Published: March 8, 2014
ST. LOUIS (AP) — It was go time.
The Clayton Greyhounds and the Ladue Rams were in the regional soccer playoffs, and the neighboring high school rivals were competing hard for bragging rights.
Clayton sophomore Sam Schneider was playing striker, a key scoring position constantly under attack by defenders. The game was intensely physical, and Sam took four hard falls and pushes to the ground. But he kept playing.
Not once did anyone think Sam had suffered a concussion, because nobody on the sidelines saw him take a hit to the head.
"There was never one giant moment in the game when anyone thought he should be taken off the field," recalled Sam's mother, Alison Schneider.
That evening, Sam complained of a headache. Schneider told her son to take an Advil.
"He 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?'?"
The 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 cognitive abilities.
Clayton high school 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 response time, memory, and cognitive and visual recognition skills.
In the days after an injury, retaking the test can confirm a decline in skills and a potential concussion. Later, a school or physician will re-administer the test to see if those skills have rebounded to the baseline scores. That can indicate whether the athlete is healed and ready to play.
"Before this test, to get back to that level of play — it was always kind of a guessing game," Clayton High School Athletic Director Bob Bone said. "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."
This is 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.
Concussions are brain injuries at the cellular level that cause adverse biochemical reactions, but they cannot be 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 diagnosis of concussion.
In today's 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 youths want to play. Studies suggest that half of concussions go unreported.
Bone said baseline and post-injury testing took the pressure off coaches and parents making sometimes emotional decisions about youths' returning to play. At Clayton High School, the athletic director and physicians — not the coaches — make that call, he said.
"I 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."
Last 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, but most athletes opt in.
The test is scored in six areas: verbal memory, visual memory, visual motor speed, reaction time, impulse control and reported symptoms.
In some 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 of the childhood game Perfection or the card game Memory. Another part asks test-takers to click as quickly as they can on numbers descending in order from 50 to zero. One section mixes word memory and image memory problems.
At least 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.
"Most of our seventh- and eighth-graders are also playing sports, and they are in contact sports like our upper school kids are," MICDS head athletic trainer Stacey Morgan said. "It just seemed logical to include them."
An ImPACT official could not estimate the number of schools using the testing but said use had 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.
"This doesn't identify 100 percent of any concussion," Doug Tauchen, director of technical support for ImPACT, said. "This is just a tool that a good, trained physician will use to identify what's going on in this individual."