UPMC doctors developed stress test for brain
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It's called the invisible injury because the damage is inside one's head and the symptoms of headache, nausea, wooziness or spotty concentration don't show up like a swollen ankle or a broken nose.
So to treat, prevent and understand concussions, doctors at UPMC have made it observable through a groundbreaking test that tracks mental acuity, before and after brain trauma.
"It puts the brain through a stress test," said Dr. Mark Lovell, director of the sports medicine concussion program for the University of Pittsburgh Medical Center. "It's a tool that allows us to study the cognitive process -- how we think, how we remember. It alerts us when the brain is not functioning properly."
A concussion is the violent shaking or jarring of the brain. The injury has been in public conversations this week because Steelers quarterback Ben Roethlisberger missed a game after taking a knee to the head in Kansas City. He is expected to have medical clearance to play Sunday.
But big-time athletes in violent professions don't have a monopoly on head injuries. The first two days of this week, Dr. Lovell saw 24 patients at his South Hills office -- high school cheerleaders, kids hurt in car crashes, football players, a soccer player. At all three UPMC clinics where concussions are treated, the number is 200 a week. According to national figures compiled by the Centers For Disease Control, up to 3.6 million people suffer concussions each year.
"We thought it would slow down after football season, but it hasn't," Dr. Lovell said. "It doesn't just happen to football players. Concussions can occur in virtually every sport."
Athletes are said to play with heart or to have golden arms and crazy legs, but the brain is the most important and least understood organ in the body.
It has been called a three-pound universe, or the final frontier in medicine. The brain allows us to perceive the world and perceive ourselves. It is the home of the sense of self.
"The brain runs things," said Dr. Lovell. "We don't understand it as well as other organs in the body because it's so complicated. We're learning by leaps and bounds, yet almost everything we know about concussions we've learned in the last five to 10 years."
The experts note that no two concussions are the same, just as no two people have identical thought processes.
In the past, athletes who suffered brain injuries were said to have had their bell rung, a terrible misnomer.
Early testing was as primitive as holding up fingers in front of an athlete or asking what day of the week it is.
Understanding was just as primitive. For example, Chuck Muncie, who had a remarkable college and NFL career, was kicked off his high school team in Uniontown because he wouldn't play with a concussion in the early 1970s.
Then along came ImPACT (Immediate Post-concussion and Cognitive Testing). It was created and developed by Dr. Lovell and first used through the Steelers in the 1990s. In fact, running back Merrill Hoge established a baseline with the Steelers, which was consulted after he went to the Bears and endured two concussions that led to his retirement.
Dr. Lovell is associated with Dr. Joseph Maroon, the Steelers' neurosurgeon who made the call to sit Mr. Roethlisberger on Sunday. UPMC also has four other Ph.D.'s in its sports concussion program.
Administered on a computer, ImPACT takes 20 minutes to complete. Essentially, a combination of words, colors, shapes and numbers are used to test recognition, memory and reaction times. (One side effect of taking the test is a headache, because the test stimulates blood flow in the brain.)
For example, the test gives a number sequence to a series of shapes. The participant will then be asked to match a number to the corresponding shape. Also, a list of words is shown, and the participant is asked to say if a word was or was not included on the list.
As a comparison, the baseline number is like the time an athlete can run the 40-yard dash. If one's speed goes from 4.3 to 4.8 seconds, it would be an indication that something is wrong. If a concussion test shows a number significantly different from the baseline, the alarm sounds for doctors.
"The number we get from the test establishes a standard for us to work from. It alerts us if the brain isn't functioning properly," Dr. Lovell said. "We've given the test 800,000 times. We know what normal is."
A blow to the head can cause a "firestorm" in the brain, Dr. Lovell said. A concussion changes the chemistry in the fluid surrounding the brain, which makes billions of functions a second based on chemical reactions. An injury could interrupt synaptic pathways and lead to dysfunction.
"Nobody wants their athletes hurt. It's not good for the athlete, it's not good for the team, it's not good for the sport," Dr. Lovell said. "Testing is 100 percent about protecting the health of athletes."
Testing can be done in 14 different languages.
It should also be noted that while athletes receive a lot of attention because of concussions, the Maine National Guard is testing its soldiers. It's a reminder about priorities that the blast wounds and head trauma suffered by troops in Afghanistan and Iraq get less publicity than the concussions of big-time quarterbacks.
Meanwhile, the tests place the decisions about returning to action on doctors rather than on coaches or players.
"We know they are extremely competitive people who do not want to talk about symptoms. We know athletes will not police themselves. They're interested in playing. Our interest is in protecting them, sometimes from themselves," Dr. Lovell said.
About 80 percent of NFL players, who have a higher than normal recovery rate from injuries, can mend from a concussion in three weeks. The remainder can take significantly longer.
Incurring a second concussion before the first heals can have long-term consequences, particularly in children.
UPMC has been able to provide blanket test coverage to high school athletes in Western Pennsylvania. The cost to test a school is about the cost of two football helmets, Dr. Lovell said, and there are sponsors who are picking up some tabs.
High schools in all 50 states use the UPMC test. And it's important to test early.
"Some kids have had three or four concussions by time get to high school," Dr. Lovell said.
"Only a small percentage of kids make it to the NFL. We don't want them to lose their brains before they end up needing it."
First Published December 3, 2009 12:00 am