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| HealthMonday, October 8, 2007 11:38 AM CDT |
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Test objectively measures extent of brain injuries
BLOOMINGTON -- Jamie Garrett spent 25 minutes at a laptop computer, testing her memory of words, designs and positions, her attention span, her reaction time, and her problem solving. "It's a little tiring," Garrett, 30, of Normal, admitted in the middle of the timed test. "I always had a pretty good memory, so it's frustrating that my memory isn't as good as it was." But it's getting better and is nearly back to normal, and her neurologist, Dr. Edward Pegg, who is confident that Garrett will make a complete recovery. Garrett sustained a concussion playing volleyball Nov. 12. She and Pegg know she is recovering because of the results of objective computerized neuropsychological testing that she has been undergoing at Pegg's office in Eastland Medical Plaza II, Bloomington. The test is called ImPACT. Pegg recommends it for high school and college student-athletes in contact sports and said adults who remain active in contact sports -- like Garrett -- can benefit as well. Pegg recommends players in contact sports take a baseline test. Then, if they sustain a head injury, they can take a second test, which objectively measures the impact of the concussion on their attention span, working memory, response variability, non-verbal problem solving, impulse control, and reaction time. Results are compared to the baseline test to determine the extent of brain injury. Over time, people may take other tests to monitor their recovery to help determine when they can resume work, school or sports, Pegg said. The test results are objective and participants are measured against themselves as well as people of a similar age and education level. Without ImPACT, management of concussions is more subjective, Pegg said. There are more than a dozen different guidelines for concussion management and none can measure subtle changes in the brain that happen with concussion. As a result, concussion management relies a lot on the athlete accurately reporting symptoms. If the person wants to get back in the game or doesn't want to miss work or school, the full degree of symptoms may not be reported, Pegg said. "So we ended up sending a lot of 'em back in the game with a concussion," Pegg said. "We didn't realize it." Most people with a concussion recover. But some experience chronic headaches, fatigue, sleep difficulties, personality changes, sensitivity to light and noise, dizziness and deficits in memory, problem solving and academic functioning. This is called post-concussion syndrome. The even greater risk is that a second blow to the head while the brain is not yet healed from the first concussion can cause second impact syndrome. With second impact syndrome, the blow to the head causes the nervous system to lose control, Pegg said. Increased blood flow causes swelling in the brain and the brain shuts down, causing a coma. In some cases, the swelling may continue and lead to death, he said. The risk of second impact syndrome can be lessened and the degree of post-concussion syndrome can be reduced if the person is allowed time to recover from their initial concussion and treated appropriately, Pegg said. ImPACT tests for major and subtle changes in the brain, said Pegg, who analyzes the results and discusses them with patients. "You can have subtle damage to the brain with no outward symptoms," Pegg said. "You're just not firing on all eight cylinders." Previous tests wouldn't pick up on that, he said. Even an MRI (magnetic resonance imaging) picks up only major swelling or bleeding in the brain, he said. "This (ImPACT) makes our ability to recognize concussion much more sensitive," he said. "All this stuff (being tested by ImPACT) requires the interaction of different parts of the brain," Pegg said as Garrett took her test. He said a test with his analysis of the data costs about $200. "We have a better way of knowing whether her brain has repaired itself completely," said Pegg, who has been a neurologist in Bloomington-Normal for many years. "We'll feel better about sending players back to play." Pegg -- who began offering ImPACT several months ago -- predicted that in five years, most colleges and high schools will require ImPACT testing for their student athletes and many physically active adults will take the test as well. During the summer, Illinois State University had its student-athletes who are at higher risk for injury take a baseline ImPACT test, said John Munn, Illinois State's head athletic trainer. They were football, basketball, soccer, baseball, softball and volleyball players, as well as gymnasts, divers and pole vaulters. "It's a no-brainer -- no pun intended," Munn said of having student-athletes take the test. "It would be idiotic not to do it." Prior to the past two years, concession assessment was subjective, he said. Two years ago, Illinois State began using a test -- with guidelines from the American Academy of Neurology -- that was similar to ImPACT, but it wasn't as comprehensive, was pencil-and-paper rather than a computer program, and wasn't timed, he said. "The biggest problem was some of it still came down to self-reporting of symptoms," Munn said. "We have every athlete fill out a medical history and one of the questions we ask them is if they've ever had their bell rung. We're counting on them to be truthful." During a game or practice, if an athlete sustained a head injury and appeared to recover outwardly, they may downplay internal symptoms, such as headache, Munn said. "We tell 'em to be honest, but these are pretty motivated athletes," he said. ImPACT takes that subjectivity away. "You can't fake it," Munn said. "It's concrete evidence." When student-athletes sustain a head injury, they are sent to Pegg's office for a follow-up ImPACT test and Pegg's evaluation to determine their degree of concussion and whether it's safe for them to return to their sport, Munn said. By late September, seven or eight football players, soccer players and volleyball players had been in to take a second test. Munn said he may have all ISU student-athletes take a baseline ImPACT test next year. "This is such an upgrade from what we had in the past," he said. "I sleep better at night knowing that Dr. Pegg is looking over our shoulder and knowing that we're doing everything we can to keep our student-athletes safe." Concussion numbers• The annual incidence of sports-related concussion in the United States is estimated at 300,000. • Most people recover. The number of people who experience cognitive and neurobehavioral difficulties related to concussion is unknown. • Second impact syndrome has lead to 30 to 40 deaths in the past decade. Who offers ImPACT?Medical professionals who offer the ImPACT concussion test in Central Illinois are: • Dr. Edward Pegg, Eastland Medical Plaza II, Bloomington, (309) 661-7344 • Dr. John Speca, Peak Orthopaedic & Sports Care, Streator, (815) 673-3223 • Dr. Jeremy Henrichs, The Paxton Clinic, Paxton, (217) 379-4864 SOURCE: www.impacttest.com Two stories prove benefits of ImPACT testing on recoveryBy Paul Swiech | pswiech@pantagraph.com BLOOMINGTON -- The new computerized neuropsychological test to measure degree of concussion may benefit student-athletes as well as adults who remain in contact sports, Dr. Edward Pegg said. Two illustrations follow. Jamie Garrett The pass was high and tight to the volleyball net and Jamie Garrett jumped up to hit it over. What the 30-year-old registered nurse didn't realize during that game Nov. 12 was that a teammate was coming up on her right. He tried to duck out of her way but hit her legs and she fell backward. Her lower back and the back of her head hit the Pepper Ridge Elementary School gym floor. "I was knocked unconscious," she said. "The next thing I remember was trying to stand up. I was very dizzy and felt very sick to my stomach. I was faint and was having trouble focusing my vision." Garrett decided to go home. She now admits that was a mistake. "I was in a little bit of denial. I should have known better as a nurse." But Garrett figured that as a nurse on the neuro-specialty unit of BroMenn Regional Medical Center, and as an active volleyball and basketball player and runner, she could take care of herself and she knew what concussion symptoms to keep an eye on. "I would give myself spot checks and would talk through where I was. My speech was slow." The next day, she returned to work. But when she called one object by the wrong name and gave the wrong date, she was sent home. Gradually, she improved and returned to work. But she still had trouble with short-term memory. Garrett emphasized that her patients never were in jeopardy. She was able to respond to crises and she writes everything down, so she never forgot anything pressing. An example of a memory problem, she said, was forgetting to quickly return a non-urgent phone call. "Still, it was very frustrating," she said. "I always had a great memory. I'm a competitive person and always want to excel." Socially, a couple of friends told her that she didn't remember some parts of their conversations with her and her focus wasn't there. She went to Pegg, who already was treating her for occasional migraine headaches. He told her about the new ImPACT test and she took it April 12. Even Pegg was surprised at how poorly she scored on that first test, considering she is a neuro-specialty nurse with a master's degree who was able to continue to work. He said the test measured subtle changes in the brain from the concussion. Pegg told her that she had to stop all sports because of the risk of second impact syndrome -- a serious brain injury if she would injure her head again before it healed. "I was devastated," Garrett said. "I knew something was not right but I didn't think it was that major of an issue." She stopped sports to allow her brain time to heal. Pegg prescribed medicines to help improve her concentration, but Garrett said they didn't help much. She did puzzles, Sudoku and increased her reading to exercise her brain. "I think the combination of the healing and the brain exercises have helped," she said. In addition to working with Pegg, she met with psychologist Mel French, who gave her an additional test, then looked at test results and suggested brain exercises and techniques to help work parts of the brain that needed help. "The (brain) cells exhaust easily and that's why I need to keep exercising (the brain)," she said. "It's like training for a marathon." Garrett took her second ImPACT test in May and the results showed that she was recovering. She took her third test in July and Pegg concluded she had recovered enough to resume running. Garrett, who took her fourth test Sept. 26, will resume basketball this month. Pegg believes Garrett will make a complete recovery, though she still has occasional memory problems. Erik Sipes Erik Sipes was running the ball in a freshmen-vs.-sophomores scrimmage at Normal Community West High School in August. "I don't remember the hit that gave me the concussion," Sipes, a 14-year-old freshman, said recently from his home in Hudson. "I know it was helmet-to-helmet contact. I felt dazed, like I wasn't right. I felt dizzy but continued to play." It wasn't outwardly obvious that he had a concussion, recalled his mother, Tena Parido, who was watching the scrimmage. She saw the helmet-to-helmet contact and saw Sipes shake it off. "He continued to catch and run the ball and tackle," she said of Sipes, who played running back on offense and linebacker on defense. After the scrimmage, his dad told Parido that Sipes wasn't right. "His eyes were glazed over. He knew his name but the last thing he remembered was having two bananas for lunch." This was about 6 p.m. "I don't remember anything about the game," Sipes said. "I felt lightheaded, dizzy and my head still hurt." He was taken to the BroMenn Regional Medical Center emergency department in Normal and it took him about four hours to figure out what had happened. "Mainly, I was frustrated. I didn't want to be out from football," he said. He was given pain medicine and sent home to rest. He took it easy Saturday and Sunday and stayed home from school on Monday and Tuesday. His coaches were aware of the ImPACT test Pegg was giving student-athletes at risk of concussion and Pegg gave the test to Sipes on Thursday. Sipes was at risk of second impact syndrome, a serious brain injury, because he had sustained a previous concussion in summer 2006 when he fell face first on concrete while playing basketball in his driveway. With that concussion, he recovered quickly but had to stay out of sports for two weeks. "I thought it (the ImPACT test) was fairly easy," he said. "But there were some memory things that I had trouble with. I had trouble remembering some words and shapes and my reaction time was not what it usually is." "He did a little below standard for his age and considering his grades," Parido said. Pegg told Sipes to take it easy. When he took the test a second time a week later, he did a lot better because his brain was healing. Sipes appreciates the test because it showed the extent of his injury, then showed how he was recovering. He said he feels normal, "just like before the concussion." He said the concussion doesn't affect his school work or football playing. However, an unrelated thigh injury -- called a quad contusion -- has recently limited his playing time. Parido likes that ImPACT, a test used by some professional sports teams, is available for student-athletes in Central Illinois. "It's amazing what happens to the brain -- and this test shows you," she said. "It's comforting to know that, if anything more should happen, we and Dr. Pegg have that information." E-mail this story | Print this story | Search archives | RSS Show comments |  Hide comments | Hide comments on all stories |
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