There is a new, easy test to assess whether or not an athlete has sustained a concussion. Better yet, it's easy to administer and amazingly inexpensive. With students returning to school and athletic programs already ramping up, now is a good time for news of this to get out.
The start this month of high school and college football seasons across the country renews concerns about the issue of repeated head impacts and how to manage or, preferably, avoid concussions. Unfortunately, the resources to deal with the problem remain limited. Newly released, state-of-the-art football helmets, for instance, may measure how much force each player’s head is absorbing and relay that data via telemetry to trainers on the sidelines, but at $1,500 or so per helmet, they are unattainable for most teams.More below the Orange Omnilepticon.
Which is why a study published recently in The British Journal of Sports Medicine is so appealing. Eminently practical, it offers a means by which any team, no matter how small or cash-strapped, can assess the likelihood of one of its players having sustained an on-field concussion. It also celebrates a nifty, D.I.Y., MacGyver-ish sensibility rarely seen in our technology-obsessed times.
Head injuries are not a joke, but diagnosing a concussion is not easy. It's not just about how hard someone is hit - it's also about the way the force was transmitted and whether or not the brain was injured by the blow. Individuals differ too. For an athlete in the middle of a game, a coach or trainer has to be able to detect when they've sustained a damaging impact as quickly as possible. Sustained unconsciousness, slurred speech, confusion, unevenly dilated pupils - these are gross symptoms of injury. More subtle damage is harder to detect, but still needs to be treated. The problem is how to recognize it.
As Gretchen Reynolds reports, researchers at the University of Michigan decided to investigate whether or not a test of an athlete's reaction time could be used to gauge if they had suffered a concussion.
The study’s authors began with the simple idea that, to manage sports-related concussions, “you need to be able to quickly and easily assess” whether a given player has actually sustained one, said Steven P. Broglio, director of the University of Michigan’s NeuroSport Research Laboratory and co-author of the study. Not every head impact results in a concussion.emphasis added
One means of assessing concussion status, Dr. Broglio continued, is to look at a player’s reaction time, since it is known to increase immediately after a concussion. A variety of scientifically validated tools exist to measure players’ reaction times, but most require a computer and sophisticated software, and are not practicable on the sidelines or in the budgets of many teams.
The device they came up with is remarkably simple:
...After some noodling, Dr. Eckner came up with the idea of attaching a hockey puck via adhesive to a long wooden dowel, and marking centimeters in ink along the length of the dowel.emphasis added
To use the device, an evaluator simply holds it in front of an athlete who is seated at a table with one arm resting on the surface and his hand at the table’s edge. The evaluator aligns the puck with the bottom of the athlete’s hand and lets go. The athlete catches the falling stick. The evaluator marks where his hand lands, and, voila, a coach or trainer has a baseline measure of someone’s reaction time. Theoretically, should a player later be suspected of having sustained a concussion, the trainer could pull out the dowel-puck, repeat the test, and, if the player’s reaction time were slower, conclude that he or she likely was concussed.
The distance the stick falls before the athlete grasps it is directly related to how fast the athlete recognizes that the stick is dropping and how quickly they can react to catch it. That distance can be used to determine exactly how long it took the athlete to react - it's a simple calculation based on the physics of falling objects and gravitational acceleration. The person administering the test doesn't need to use a stopwatch or even signal the athlete when the stick is released - it's all about how quickly the athlete can respond. If they take longer than their baseline tests show they should (the stick falls a greater distance), it indicates they should be treated as suffering from a concussion.
That, at least, was what the researchers thought would happen - but they still needed to test it. They measured the reaction times of a number of collegiate and high school players before their sports seasons began, and then waited to see what would happen as the athletes engaged in sports such as hockey, soccer and football. They compared athletes who had been diagnosed as having a concussion with athletes who had not. Although the sample size was small (28 in each group), the results were clear.
The dowel-puck turned out to be a remarkably reliable indicator of a concussion. Those athletes who had sustained the injury were significantly slower now to grasp the dowel, often requiring a full second more. The un-concussed athletes, on the other hand, displayed equivalent or, in many cases, faster reaction times on their re-test.emphasis added
The outcome of the testing was so consistent that even its developers seemed a bit taken aback. This “single, five-minute test” requiring “equipment costing less than five U.S. dollars” had “comparable test characteristics to other concussion assessment tools, including lengthier, computerized neuropsychological test batteries.”
Some caveats need to be addressed here. While extremely promising, these results are based on a small sample. Continued studies will need to be done with more subjects. Further, this test does not replace all of the other means currently used to diagnose a concussion. With that conceded however, this is still a very important piece of research. The simplicity of the test, the speed with which it can be administered, its minimal cost, and the accuracy it has demonstrated so far - all of these advantages mean it is something anyone involved in a sports program where concussion is a risk should be aware of this new tool for diagnosing concussion.
The benefits are obvious. An athlete who is suffering from an increase in the time it takes them to react to what is happening is more likely to get injured again. There is evidence that cumulative effects of trauma to the brain are not something to ignore.
While there have been efforts made to try to decrease the number of head injuries, according to Dr. Kevin M. Guskiewicz, there are about 300,000 sports related concussions every single year. Also, after sampling 4251 football players, of those who suffered from a concussions, 6.5% suffered another concussion during the same exact season. According to another study done by University of North Carolina showed that 31% of concussed athletes rushed immediately back onto the field after injury. This is showing that far too many times, players are being rushed back to the field too quickly.emphasis added
There are some further developments that may follow from this research. Can this test can also gauge how quickly an athlete is recovering - will reaction times return to pre-concussion norms, and if so, how quickly? Can it be used even when a baseline reaction time number is not known, to assess someone on the basis of what expected reaction times should be for a given age, etc.? How often can it be expected to give inconclusive or false negative results?
Could this be used as a battlefield medicine tool? The risks and consequences of Traumatic Brain Injury are becoming too well known. It has become a particular risk for our military. Being able to quickly diagnose a concussion would be an immense benefit to our troops.
Would this be a useful test to add to an annual physical? Potentially a baseline measurement of reaction times over a person's life might yield useful information. It might give early indication of some health problems, and might be useful in assessing the risks of falling for an elderly person, or evaluating their ability to operate a vehicle. It might be adaptable as a field test for someone pulled over as a suspected DUI.
The impressive thing about this test is its basic simplicity and its potential for the diagnosis and treatment of brain injuries. Kudos to the research team at the University of Michigan for coming up with this idea.