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Oxbow Applies Concussion Testing System To Athletes

Oxbow Union High senior Caleb LaFaille pores over a question on the online imPACT concussion test at the Bradford, Vt., school in late August.
(Valley News - Greg Fennell)

Oxbow Union High senior Caleb LaFaille pores over a question on the online imPACT concussion test at the Bradford, Vt., school in late August. (Valley News - Greg Fennell) Purchase photo reprints »

— Rich Thornton believes in concussion testing. As athletic director at a high school with a varsity football program, he believed in it enough to have tried it on his own before help arrived.

He’s been especially thankful since Dartmouth-Hitchcock Medical Center began its outreach program to area schools, offering to administer testing through Pittsburgh-based imPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Applications. The Oxbow Union High School AD has roughly 200 student-athletes under his watch, and he views it as essential to have a good gauge on their health.

“I did the imPACT testing myself two years ago, and I found doing it myself, it was just overwhelming,” Thornton said. “I’m a one-person department, more or less, and I just got bogged down in it. And I started to hear reports that there was some unreliability about the test itself if it’s not administered properly. So I said until I can get more resources working for me, I’m going to disband it.” With the help of DHMC’s orthopedics department, testing resumed at Oxbow last August after a one-year hiatus. The hospital’s sports medicine section added schools up and down Interstates 89 and 91 as fall sports ramped up.

“If an athlete sustains a concussion on the field of play, we want them pulled out of play, and we want them evaluated and not returned to play or returned to school until they have been adequately evaluated and their symptoms have resolved,” said Susanna Gadsby, the nurse coordinator for DHMC sports medicine who oversaw the Oxbow testing.

“The imPACT gives us a tool to help clear them to return to play. It sort of takes a little of the guesswork out of sending them back, because if they tell us their symptoms are clear, they feel great and they’re ready for this Saturday’s championship game, sometimes that can be a little difficult to believe.” Using imPACT enables a school to get a set of baseline statistics against which to compare when an athlete sustains a head injury. Under DHMC’s guidance, Oxbow student-athletes went through a 40-minute, computer-based memory and reaction test as well as a short set of balance tests with one of the sports medicine department’s athletic trainers.

Emphasizing memory and reaction, the imPACT test is challenging enough to a non-concussed brain.

“This thing is designed to confuse you; it’s hard on the head,” Thornton said with a grin. “So if you’re still hurting, you will walk out really confused.” The balance tests — standing still with eyes closed, balancing on one leg and the like, both on the floor and on a stability pad — add a neurological component to concussion review, Gadsby said.

“If you are concussed and you have some inner ear injury from that, you’re not going to do anything,” she said. “Even standing here with your feet together, you’re going to be all over the place because you’ve lost your ability to center yourself.

“This is just getting their baseline stuff. If they are concussed, all of that information is going to be available. They’ll come either to Dartmouth or (to their doctor) and then we’ve got this information and they’re tested against themselves. If they don’t have a baseline, there are 3 million student-athletes who have done this test in the database, so they are tested against normative values for their age group, their gender, their academic standing, their history.” Gadsby said initial testing requires a level of trust in the students, making the assumption they haven’t sustained a recent concussion and will test to the best of their abilities. On the other hand, imPACT is set up to throw a “red flag” in telltale cases.

“For instance, we happened to have the entire football team in here, which probably didn’t make it any easier because they were pals, they probably weren’t focusing as well,” Gadsby said. “One of the tests was invalid, so he’ll have to come back.” The imPACT test — whether Thornton administers it or he enlists DHMC’s help — costs $500, which nets 300 initial tests and up to 90 follow-ups for concussed athletes, he said. It’s well worth the investment, especially for a school with a football team.

“We’re going to take every advantage we can with these (medical) people,” Thornton said. “I think the safety of our athletes, all our student-athletes, is my No. 1 concern, and it should be the No. 1 concern of our coaches, too.”

Greg Fennell can be reached at gfennell@vnews.com or 603-727-3226.