In the battle against brain injuries, knowledge is power.
The Brant and District Football Club is taking a proactive approach to concussions by putting out a call to its players over the age of 11 to undergo a pre-emptive cognitive test.
The ImPACT test, which stands for Immediate Post-Concussion Assessment and Cognitive Testing, is quickly becoming the standard for measuring how severe an athlete’s head injury is and how their recovery is progressing.
“It’s the most scientifically validated concussion evaluation system on the market,” Dr. Tyler Fletcher said. “It’s a 20-minute neuro-psych test that measures how well the brain is working.”
Fletcher has teamed up with the Brant and District Football Club, also known as the Bisons, as its official sports therapist. The owner of Cobblestone Medicine and Rehab has a passion for sports medicine and specializes in concussion assessment and rehabilitation.
Fletcher and club president Brad Ward are asking all young athletes with the club to take the $25 ImPACT test as a way to facilitate a proper return to sport following a head injury.
“The days of an athlete telling his coach how many fingers were being held up after a blow to the head are long gone,” Ward said. “Our organization wanted to be proactive in dealing with the issue in our sport.”
The ImPACT test consists of varying shape, number and word questions that measure visual memory, processing speed and reaction time.
Fifteen-year-old Brydan McMahon took his baseline test on Saturday.
“There were different number patterns and different shapes,” he said. “It kept switching it up and making it harder.”
McMahon plays centre on the junior varsity Bisons squad, as well as with the Brantford Collegiate Institute Mustangs.
“Every linebacker usually blitzes me and I am usually one of the first ones to get hit,” he said. “I decided to take the test to make sure we know as much as we can if I ever get a concussion.”
Having a baseline of a player’s score on the test when they are healthy can go a long way in determining when a concussion has fully healed, Fletcher said.
“Concussions are an invisible injury,” he said. “There is often pressure to return to play, especially at a competitive level. If a kid is on a path for a national team or to play for a scholarship, the athlete, mom and dad sometimes want them to go back and play. We need tests like this to know if it’s safe.”
Having the baseline ImPACT test allows Fletcher to have quantifiable data in which to aid in a player’s recovery.
“Without the baseline we can still do a comparison to their grades in school,” he said. “A C-level student should be able to get about 70 per cent on the ImPACT. But the baseline is our gold standard because it is adjusted for the athlete. It’s comparing apples to apples.”
Sixteen-year-old Emma Gratton did not have a baseline test to work with when she visited Fletcher’s clinic last spring after a serious concussion.
“Emma’s case was definitely one of the more severe ones we’ve ever seen,” Fletcher said.
During a trip with her Paris District High School rugby team to Australia, Gratton took a knee to the head during a scrum collapse. She was taken to hospital in Australia, where doctors said she was fine. But serious symptoms dogged her after returning to Canada.
“It turned out to be a skull fracture,” Gratton said. “It was constant headaches and dizziness. My eyes were blurry and my hearing wasn’t the same.”
Gratton had several months of recovery working with Fletcher and his team. They used the ImPACT test to track her recovery and determine when it was safe for her to return to sports.
She recently started playing hockey again and looks forward to getting back on the rugby pitch.
The ImPACT test is only one tool used by Cobblestone Medicine and Rehab, though, as Fletcher said balance testing, heart rate monitoring and other neurological exams come into play for more serious concussions.
Fletcher believes a rising awareness about concussions in sports is not due to an increased frequency of concussions, but rather the improved ability of doctors to diagnose a concussion.
“Ten or 20 years ago, we never had the research teams and testing,” he said. “I also work in Talbot Trail Physiotherapy at the St. Thomas Elgin General Hospital. Any (patients with) concussions that walk into the ER will be sent down to see our team. That never used to happen before. Kids would be sent home and told to rest in a dark room for a week.”
A 2005 study in the Journal of Emergency Medicine suggested that 88 per cent of concussions can go unrecognized by an injured person.
While rest in a dark room can heal about 90 per cent of concussions by allowing inflammation of the brain to go down, Fletcher said it’s the other 10 per cent of concussion sufferers who need planned rehabilitation if they want to fully recover.
“They need to come in and get treatment or they will never get better,” he said. “They are going to be those 40 year olds that have the 10-out-of-10 severe headaches every day.”
Fletcher said an athlete does not need to be knocked unconscious to suffer a concussion.
“A concussion usually occurs from acceleration and deceleration forces on the head and neck,” he said. “The individual does not have to lose consciousness. Most of the patients I see remain in the game and actually keep playing several days after the injury.”
But Fletcher said that time is often the most crucial for assessing the severity of a concussion and preventing further injury.
“The faster they can get in here and get it looked at the better,” he said. “Especially in the high-risk sports like football, soccer, hockey, rugby, boxing, wrestling and lacrosse. Athletes should definitely be coming in for an ImPACT test after any head injury.”
The exact mechanisms of a concussion’s effect on an individual is not fully understood by the medical community, Fletcher said.
“But many believe it is the compression on the brain from the skull,” he said. “These forces result in swelling and inflammation on the brain, progressing to decreases in blood flow, reduced energy, metabolism and trauma to sensitive brain tissue.”
Concussions result in an array of symptoms that typically are a mix of headaches, dizziness, altered memory, sleep disturbances and sometimes even personality changes.
Fletcher has helped build concussion management teams at Cobblestone Medicine and Rehab on Rest Acres Road and Dix Natural Health Centre on Paris Road. The teams include management of all symptoms by using health professionals in chiropractics, physiotherapy, family medicine, massage therapy, social work, diet, bracing and custom orthotics.
“The best thing individuals from any age group…can do is get evaluated by someone who deals with and has the knowledge behind them in concussion management,” Fletcher said. “Most concussions will resolve within seven to 10 days, but others will persist and get worse. It’s better to get looked at sooner than later.”