Pre-Season Testing and HS Athletic Injuries

Pre-Season Testing Can Lead to Better Management of Injured High School Athletes

High school football players hitting the field in the future will hopefully take some extra precautions to protect their brains. Over 250,000 football players, approximately 15 percent, suffer a concussion each season. The decision on when, and if, a player is ready to return to action is difficult for even the most skilled coaches and trainers.

"The problem with head injuries is that there are no definitive tests to administer when the brain is injured," Joseph Maroon, MD, a neurosurgeon, said. "There are aptitude tests, but there's no 'normal' to test the athlete against. If an athlete scores an 8 on a certain test, that doesn't really tell us anything without knowing what his score would have been before he or she suffered the concussion."

While working with the Pittsburgh Steelers, Dr. Maroon and his colleagues developed a battery of preseason neuropsychological tests for the team. Each player is tested before the season and the results are used as a comparison in the event the athlete receives a blow to the head. The entire National Football League and National Hockey League have now adopted these standards of preseason neuropsychological testing. Dr. Maroon and his colleagues will make the testing system available to high school teams soon through a computer software program.

Dr. Maroon will describe the testing system and new software program at the 67th Annual Meeting of The American Association of Neurological Surgeons (AANS) on April 27, 1999 in New Orleans, Louisiana.

"By having a baseline for each player at the beginning of the season, it provides a way to give coaches and athletes objective data on the player's status," Dr. Maroon said. "We use this system almost every game for the Steelers, and is how we assessed Merill Hodge and recommended he not return at all."

In a recent study, approximately 1800 professional, 500 college and 800 high school athletes were tested in the preseason. Sixty five percent of those were re-tested after suffering a concussion. The results were crucial in recommending that three professional players forego their athletic career and helped establish parameters for return to play in the rest.

Preseason neuropsychological screening involves testing cognitive actions like memory recall, the ability to utilize information and rapid eye-hand movements. The method includes the following tests: Orientation Questionnaire, Hopkins Verbal Learning Test, Color Trails, Oral Words Association, Symbol Digit Modalities, Ruff's Figural Fluency, PSU Cancellation Test and Post-Concussion Symptoms Scale.

"After a concussion, the patient can have problems with amnesia, confusion and concentration," Dr. Maroon. "The damage caused after one concussion is often reversible after an appropriate recovery time, but if a second injury is sustained before then, the damage can become permanent. The decision on when an athlete is ready to return to play isn't straight-forward."

The process of conducting neuropsychological testing is also challenging. After the initial round of testing, the athlete must be tested again within 24 hours after sustaining a concussion.

"The advantage of the computer is that the tests can be flashed on a screen and the results recorded," Mark Lovell, PhD, a neuropsychologist at Henry Ford Hospital in Detroit. "This takes away any inconsistencies in the administration of the test and makes it easier to pick up subtle changes in memory and recall."

The software program is currently being tested in colleges and high schools through a grant from the National College Athletic Association. The program will continue to be tested in the 1999 football season and will be ready for widespread distribution for the 2000 season.

"The biggest challenge right now is the ability to interpret the data," Dr. Lovell said. "In the testing phase, there is a doctor familiar with neuropsychological testing available to interpret the results. We are fine-tuning the software program and expect to be ready for widespread distribution in 6 months."

Founded in 1931 as the Harvey Cushing Society, The American Association of Neurological Surgeons is a scientific and education association with approximately 5,300 members in the United States, Canada and Mexico. It is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members must be certified by the American Board of Neurological Surgeons. Neurosurgery is the medical specialty dealing with the diagnosis and treatment of disorders affecting the nervous system, brain, spinal cord and spinal column.

# # #

For more information on the AANS, visit our Web site at www.neurosurgery.org.

Media Representatives: If you would like to attend the conference or interview a neurosurgeon - either on-site or via telephone - please contact the AANS Communications Department at (847) 692-9500 or call Barb Peck in the Press Room at the meeting beginning Sunday afternoon, April 25, 1999 at (504) 670-6434.