable to consequences from a hit to the head, sports agent Leigh Steinberg wrote in an October 2012 Daily Pilot column.

"Youthful brains are still in the process of formation and can potentially be impacted for life by a serious blow," said Steinberg, who held several conferences on concussions in Newport Beach during the 1990s. "It takes the teenage brain much longer to recover from a concussion."

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