TARPON SPRINGS — East Lake High School running back Weston Fordham did more than sprints and bench presses to get ready for football season last year. He also took a computerized test designed to measure his cognitive skills — how fast he could recognize patterns in a series of symbols, for instance, or how many words he could memorize in a given time.
At the time, the 20-minute test seemed the least consequential portion of his preseason preparations. Then later that fall, Fordham was diagnosed with a concussion after taking a third-quarter blow to the lower jaw from a linebacker. The team was midway through its season, and, naturally, Fordham wanted to know when he could return to the field.
Science has yet to establish a gold standard for answering that question. But Fordham's trainer, doctor and coaches for the first time had a widely-used computerized test — the same one used by the National Football League — to help make the call.
As part of a partnership between two BayCare Health System hospitals and the Pinellas County School District, athletic trainers at more than a dozen high schools now use a commercial software program called ImPACT, developed by researchers at University of Pittsburgh.
The program has been used for several years in a dozen high schools in Hillsborough and Pasco counties as part of an initiative with University of South Florida's Sports Medicine and Athletic Related Trauma (SMART) Institute, said institute director Barbara Morris.
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One of a number of neurocognitive tests on the market, ImPACT lets doctors and trainers get baseline assessments of athletes before the season begins. After head injuries, the athletes take the same test again. If they can't match or exceed their original scores, they stay on the sidelines.
That's an important point considering that athletes are known to downplay their symptoms to get back in the game, said Michael Ouellette, a BayCare athletic trainer assigned to the sports programs at East Lake High School.
"As opposed to just asking them how they feel today," he said, "we have something to measure now."
A concussion is a type of traumatic brain injury caused by a blow to the head or body that jars or shakes the brain against the skull. Mounting scientific evidence links repeated head trauma to long-term brain damage. Last week, the NFL reached a $765 million settlement in the combined lawsuits of retired players whose brains were damaged by concussions.
BayCare's Morton Plant Hospital and St. Anthony's Hospital have assigned athletic trainers to Pinellas schools for nearly a decade. But the trainers implemented the cognitive tests for most sports — including football, soccer and baseball — just last year. Dr. Ted Farrar, a family and sports medicine physician for BayCare's Morton Plant Mease, calls ImPACT a "tool in the toolbox." Doctors still have to do a physical exam — checking balance and reviewing symptoms — before clearing the athletes for play.
He added that the test gives some quantitative information that can be reassuring to parents and coaches about progress.
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Questions remain about the tests' use. Critics say private companies behind the tests rely more on marketing than scientific rigor to sell their products. NFL players have talked about "sandbagging" baseline tests — deliberately scoring low — so if they are injured, they stand a better chance of beating their original scores.
A 2011 survey of the research of the ImPACT tests concluded they haven't been proven reliable enough to serve as a measure of brain health. While ImPACT makes reference on its website to being backed up by 140 peer-reviewed studies, critics note that other studies had shown too much variability between baseline tests and follow-up tests among non-injured athletes.
"I think there's a mind-set that if it's good enough for the NFL ... that's good enough for the high schools," said Thomas Redick, an assistant professor of psychological sciences at Purdue University and a co-author of the study, which was published in the Journal of Clinical and Experimental Neuropsychology. "I don't think it's providing as much useful information as many athletic trainers are looking for it to."
Redick said money spent on the tests might be better directed elsewhere. In the Tampa Bay area, BayCare foundations pay for the tests in Pinellas and USF's SMART Institute picks up the tabs in Hillsborough and Pasco.
Still, Redick said the neurocognitive tests are part of an effort to get a more objective measure of head injuries. Researchers have talked about developing a blood test or portable brain scanning equipment that could fill that need, he said, but such proposals may require years to come to fruition, if they ever do.
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Morris, the director at the SMART Institute, said concussion treatment is continuing to evolve. Not that long ago, she said, coaches thought little of sending a kid who had taken a hit to the head back into the game.
"A concussion is very scary in that there's nothing to put a Band-Aid on," said Morris.
Morris said the most promising development in Florida was the passage of a concussion law last year. The law requires young athletes with head injuries be taken out of sporting events for at least 24 hours. They can't return without medical clearance. The athlete has to complete a four-step plan — starting out with light aerobic exercise — before a physician can approve his or her return.
"It has changed the playing field in Florida," Morris said.
Fordham, the East Lake running back, took three weeks off before he hit the field again. When he took his follow-up test after some rest, he scored in the 80s — above his original score in the 70s. That gave him some confidence as he headed back to the game, though he admitted he didn't take the test seriously the first time around. But he does now, he said, and he tells his teammates they should, too.
Jodie Tillman can be reached at firstname.lastname@example.org or (813) 226-3374.