High schools expand concussion playbook

Frank Banecker got jacked up.

It was early in the third quarter when two defenders converged on the Cherry Hill High School West football player, sending him flat onto his back. The junior fullback quickly bounced up and handed the ball to the referee.

"Right after the play, my head hurt," Banecker said. "I walked to the sidelines, and my head felt fine again, so I kept playing."

His mother, Loretta, cringed in the stands at Winslow Township High School and told her husband, Frank Sr., that she thought their son was hurt. Her husband shrugged it off, and their son finished the game.

It wasn't until that night, when he pushed aside his favorite pasta dish and went to bed at 9:30 p.m., that his father agreed that something was wrong.

Banecker had suffered a mild concussion with delayed symptoms. The next morning, his trainer, John Laird, gave him a video-gamelike test to measure his reaction and thinking skills. Laird repeated the test several times before clearing Banecker to return to the field in 10 days.

Recent high-profile head injuries among pro players have put the spotlight on concussions.

Now the same kind of attention and neuropsychological testing being used by pro teams to detect brain injuries is making its way into high schools.

Thirty-two schools in the Philadelphia region have signed up to use the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT), one of the country's most widely used tests.

Cherry Hill West two years ago got a three-year, $1,500 license funded by their booster clubs and a state grant.

Radnor and Conestoga received the program this year through a state grant.

"The athletic training staff is just trying to be proactive, and I think it's a great idea," Radnor head football coach Tom Ryan said. "It's going to happen eventually, I think, where it's going to be mandatory statewide."

Recent studies say young athletes are more at risk of injuries because their brains are not fully developed until 18 years old. And recovery may take longer for high school athletes than for older athletes.

Girls are particularly vulnerable, according to a study coming out in December in the Journal of Athletic Training: In sports played by both sexes, girls suffered more concussions. Weaker head and neck muscles and a greater tendency by females to report an injury were cited as possible reasons.

"What they used to call 'dings' and 'getting your bell rung' are more serious," said Bradley Smith of Orthopedics Specialists in Bryn Mawr, who is a concussion consultant for Radnor and Conestoga High Schools.

Most schools use the tests for, at least, football, soccer and lacrosse.

At the start of the season, athletes take a baseline test resembling a video game that measures verbal and visual memory, reaction time, impulse control, and information processing speed.

The athlete retakes the test after a head injury and again when he or she is symptom-free. The athletic trainer then compares the results.

"Often athletes will come to me and say they're fine," said Michael Collins, one of ImPACT's developers. "This is a way to look under the hood of those injuries."

HeadMinder Inc.'s Concussion Resolution Index is a similar test.

Some private practices, such as Orthopedics Specialists, which provided the ImPACT test to Radnor and Conestoga, also offer the testing as an outpatient service for athletes that play intramural or non-school-related sports.

But the computerized tests are not the only option. Some schools use the Standardized Assessment of Concussion, a pre- and post-cognitive test done on paper. Larry Cooper, secondary-school chairman of the Pennsylvania Athletic Trainers' Society and trainer at Penn-Trafford High School near Pittsburgh, said he had been using the SAC for five years.

On the sidelines, athletic trainers can also assess injured athletes by asking them questions from the Sport Concussion Assessment Tool, which they can carry on a pocket-size card.

"A lot of my fellow athletic trainers use [ImPACT] and they love it, but there's issues, too," Cooper said. "The problem is convincing the district that not just football should be tested."

More high schools are also hiring athletic trainers who have the expertise to spot and treat concussions, Cooper said.

Robert Cabry, of Premier Orthopedic & Sports Medicine Associates, said he liked the computer tests but warned against the hype. "It should just be another one of the doctor's tools."

A concussion, or a mild traumatic brain injury, occurs when the brain shakes violently inside the skull. The most recognizable symptoms are headache, dizziness, nausea and memory loss, according to the Centers for Disease Prevention and Control. Loss of consciousness happens in severe cases.

Post-concussion syndrome can cause persistent symptoms for months, according to the journal of the American College of Sports Medicine.

Worse, if a concussion is not diagnosed and an athlete returns to the field and suffers another blow, it can lead to rare, but fatal, brain swelling known as second-impact syndrome.

Concussions also have a cumulative impact and can leave an athlete more susceptible to future brain injury, according to a 2004 study from Clinical and Medicine Research.

While media attention has increased public awareness, high school athletes may still not report the injury, Cabry said.

Those players "are still going to hide it, and we probably have even a little more hesitancy now because they know they're going to get yanked from the game."

Just having the test results can often help coaches, players and parents accept that a key player has to sit out a game.

"I mean, if you get hit really hard and you just black out," you obviously wouldn't play, said Myles Britton, a Radnor football player. "But if you get up and feel a little dizzy and feel all right, then you go ask to get back in."

Although Loretta Banecker thinks Laird would have spotted her son's concussion without the tests, she said there would have been "some heated discussion" in the house about pulling her son from the game.

Laird agreed that the tests were worthwhile "for the peace of mind it gives the parents and the peace of mind it gives me."

1986-87: The Army develops Automated Neuropsychological Assessment Metrics, the first computerized cognitive assessment tool.

1997-2004: More than 300 studies are published on concussion management of student-athletes.

1998: ImPACT is developed at the University of Pittsburgh Medical Center.

2001: The first International Symposium on Concussion in Sport is held in Vienna, Austria.

2006: Former Philadelphia Eagle Andre Waters commits suicide at 44. After an inquiry, a doctor said brain damage from playing football had led to Waters' depression and death.

2007: The NFL holds a Concussion Summit in Chicago and launches its own study.

SOURCE: Inquirer researchEndText

Go to go.philly.com/head to see one company's test to help detect a concussion.EndText