Fidgety little Indians and big Indians -- from Peters youth football to West Allegheny High middle-schoolers, junior-varsity and varsity -- lined up in shorts and T-shirts to take the ImPACT test in early August.
So did hundreds of teams across Western Pennsylvania and thousands beyond. Some 120 organizations, 15,000 football players and 48,000 athletes from the region's ZIP codes alone subscribe to this baseline examination, a valuable tool in assessing brain function before and after a concussion. Nearly half of the high schools across the state employ this UPMC Sports Medicine test, said Mark Lovell, who has a doctorate in neuropsychology and is an internationally acknowledged expert in concussions. He expects the figure to hit 75 percent next year.
It is used in all 50 states, the District of Columbia and across Canada; throughout professional hockey and football; by Major League Baseball and its umpires; Major League Soccer; and the NCAA. It is given in 14 languages, including Cantonese and Mandarin.
There are other measures and tests. But ImPACT remains one of the most-used and scientifically validated in America. Dr. Lovell began formulating the test at Allegheny General Hospital and the Henry Ford Health System in Detroit with co-founder Michael "Micky" Collins. In 2000, Dr. Lovell joined UPMC with Dr. Joseph Maroon, the Steelers team neurosurgeon, who a decade earlier started seeking a concussion test to satisfy then-coach Chuck Noll's requirement for objective data.
Dr. Lovell partnered with Penguins team physician Dr. Chip Burke in bringing it to the NHL and with Dr. Maroon, in bringing it to the NFL and to the world -- online. However, the preferred method is via a supervised school software program, where the big Indians did theirs in West Allegheny High's computer lab, or in physicians' offices such as UPMC Sports Medicine's South Side headquarters, where little Indians took it.
As with drug-detection urinalysis, there can be attempts to cheat in brain tests.
"Athletes are so competitive nowadays, people will do anything," Dr. Lovell said. But built-in safeguards and re-testing bring results in line.
What is this 20-minute test that athletes are recommended to take every other year to record their up-to-date baseline?
The computer exam begins with biographical questions, such as the test-taker's sport of participation, whose options range from cheerleading to rowing to skateboarding to skiing. It includes football categories from middle school to freshman to junior varsity to varsity to simply the general football.
The personal information, most important, asks the patient to rate his/her concussion-related symptoms on a numerical basis of severity: headaches, nausea, vomiting, balance problems, dizziness, fatigue, sleeping too little or too much, sensitivity to light or noise, numbness, fogginess and so on.
Then comes the actual exam: It's a stress test for the brain, causing the heart rate to rise and checking symptoms. It is common for a concussed athlete to complain of a headache or dizziness from the test itself. West Allegheny High athletic director and longtime athletic trainer Dave McBain called it a 40-yard dash for the brain. If it finishes with worse numbers than in the first race, the time has come to rest it.
There are six test parts, called modules. First comes words to jog the memory -- you get two chances to learn them, and a series of questions to test that memory. The second part entails designs to recall. The third is a speed study in memory, containing a red circle, a blue square and a quick-twitch click of the mouse to identify them. The fourth section involves numbers and shapes; the fifth, a cognitive probe using colors. Finally, there is another reaction test with numbers, clicking backwards from 25 to 1 -- Dr. Lovell said only a few NFL quarterbacks reached 1 -- and recalling placements of X's and O's.
"You'll see scores go from the 80s to the 1st percentile," Dr. Lovell said of the precipitous drop from the inaugural baseline test to the post-injury retake. "You see parents freak out at times, and I'll tell them, 'Don't worry, that will be back to normal.'
"We start to worry when they hit the three- to four-week mark and they continue to have significant symptoms. Sometimes, they tell you what you want to hear about how they're really feeling." He waved a copy of one high-school lineman's retest, the result objectively showing cognitive progress. "Which is why we do this in the first place."