Football teams take new approach on concussions
Oct. 25, 20002

By Bob Condor
Chicago Tribune

CHICAGO — Fall weekends start with a colossal headache for Joe Trubich. He is a 17-year-old star linebacker and tight end for Lockport Township High School in suburban Chicago.

“By the end of each game, my head is killing me,” said Trubich, a 6-5, 215-pound senior.

In 2000, Trubich suffered a concussion while tackling an opponent. It’s what football players call “getting your bell rung.” Retired superstar quarterbacks Troy Aikman and Steve Young know the sensation, enduring 18 concussions between them in Hall of Fame-caliber careers. Chicago Bears backup quarterback Chris Chandler, a 36-year-old veteran and Super Bowl starter, has faced concussion problems and subsequent questions about retirement throughout his 15-year career.

For Trubich, the “bell-ringer” signaled the end of his play that game. But his experience was a beginning entry in a swift transformation regarding the diagnosis and treatment of concussion injuries.

Lockport is one of only two Chicago-area high schools using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) software system developed at the University of Pittsburgh. Nine teams in the National Football League now use the ImPACT system, and most all others conduct some form of neurophysiological testing. The Bears have performed a version of base-line testing since 1994. All teams in the National Hockey League use ImPACT. More than 100 college programs and high schools across the country have started using the ImPACT software (the one-time fee is roughly $1,000) since Lockport was among the first to sign up three years ago.

The concept is simple enough. Players are tested for memory and other cognitive abilities (such as spatial thinking) at “base line” before each season. The “test” presents a series of words, free-form images and flashing lights, then evaluates the player’s ability to recall if those words or images were shown previously or the exact sequence of the flashing lights. There is no right or wrong answer; some participants score higher than others.

“If you hurt your ankle, we could always compare it to your other ankle,” said Joe Cunnane, head athletic trainer at Lockport. “Now we can basically compare your brain to your brain.”

When a player suffers a possible concussion during a season, he or she can be retested and compared against their normal selves. The University of Pittsburgh protocol calls for the first test within 24 to 48 hours after the head blow. If the player fails to reach the base-line score, then tests will be administered Day 3, Day 5, Day 7 and so on until a player returns to mental performance at least equal to the base line.

Even when the player performs up to the base line on the first try, there still will be a follow-up test at Day 5 to 7 because new research indicates that the brain might actually worsen several days after the brain injury.

“A player can be ‘fine’ 15 minutes after the hit, but symptoms can develop two days later,” said Michael W. Collins, assistant director of the University of Pittsburgh Sports Medicine Concussion Program. “It may not be a linear relationship.”

In Trubich’s case, he was approved to play the following Friday but only after performing at the base line three times. The result was undramatic, just how Cunnane likes it.

“It is unbelievably reassuring to know if an athlete’s mental function is normal before clearing him to play,” Cunnane said.

Standard procedure on the Lockport sidelines — and, increasingly, pro football games — is holding a player from action if there is any concern about brain injury. There are several versions of “sideline cards” that trainers and doctors carry to ask a series of questions. For instance, trainers might ask the athlete to identify the opponent or recite the days of the week backward. If a player doesn’t readily and correctly answer those questions, failure should be enough to end participation for the day.

“Counting fingers or asking a player if ‘you are feeling OK’ are things of the past,” said Dr. Christopher Giza, a pediatrician and neurosurgeon at the University of California at Los Angeles who was the opening speaker at a July concussion-research conference organized by the University of Pittsburgh School of Medicine.

Another relic is believing that an athlete must be knocked out to suffer a concussion. Giza explained that a concussion is “a trauma-induced alteration in mental status that may or may not involve loss of consciousness.” Amnesia right before or following the head blow is a more reliable indicator.

Sports-related concussion research is a relatively new field. The Pitt researchers have base-line-tested more than 3,000 athletes and have 400 concussion-injury cases in their database. The National Football League has 600 concussions that can be evaluated.

The National Institutes of Health just awarded Pitt $3 million to study concussion diagnosis among high school athletes using ImPACT software and a cutting-edge “functional magnetic-resonance imaging” (fMRI) system that measures blood flow to the brain.

Yet one major obstacle is lodged firmly in any path toward healthier brains among athletes, especially football players who participate in a game that legendary coach Vince Lombardi once said was “not a contact sport; it’s a collision sport.”

“I suffered six concussions while playing,” said Mike Tomczak, the former Bears and Steelers quarterback who lasted 16 NFL seasons. “Some of them were self-induced because I was trying to block guys who were 6 inches taller and 40 pounds heavier. Other times I hurt myself when my head slammed to the ground after being tackled.

“Like it or not, there are coaches who coach players on how to knock guys out the game by injuring a knee or head. But you can ice your knee. You can’t ice the brain.”