Impact of Concussions

West Potomac linebacker Matthew Voltmer ended up on the ground on Aug. 14 and he doesn’t remember how he got there.

It was a morning session during two-a-day practices at the high school in Mount Vernon, and the Wolverines were engaged in a hitting drill. A collision was the culprit, but Voltmer is uncertain of the details.

“I think we collided heads. To be honest, I don’t remember the actual collision,” Voltmer said. “I remember being about three feet away and then, next thing I know, I’m on my knees in front of him.”

The junior got up, shook his head and got back in the drill.

Later that afternoon, between practices, Voltmer was watching TV when he realized the screen appeared brighter than usual. He didn’t feel right, but he loves football and wanted to return for the team’s second practice.

His mother had different ideas.

A teammate had informed Voltmer’s mother of the hit her son took earlier in the day. After shining a light in his eyes and getting no response in his pupils, sign of a potential concussion, she took Voltmer to the hospital. Doctors performed a CAT scan and found a small bruise on his brain.

If Voltmer needed additional reason for not returning to the field promptly, it came three days later, when he took the ImPACT test.

IMPACT IS A SOFTWARE program geared toward managing the harmful effects of a concussion, including keeping an athlete off the field until he or she is fully recovered. Sustaining a second blow to the head while suffering from an initial concussion can cause second-impact syndrome, which is potentially fatal. According to the ImPACT Website, second-impact syndrome has led to 30-40 deaths in the last 10 years.

ImPACT provides a baseline by measuring cognitive functioning through a series of recognition tests administered on a computer. Once a baseline is established, the test can be taken again for comparative purposes if it is possible an athlete has suffered a concussion. Data from the second test can help lead to a diagnosis and track recovery. Test results are kept at the University of Pittsburgh.

VOLTMER, THE WEST POTOMAC linebacker, had established a baseline when he took the test as a freshman. Two years later, the results from his second test showed a decrease in the quality brain function. Voltmer said he remembered most of what the test entailed from his freshman year, and noticed himself struggling at times when he took it a second time.

“Every single subject was lower, reaction time, memory, [performance on] everything was much worse than my baseline,” Voltmer said. “In the reaction [segment] I remember there’s one where you press a button if a red square shows up [and] press a button where a blue circle shows up, and I did the opposite for about two sets.”

Voltmer agreed the results produced by taking the ImPACT test for a second time helped convince him to take the injury seriously. He sat out for about two weeks and missed the Sept. 3 season opener against Mount Vernon before returning to action.

Teammate Dustin Hess, also a junior linebacker, experienced dizziness and ringing in his ears after an Aug. 17 hit during practice. He continued to participate, but after a second blow later in the evening, he decided it was time to tell someone.

“I was feeling [dizzy] after impact, but I didn’t report it until the evening because I thought I’d be all right,” Hess said. “Then I came out here and practiced and I hit myself again and that was the last string. I couldn’t see straight.”

Hess, who also established a baseline with ImPACT testing during his freshman year, took the test two days later and produced diminished results. He also missed practice for two weeks and did not play against Mount Vernon.

Hess said waiting to report his symptoms was “stupid” and he would not try to play through symptoms if they occurred in the future.

EVERY HIGH SCHOOL in Fairfax County uses ImPACT testing to protect student athletes with possible concussions. Jon Almquist, athletic training program administrator for FCPS, said ImPACT provides information unattainable by the naked eye or a standard evaluation. But Almquist added ImPACT is only part of the solution in terms of managing concussions.

Almquist said schools dial 911 if convulsions or vomiting is associated with a head impact. Otherwise, athletes are given a sideline exam and monitored after a head injury to determine down which path he or she is headed. Will the athlete be able to go home after the event, or will he or she be in need of further medical attention?

A full clinical evaluation is another tool, Almquist said. This involves examining a patient’s medical history and trends, primarily whether the athlete has suffered a head injury.

An ImPACT test would likely be given 24 to 72 hours after head trauma, to test how the brain is functioning.

“It’s a tool in our tool box,” Almquist said of ImPACT. “No one thing across the board is the answer. … Everything has to be together. It’s kind of like parts of a formula.”

Almquist said the number of concussions recorded during the past 15 years is “much higher” than in the past, due primarily to a better understanding of concussions among medical personnel.

WEST POTOMAC head football coach Eric Henderson said he suffered at least 12 concussions during his football career at Fort Hunt High School and the University of Rhode Island. Henderson, who played left tackle at URI, said fighting through concussion symptoms was commonplace 20 years ago.

“When I played, yeah, you tried to suck that up,” he said. “Now, the kids are so educated on head injuries and ‘don’t push a head injury,’ that they almost become self advocates, which is good.

“… I remember blacking out in a game and playing in the second half. That’s what you did: ‘Oh, he’s awake?’ A little ammonia capsule under the nose and ‘OK, there no visible blood. I think he can go back in.’ That’s how it was. But it was 1987. Nobody did the longitudinal studies on head injuries that people have done [recently]. … My memory sucks. It’s atrocious, and I know it’s due to all the concussions. … I can’t remember stretches of games in college.”

DR. JILLIAN SCHNEIDER of Springfield, a clinical pediatric neuropsychologist who works with ImPACT, said convincing an athlete to stay off the field while recovering from a concussion can be “challenging.”

“If they talk about the importance of getting back on the field even though they’re experiencing symptoms, I’ll talk about second-impact syndrome,” she said. “I’ll emphasize if they have another [head] injury [while recovering], their symptoms are going to be worse and they might miss a season stead of a game.”

Schneider said football is the No. 1 producer of concussions among sports, adding lacrosse, hockey and boxing are among the top sports that lead to head injury.

Rest is the best way to recover from a concussion, Schneider said. Patients should stay away from physical activity, which she described as anything that elevates the heart rate, and should limit cognitive stress, such as reading and studying, she said.

T.C. Williams High School in Alexandria, does not use ImPACT testing. Tanya Hecox, the school’s head athletic trainer, said it’s a money-related choice. T.C. Williams uses Standardized Assessment of Concussion testing.

WALT WHITMAN High School in Bethesda, Md., also uses ImPACT testing. Members of the field hockey and girls soccer team took the test Oct. 16 for baseline purposes. Celeste Pilato, a junior on the field hockey team, suffered from headaches and nausea, common concussion symptoms, after being hit in the head with a ball during a Sept. 29 game against Walter Johnson. A doctor later diagnosed with benign positional vertigo, but said it was nice to have a baseline established if needed.

Maryam Hedayati, a parent volunteer and substitute teacher for Montgomery County, supervised during the recent ImPACT tests at Whitman. Hedayati explained to those in the room the test is not an academic quiz grading right or wrong answers, but rather a method used to collect data.

Hedayati has two sons on the Whitman football team. She said the oldest, Sassan Nejad, was concerned about how well he would do the first time he took the test, a worry Hedayati looks to eliminate.

“If they know this is just gathering information, and they’re in a calm position,” she said, “then they take their time and they do their best. And their answers, to me, will be more accurate.”

WINSTON CHURCHILL High School in Potomac, Md., is in its first year using ImPACT. Dave Kelly, in his second year as the school’s athletic director, said any athlete viewed as being at risk for a concussion is encouraged to take the test. Kelly said the school paid a $750 fee, which allows up to 600 students to be tested this year.

“We’ve had a number of kids who’ve had concussions each season,” Kelly said. “Quite frankly, it’s valuable to have in case a child does sustain trauma to the brain because it gives you a baseline. … It’s highly recommended.”

The annual occurrence of sports-related concussions is estimated at 300,000, according the ImPACT Website. Schneider said it’s “critical” to preventing further concussion damage.

Dr. Hirad Bagy of the United Wellness Center in Herndon, and team chiropractor for D.C. United, works with ImPACT and said a benefit of the test is the concrete numbers it provides. With some concussion symptoms such as drowsiness, common in the day-to-day life of a teenager, the data helps give a clearer picture of potential problems.

Bagy referred to the ImPACT test as “invaluable” and “amazing.”