The Manchester Enterprise
A Heritage Newspaper
Weekly Publication
State physician introduces new testing system for concussions
Baseline exams help show seriousness of hits to the head
By Terry Jacoby, Heritage Newspapers
PUBLISHED: December 6, 2007
Dr. Michael Czarnota, a Michigan physician and official neuropsychology consultant of the Canadian Hockey League, remembers Tony, a 17-year old hockey player with a history of concussions who was injured during a game early in the season.
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"He apparently hit the boards with his head and experienced both concussion and neck injury symptoms," Czarnota said.
Despite his symptoms, Tony continued practicing and playing over the next several weeks, but exertion only worsened his symptoms and he was eventually forced to stop. He returned home and remained relatively inactive until he attempted to exercise with a stationary bike one month later.
"Dizziness and headache returned and he again was forced to discontinue activity," Czarnota said. "After several more months, he was eventually referred for consultation and underwent evaluation. Information was provided to him and his family about expected recovery and a treatment plan was implemented with his family, physician and coach. Once he was determined to be symptom free he began to participate in a series of controlled and increasingly demanding steps of physical activity."
Tony was able to complete this process, return to action without a return of symptoms and complete the season without further difficulty.
"The coach mentioned that if the concussion had been recognized and managed appropriately at the outset the player could have avoided at least four months of worrisome and persistent symptoms," Czarnota said.
Tony is not an isolated case. Hockey and concussions tend to go together like ice and water. Despite advances in helmet technology and even some rule changes to soften the hard blows, hockey is still a contact sport. And with contact, comes concerns.
Concussion is defined as a disruption in how the brain works and can affect a person's thinking, emotions and actions. It's a remarkably complex condition because different areas of the brain can be disrupted in different instances and will produce different symptoms depending on the athlete. CT scans and magnetic-resonance imaging exams (MRIs) are usually read as normal because a concussion doesn't usually change the way the brain looks, but rather how it works.
Czarnota has helped introduce baseline testing, a relatively brief, but challenging collection of tests of how the brain works: concentration, memory, thinking skills, reaction time and self-report symptoms. The tests are conducted in advance of the season to establish what is "normal" for each person.
"Baseline testing generally refers to thinking or cognitive assessment and can now be accessed through a variety of computer programs (ANAM, CogSport, ImPACT) including some that can be completed on-line," said Czarnota, who also is consultant for several Michigan high schools and universities, including Northern Michigan University and Saginaw Valley State University. "ImPACT is the most widely used and accepted model in the United States and Canada with users that include the NFL, NHL, Canadian Junior Hockey, Central Hockey League, Big Ten universities and many others."
Baseline testing can be arranged through the organization or school or can be done individually at home or in a clinic.
"After a concussion, a clinician completes post-injury tests and the results are compared directly to that person's pre-injury baseline performance," said Czarnota, who has been using ImPACT since its inception and has presented the program at several international conferences on concussion. "This is the most sensitive method to detect the presence of a concussion and to determine the extent of the injury."
Some schools and organizations may also include tests of balance and stability as part of the baseline process, but this is coordinated best by an athletic trainer and is not available to most younger athletes.
Czarnota said local AAA hockey organizations, such as Compuware and Honeybaked, have acknowledged a benefit to having comprehensive information and services available to coaches, parents and athletes.
"They have expressed strong support and will encourage their coaches and families to take full advantage of all that comprehensive concussion services can offer," he said.
Baseline testing, which can be part of a comprehensive clinical service that includes post-concussion evaluations or can be separate, costs $10 per athlete per year if done through a team or individually, less if arranged through the school's athletic department.
Czarnota said concussions are nothing to mess around with and should be taken very seriously.
"Concussion is an equal opportunity injury that affects all sports, but especially football, ice hockey, soccer, equestrian and competitive cheer," he said. "With regard to ice hockey, it occurs just as frequently in college men's and women's teams and is one of the most frequent injuries at the Major Junior, college and professional levels.
"Unfortunately, playing or exercising when the brain is in this vulnerable state of recovery can lead to further injury, more profound and persistent problems and, in the case of Second Impact Syndrome, irreparable brain damage. Never allow a symptomatic athlete to exercise, practice or compete."
While vomiting can be a sign of concussion, it is by no means the only sign.
"Many people also believe that a person must be unconscious to have had a concussion, but research indicates that to be true in only 10 percent of the cases," Dr. Czarnota said. "That means that the vast majority of concussions - around 90 percent - do not involve loss of consciousness."
Signs and symptoms to look for include a dazed or vacant expression, confusion about assignments, forgets plays, disoriented, inappropriate emotions, lack of coordination or balance, slow in answering questions or loss of consciousness and any change in typical behavior.
There has been a rise in concussions, in part because of improved technology to diagnose them. The Center for Disease Control (CDC) has labeled sports concussions a "silent epidemic" and estimates 300,000 sport concussions per year.
Dr. Czarnota points out that the best helmet in the world cannot prevent concussions that result from snapping whiplash type impacts or those that occur from glancing blows to the head and face that rapidly twist or rotate the brain and brain stem.
"And youth hockey players often play with second-hand helmets that have been used for many years and likely offer reduced protection compared to the newest models," he said.
As a consultant, Dr. Czarnota provides information to make parents, coaches and players more educated about concussions.
"Most concussions, if treated properly, tend to recover within one to two weeks," he said. "Proper treatment starts with accurate recognition, individualized care and a gradual return to activity and play. Good concussion management is not anti-sport - it is meant to return the athlete to play as quickly and as safely as possible."
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