Putting concussions to the test
Neurocognitive exams are a valuable tool in diagnosis and treatment for young athletes
HULL — In a computer lab at Hull High School, seven students stare at screens, watching words flash past. Wheel. Bath. Fight. Ice. Water. Plate. Moments later, the same screens fill with scribbled designs, then colored shapes, then number grids. The students click away, speeding through memory and countdown tests. This is no ordinary exam. But it may be the most important one the students take all school year.
Neurocognitive exams, such as the computer-based ImPACT test given in Hull, are increasingly popular tools in the ongoing effort to protect young athletes against the short- and long-term dangers of concussions. The tests are designed to measure cognitive abilities such as recall, reaction time, and pattern recognition.
At Hull High School, athletic director Jim Quatromoni administers the roughly 20-minute test to student-athletes to establish a cognitive-function baseline, a valuable point of reference after a head injury. “It’s a piece of the puzzle,’’ said Quatromoni. “When you break your arm, it’s all there to see. When you experience a concussion, more often than not, unless you tell us, we’re not going to know anything is wrong. “I tell the kids that this test is designed to be a tool. We’re doing this so we can give the doctors a tool to better treat our student-athletes when an injury happens in or out of school.’’
With recent NFL headlines about helmet-to-helmet hits and new studies about how hard hits affect much younger athletes, there is heightened awareness about concussions and their consequences. Post-concussion syndrome. Second-impact syndrome. Chronic Traumatic Encephalopathy (CTE), the degenerative brain disease now commonly associated with football players. And there is a growing desire to better diagnose and treat athletes who suffer concussions, especially the youngest.
When Quatromoni introduced ImPACT testing at Hull three years ago, the reception was mixed. Football players worried that it would sideline them longer. (It doesn’t.) Now, ImPACT — which stands for Immediate Post-Concussion Assessment and Cognitive Testing — is sought after in Hull, with youth football players taking it two weeks ago. The company behind ImPACT reports a tenfold increase in demand for its tests over the last few years. Also, according to ImPACT, 30 states are trying to pass legislation that would recommend neurocognitive testing for all student-athletes.
In July, Massachusetts passed a law directing anyone involved in extracurricular athletics at MIAA schools to go through a head-injury safety training program.
Hull is one example of how schools can take the initiative when it comes to concussions. The latest concussion news — including the recent death of a Kansas high school senior who may have returned to football too early from a concussion — makes it clear that athletes in high school and youth sports have as much to worry about as the pros, if not more.
“We now know that, as young as 18, individuals can already be on their way to Chronic Traumatic Encephalopathy,’’ said Dr. Robert Cantu, one of the nation’s top sports concussion experts. “At the NFL level, they’re being paid millions and they’re going to take those risks in most cases.
“But these youngsters don’t know what they’re putting themselves at risk for. It is hugely important they understand the correct way to manage concussions and minimize their chance of coming up with some of the bad consequences — post-concussion syndrome or, worse, CTE.’’
When an opposing running back dove for the goal line, Hull linebacker Connor Duhaime tried to stop him in midair. As Duhaime described it, they “smashed heads’’ and fell to the ground. Picking himself up, a dizzy Duhaime saw double for a few moments. Once his vision returned to normal, he dismissed the hard helmet-to-helmet hit as part of the game. At least until he returned to school and sat for an ImPACT test.
Duhaime struggled with every part of the test. He could not concentrate, recall words, see colors and shapes without distortion, or react quickly to prompts on the computer screen. He knew something was wrong, very wrong. When Quatromoni saw the results and how many boxes Duhaime checked off in the symptom inventory part of the evaluation, he came to the same conclusion.
Duhaime went to South Shore Hospital and saw Dr. Janet Kent, who runs a concussion clinic at the hospital and is an ImPACT consultant who often manages the more severely concussed athletes at Hull High. When Duhaime learned he had suffered a concussion and what that meant, his fatigue and occasional vomiting made more sense. Kent developed a post-concussion treatment and reevaluation plan for him. Duhaime was back on the field a month later. “If I didn’t take that test, I probably would’ve never got it checked out,’’ said Duhaime, who suffered the concussion two years ago as a sophomore. “I definitely wouldn’t be playing now. If I didn’t get that test taken when I did, I probably would have gotten another good hit my sophomore year and been knocked out cold or
something.’’ Now, as a senior captain, Duhaime has taken the ImPACT test nine times to check his post-concussion progress. His case is a prime example of why Hull does the testing and how it can help.
Quatromoni looked into ImPACT testing three years ago after being uncertain about whether a female athlete had sustained a concussion. Today he tells kids, “We’re giving you this test so that you’re only out as long as you need to be.’’ He also emphasizes that the test is no substitute for a doctor’s evaluation and clearance.
While ImPACT testing and similar programs don’t do it all and don’t claim to, use of it often helps establish a concussion policy in schools.
Testing licenses for schools cost $500-$1,000 per year, depending on the size of the package. A $500 license includes 300 baseline tests for the first year and 150 each subsequent year. (Tests are considered valid for two years.) In Massachusetts, nearly 30 colleges and nearly 100 high schools are listed as ImPACT clients.
“It started top down with the professional sports, but my goal has always been for this to be available for the most needy group of athletes, and that’s kids,’’ said Dr. Mark Lovell, a sports concussion expert and neuropsychologist who developed the ImPACT software. “They’re the group that has the fewest resources dedicated to them. If you go to a recreational football game, you’ll be lucky if there’s any medical presence whatsoever. And that means you have the potential for injuries to be missed.’’
To determine how well an athlete is recovering from a concussion, neurologic tests monitoring balance, coordination, vision, and eye movement, among other functions, also should be done. Cantu drove home this cautionary point when discussing the usefulness of neurocognitive tests such as ImPACT.
“I use it after somebody completely recovers from all symptoms of a concussion and the neurologic exam is normal,’’ said Cantu, a clinical professor of neurosurgery at Boston University School of Medicine and co-director of BU’s Center for the Study of Traumatic Encephalopathy. “It’s an extremely good tool for what it does. But it’s egregiously misused as a ‘red light, green light,’ which it can’t be. “Unfortunately, when school systems invest money in doing that kind of testing, some just wind up using this one tool.’’
Earlier this season, a hard hit left a Hull youth football player on the ground for 10 minutes. He was carried off the field on a backboard. That scene, combined with the latest concussion news, spurred parents to action. They contacted Quatromoni and arranged ImPACT testing for the 44 boys on the Peewee and Midget teams (ages 10-14). At first, said Hull Youth Football Association president Bob Cambra, “There was some skepticism about the test and why we were offering it.’’ But most parents embraced the opportunity.
“It’s a relief,’’ said Stephanie Peters, mother of two sons who play Hull youth football. “If I have to go to the emergency room or a doctor, I can call somebody and get that baseline sent over and treat it as quickly as possible. You can identify if it’s a concussion right out of the gate.’’
Added Kevin Richardson, father of a son who plays Hull youth football, “With the concussion testing, it’s like there’s been a culture change. It used to be we didn’t wear bike helmets and seatbelts until there was a culture change towards public safety. The concussion testing is along those lines. It’s probably long overdue.’’
With the culture change, there is greater demand for testing. And, as with Hull youth football, parents eagerly lead the way.
Almost a year ago, Jeannine Donato heard about ImPACT after seeing her youngest son, Nolan, suffer a concussion. During his recovery, she learned more about the test and discovered that the Harvard men’s hockey team, coached by her husband Ted Donato, uses ImPACT.
Not long after Nolan suffered his concussion, Jeannine, a registered nurse with experience treating head traumas, made plans to open a baseline testing center in Norwell and call it “A Head of the Game.’’ She expects to start testing within the next couple weeks, charging $50 per exam. There are 150 kids already signed up.
Jeannine aims to serve athletes not yet in high school or not offered ImPACT at their high schools. “With kids, this is the time where it’s the most dangerous,’’ she said. “Their brains are still developing.’’
With its focus on younger athletes, and as a testing site outside of schools and medical institutions, “A Head of the Game’’ represents a new avenue for baseline testing and concussion education. In the future, concussion awareness and treatment likely will be motivated by efforts to protect the youngest athletes as much as it’s driven by NFL headlines. When it comes to concussions, there is nothing wrong with a head start.
© Copyright 2010 Globe Newspaper Company.
 Seeking salvation from above
School roof might advertise to planes
Globe Correspondent / September 23, 2010
School officials are looking to the heavens for help with their money problems — exploring the possibility of renting the Hull High School roof to an advertiser eager to grab the attention of consumers in the thousands of airplanes flying overhead.
“We’re on the flight path for planes heading into Boston, so on most days there’s a plane flying over this high school every four to five minutes,’’ said school principal Michael Devine. “I’m sitting in my office right now and I can see two planes that are backed up above us. Make that three.’’
The planes fly low, swooping down for their approach to Logan Airport, and the noise can be deafening.
“People have said we’ve put up with the noise, the least we can do is try to make some money out of it,’’ Devine said. “I’d love to see the Nike swoosh up there. . . . I just hope Nike feels the same way.’’
Hull is far from the only school system or public entity looking for advertising to pay its bills. Boston is testing public reaction to corporate advertising in the Boston Common. Even the storied city of Venice is selling ads on tarpaulins over the facades of its historic buildings, to pay for renovations of its monuments.
And numerous school systems, including Norwell’s, have advertising in their gyms and at playing fields — both options that Hull also is considering.
The Hull School Committee reluctantly agreed to pursue the idea of turning the high school roof into a billboard, with the money going toward the school’s athletic program. “We were not very comfortable’’ with the commercial aspect of it, said chairwoman Stephanie Peters, “but we have no choice.’’
The athletic program costs $205,000 annually, Peters said, but has zero public funding for the second year.
While student fees, belt-tightening, and energetic efforts by local boosters kept sports alive last year — albeit on a reduced schedule — there is no guarantee they will survive this year.
School officials worry about fund-raising fatigue. And they don’t want to keep charging students more to play sports, especially with the economy still taking its toll on what is not a wealthy town.
There already are signs that the public — which donated $112,000 last year — may be tapped out. The boosters’ main fund-raiser — the euphemistically named “meadow muffin’’ event — brought in $12,000 less this year, Devine said.
And the annual Thanksgiving Day football game, which netted Hull $10,000 last year, moves to Cohasset this year, he said.
“We are a small community, and people in this town are doing what they can, but we acknowledge we have to look outside our community if we are going to keep the sports program going,’’ said Devine. “I don’t like using schools as billboards. But if having advertising will allow one more student athlete to be able to participate in sports, then it’s a fair trade-off for me.’’
Devine said he knows of no other school system looking at rooftop advertising. “But I don’t know of another school in such an ideal position to make it work,’’ he said.
Neither Logan Airport nor the Federal Aviation Administration keep track of how many planes fly over Hull, officials said. But the FAA’s records show 361,379 planes went in and out of Logan last year.
Hull’s plan is to approach 15 companies with distinctive logos — including Coke, Pepsi, Dunkin’ Donuts, Target, Reebok, and Nike, Devine said, sending them photos of the high school roof and maps of the well-traveled flight path above it.
Interested companies can indicate whether they’d like their ad visible only in the daytime, or want to spend more to add lights and make it glow in the dark, he said.
“We’re in completely uncharted territory here, so we have no idea how much they would pay. We’ll say we have this piece of advertising space, what do you think it’s worth?’’ Devine said.
The school won’t entertain offers, though, from any product that “promoted alcohol, violence, cigarettes, anything like that,’’ he said.
“I can guarantee you, you would never see a Budweiser logo on our roof,’’ he said.
Devine said he hoped to get advertising up by May, and said anyone who was interested could contact athletic director James Quatromoni at 781-925-3000.
Town Manager Philip Lemnios lent his support to exploring the idea.
“I don’t think it would impact the quality of life’’ in Hull, he said. “It wouldn’t be too visible to anyone other than to the folks who fly overhead, and there are plenty of them.
“It would be a great opportunity for companies to say ‘hello’ to people as they fly into Boston, to be the first thing they see. . . . We have other rooftops. Maybe we’ll start a trend.’’
Kathy Kiely, president of the Ad Club in Boston, said the Hull initiative has merits. “Their heart is in the right place,’’ she said. “I’m not sure how easy it would be to lease out [the roof] to a brand, but I applaud them for their creative energy.’’
Kiely was involved with some creative advertising herself involving the Braintree schools a number of years ago, when she was director of marketing for Bertucci’s restaurants. She’d heard the schools were going to charge students to ride the buses, and convinced the School Committee to charge Bertucci’s, instead, to wrap the buses in their advertising.
“We have to start getting creative and put a business mind to how we run our schools,’’ she said.
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