LOUIS — It was go-time.
Clayton Greyhounds and the Ladue Rams were in the regional
soccer playoffs, and the neighboring high school rivals were
competing hard for bragging rights.
High School sophomore Sam Schneider was playing striker, a key
scoring position constantly under attack by defenders. The
game was intensely physical and Schneider took four hard falls
and pushes to the ground. But he kept playing.
did anyone think Sam had suffered a concussion because nobody
on the sidelines saw him take a hit to the head.
was never one giant moment in the game when anyone thought he
should be taken off the field," recalled Sam’s mom,
evening things changed. Sam complained of a headache.
Schneider told her son to take an Advil.
just looked at me right in the eye, blankly. As if he wasn’t
looking at me at all," she said. "About 45 or 50
seconds later, he said, ‘What did you say?’"
Schneiders made sure to check on Sam throughout the night. And
they consulted with a doctor. But Sam’s first visit the next
day was with the school’s athletic trainer who held key
information: results of a computer-based test Sam had taken
earlier in the fall that had scored a selection of his
is one of at least a dozen St. Louis area schools now using
— and in some cases requiring — a baseline concussion
assessment test for its athletes. The 25-minute test,
typically given to students every two years before the start
of the athletic season, scores cognitive, memory, response
time and visual recognition skills.
days after an injury, retaking the test can confirm a decline
in skills and a possible concussion. Later, a school or
physician will re-administer the test to see if those skills
have recovered to the baseline scores. That can indicate
whether the athlete is healed and ready to return to play.
this test, to get back to that level of play — it was always
kind of a guessing game," said Clayton High School
Athletic Director Bob Bone. "This is a little bit more
concrete information that we’re using, and it makes us feel
better about the decisions we are trying to make."
an age of growing research about the debilitating effects of
untreated or repeat concussions. And with the growth of youth
sports, there is greater concern about young athletes. But
there is still no standard medical test for a physician to
unequivocally "see" a concussion.
are brain injuries at the cellular level that cause adverse
biochemical reactions, but they are not seen by MRIs, CT scans
or other X-rays. Rather physicians rely on many evaluations.
Those appraisals — along with reported symptoms such as
headaches, nausea and fogginess — can lead to a concussion
ramped-up youth sports scene, despite studies that suggest 5
percent to 10 percent of athletes experience concussions
during a specific sports season, it can be easy for a minor
concussion to be missed. It is not uncommon for student
athletes, parents and even coaches to minimize symptoms
because kids want to play. Studies suggest half of concussions
said baseline and post-injury testing takes the pressure off
coaches and parents making sometimes emotional decisions about
kids returning to play.
Clayton High School the athletic director and physicians —
not the coaches — make that call, he said.
know with coaches, especially in high-contact sports, the
tendency used to be, if the kid gets dinged, as soon as they
said they felt OK, they’d try to get them back in," he
said. "Now it’s not that way."
year Clayton High School began contracting with the company
ImPACT Applications Inc. to use its testing system. The
company is one of about four nationwide that provides the
service. Clayton’s parent teacher organization paid the
$1,000 fee. The program is optional for all athletes, though
most opt in.
measures certain neuro-cognitive functions associated with
memory and reaction speed. It is scored in six areas: verbal
memory, visual memory, visual motor speed, reaction time,
impulse control and reported symptoms.
sections test takers are required to first remember a series
of words, images or symbols and to later use a mouse to click
on images or words that match what they saw earlier — think
the childhood game Perfection or the card game Memory. Another
part asks takers to click as fast as they can on numbers
descending in order from 50 to zero. One section mixes word
memory and image memory problems together.
BEGIN OPTIONAL TRIM)
one school in the region has expanded required baseline
testing to include middle school students. Mary Institute and
St. Louis Country Day School had already required the testing
among all of its high schoolers for about seven years. Next
fall it will include seventh- and eighth-graders.
of our seventh- and eighth-graders are also playing sports,
and they are in contact sports like our upper school kids
are," said MICDS head athletic trainer Stacey Morgan.
"It just seemed logical to include them."
ImPACT official could not estimate the number of schools using
the testing, but said use has increased dramatically across
the country in the past two years. The company is the first to
warn that the testing is not going to prevent concussions, nor
revolutionize concussion care. It’s one of many approaches
that should be used together.
doesn’t identify 100 percent of any concussion, said Doug
Tauchen, director of technical support for ImPACT. "This
is just a tool that good, trained physician will use to
identify what’ s going on in this individual."
BEGIN OPTIONAL TRIM)
Bayes, a primary care sports physician with Blue Tail Medical
Group and a certified provider of the test for some high
schools in the region, said computer testing pales compared
with the value of a full physical examination that includes
assessment of balance and other issues. And he warns ImPACT
tests taken after an injury are only valuable when compared to
pre-injury baseline scores because baseline scores take into
account such things as pre-existing learning disabilities or
cognitive deficits that could also drive down a score.
Schneider, said Sam got the best of care with Clayton High
School and an affiliated physician.
morning after the game, when he visited the school’s
trainer, his memory and balance problems were obvious. So his
next stop was a visit to a physician. Schneider said Sam’s
doctor concluded that even though his head may not have taken
a direct hit during the game, his brain probably shifted
during the impact of hitting the ground, causing the
retrospect, Sam thinks he may have hit his head when he took a
spill at the end of the field and landed on a part of the
running track surrounding it.
took about eight weeks. First there were several days of deep
mind and body rest: no physical activity, no school, no
television, no video games, no loud music or bright lights.
Then there were school half-days. Sam was given a homework
pass for about three weeks and a pass on tests for six weeks
to let his brain rest and heal. Bone, the athletic director,
said Clayton High now considers a gradual re-entry into
academics just as important as a careful re-entry into
athletics when it comes to proper concussion recovery.
until Sam took the ImPACT test and scored better than his
initial baseline test that he was fully cleared for athletics
in early January.
think definitely the nicest thing was to know there was
something numerical to base decisions on," Alison
Schneider recently began his Scott Gallagher soccer club
season and said he is psyched to be back up to speed.
just kind of like the speed of the game, and how you are
always moving around and how it never stops until
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million to 3.8 million concussions occur each year.
symptoms include headache, nausea, dizziness, mental fogginess
and sensitivity to light.
than 10 percent of sport-related concussions involve loss of
half of all concussions are not reported.
percent of athletes feel no symptoms directly after receiving
a concussive blow.
is the most common sport with concussion risk for males;
soccer for females.
are twice as likely to sustain a concussion as males in a
person has already had one concussion, they are twice as
likely to suffer another. Those odds increase drastically
after a second one.
American Medical Society for Sports Medicine, Scott Bayes,
M.D., The Centers for Disease Control