To help protect their brains, athletes are now given preseason computer tests that assess memory, concentration and reaction time. Some players don helmets with "concussion reduction technology" or use special mouth guards that promise to "prevent concussions and head injuries." Others pop pills promising to improve the brain's resistance to injury or help it recover faster.
As concerns mount over the dangers of concussions, especially in youngsters whose brains are still developing, so does the demand for products that purport to help diagnose the mild traumatic brain injury, reduce the risks or prevent it from happening altogether.
But although the harm from head injuries is increasingly well-documented by science, the validity of such claims so far is not.
Though parents routinely ask for a "concussion-proof" helmet, there is no way to prevent a brain injury during athletic practice or competition, short of not participating in the sport. No one knows exactly how long to keep a concussed player out of action. And in many cases, products claiming to offer "protection" and "faster recovery" are unproven and offer a false sense of security, experts say.
Football helmets, for example, have traditionally been designed to prevent skull fractures, not concussions. They are not systematically rated for concussion safety, and the Federal Trade Commission has been asked to investigate false and misleading helmet claims.
The National Advertising Division of the Council of Better Business Bureaus has advised one company to stop saying that its mouth guard "drastically" reduces concussions and "increases strength." And there are no human trials showing that dietary supplements can help the brain resist or recover from injury, as at least one company claims.
There's even a heated debate over whether computerized baseline testing — one of the most popular diagnostic tools and one recommended by the Illinois High School Association — can reduce an athlete's risk of harm.
The human brain will always be vulnerable to injury because it sloshes around freely inside the skull, said Julian Bailes, a co-founder of the Brain Injury Research Institute and medical director of Pop Warner Football.
So instead of seeking out products, experts say parents should put their energy into familiarizing themselves with the often subtle symptoms of concussion and asking coaches about teams' plans for addressing possible concussions on the field.
"Concussions are a public health crisis, as accurate diagnosis and effective treatment may be among the biggest challenges in medicine," said Dr. Philip Schatz, a neuropsychologist and brain trauma researcher at Philadelphia's St. Joseph's University. "All you can do is hope your child is honest about whether they have symptoms and hook yourself up with a good support system — people who know something about head injuries."
Identifying concussions is important in part because a second concussion that occurs before the brain recovers from the first — which can take hours, days or weeks — can slow recovery and increase the likelihood of having long-term problems, according to the Centers for Disease Control and Prevention. In extremely rare cases, victims experience a condition called second impact syndrome that can cause brain swelling, permanent brain damage and death.
Meanwhile, news reports about the struggles of former professional football players have raised awareness about the potential long-term impact of frequent but lesser hits called subconcussive blows. These are suspected of contributing to chronic traumatic encephalopathy, a degenerative brain disease that can impair memory and judgment and cause erratic behavior, depression and problems with impulse control.
But concussions, which don't reliably show up on imaging scans, are notoriously tricky to diagnose. About 90 percent occur without loss of consciousness, and symptoms range from headaches, vomiting and dizziness to confusion, clumsy movements, forgetfulness and feeling "off" or groggy.
The warrior mentality of the athlete also can interfere with diagnosis, said Glenbrook South athletic trainer Brian Robinson, who chairs the secondary school committee for the National Athletic Trainers' Association.
"They don't want to let down friends and coaches, so many athletes — and parents, unfortunately — try to hide them," Robinson said. "They say they feel fine."
Neuropsychological tests, now mandated for hundreds of thousands of athletes each year, are designed to help athletic trainers and coaches get a handle on those problems.
A computer test, ideally taken at the beginning of the season, measures attention span, memory and reaction time. If the athlete is thought to have suffered a concussion, the video-game-like program is readministered. If there is a large drop in the score, he or she is kept out of play and monitored until the score increases.
For Wilmette's Paul Sciortino, testing revealed a lingering problem. A month after suffering a concussion during a spring practice for Butler University's football team, his test scores showed he was still having problems with visual memory and reaction time.
After seeing a neuropsychologist, Sciortino went to a physical therapist who specialized in treating balance problems, and nearly three months after the collision he was cleared to return to play. But because the concussion was his fourth, he decided to switch to baseball for his junior year.
"I'll miss it, but I'll be doing what's best for me," said Sciortino, who may wear a batting helmet that promises increased protection from 100 mph pitches.
Critics say the computer programs are unreliable and may actually increase risks because they likely have a high "false negative" rate, meaning they may show an athlete has recovered when he or she is still cognitively impaired. Athletes may also deliberately perform poorly on the baseline test to avoid getting benched if an injury is suspected, further diminishing its usefulness.
Christopher Randolph, a neuropsychologist at Loyola Medical Center, published a critical review earlier this year of a widely used test called ImPACT, for Immediate Post-Concussion Assessment and Cognitive Testing. Among other objections, he questions whether the test can reliably measure recovery.
"I think the tests are essentially a waste of time," said Randolph, whose review appeared in the journal Current Sports Medicine Reports. "Team medical personnel are better off relying upon good clinical judgment until there is some real evidence that supports a different management strategy or any specific technology for this purpose."
Many leading brain experts disagree with Randolph. And nearly everyone — including ImPACT's chief executive officer, Dr. Mark Lovell — say baseline testing shouldn't be the final word in decisions on returning to play.
The software programs simply offer more objective data and allow many athletes to be tested at once, something that wasn't possible when pencil and paper were used, Lovell said. Formerly director of the University of Pittsburgh sports concussion program, Lovell developed and implemented league-wide neurocognitive testing for both the National Football League and the National Hockey League during the 1990s.
The National Academy of Neuropsychology has called the tests the "cornerstone" of a concussion assessment. Elizabeth Pieroth, a board-certified neuropsychologist at the Midwest Center for Concussion Care in Oak Brook finds them useful, but she adds that she sees plenty of patients who have no baseline testing.
"Regardless of what tool you use, good concussion management is about educating parents and families about how to manage injury," said Pieroth, who works with Northwestern University athletes and is the concussion specialist for the Chicago Bears, Blackhawks, Fire and White Sox.
"You don't need to be so fearful that you put your kid's head in bubble wrap," she said. "It's just like any other injury — you need to understand when enough is enough. If your child had three ACL surgeries, he'd likely be done with the sport. Parents need to make the same decisions about concussions."
Mundelein's Alec Wingender, 17, worried that his athletic career might be over in 2009 after he jumped for a header during a soccer game and collided with the goalie, suffering his fourth concussion.
In addition to vertigo and whiplash, Wingender had throbbing headaches; was dizzy, nauseated and short-tempered, and had trouble remembering things.
"He was very scared," said his mother, Margie Wingender. "We all were."
Pieroth tested Wingender and referred him to a physical therapist for balance training. Nine months after the head injury, he was finally able to return to soccer.
But concussions are never far from his mind. On the field, he admits, he's still scared to get hit. And in school he has written two research papers on concussions, including one for his advanced placement psychology class titled "To what extent does a concussion impact a student's ability to learn new material?"
He found that brain chemistry is altered almost immediately upon impact. And he received an A.
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