Follow-Up: Your concussion questions answered

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In this photo released by Georgia Institute of Technology shows Biomedical Engineering Assistant Professor Michelle LaPlaca, right, demonstrating a concussion DETECT _ Display Enhanced Testing for Concussions and mTBI system _ device with the help of football player Bryan Williams, left, on the field at Georgia Institute of Technology in Atlanta, in Sept. 3, 2004. The device helps quickly detect mild concussions in virtually any setting. (AP Photo/Georgia Institute of Technology, Nicole Cappello)

In the wake of injuries sustained by prominent Philadelphia athletes and an increased emphasis on awareness about head injuries, Sports Doc has devoted a good deal of coverage to concussion treatment and prevention this fall. In a follow-up to his post last week on ImPACT Tests, today, Robert Franks, D.O. answers your questions about concussions.

Our school district currently performs baseline tests on our athletes (grades 9-12) on a yearly basis. We are also beginning to look at testing our Middle School athletes (grades 7-8) next season. My question is how often should an athlete take a baseline test?

-Sean Kelly, Central Bucks West High School athletic director

Dr. Franks: Baselines should be done every other year. ImPACT tests are reliable for ages 10 and older, and we perform them in alternate years. So if you took the test in 7th grade, you should take it again in 9th and 11th grades.

Your article on Friday said, “If a baseline is not available, the athlete is compared to their sex and age matched peers to determine in what percentile their score falls.” How is it possible to perform this comparison?

-George, Atco, N.J.

Dr. Franks: Ideally, we compare the athlete’s baseline test results to the results on the same test after they are concussed. But if we don’t have a baseline test, the data pool now is so big that our computer can generate the percentile that an athlete falls into comparative to their age- and sex-matched peers. For instance, we can say ‘Of all 16-year old males who took this test, your verbal memory scores put you in the 80th percentile.’

Recently, I read about some football players who are using or planning to use Kevlar-based protective padding in their helmets. One study concluded that the material can reduce some head trauma and possibly reduce concussions. However, there seems to be some reluctance by teams to using the pads. There seems to be a need to explore preventative measures. Any thoughts?

-Derek, Atlantic City, N.J.

Dr. Franks: There are many devices or products that people are using or recommending—another suggestion is placing protective shells over the top of helmets. But the data is still inconclusive, and the studies are not numerous enough at this point to create a drastic change. Most of the studies have been smaller, and while certain products are showing promise it’s too early to make a firm recommendation.

Are there any studies that compare specifically the safety or injury occurrence of girls’ ice hockey to other girls’ sports like soccer, basketball, field hockey, lacrosse or cheering? The trainer at our high school tells me that she's amazed she's always treating the girls from these other sports, but she is not seeing girls from ice hockey.

-Ron Hutchins, Mt. Ararat High School Girls’ Ice Hockey Head Coach, Topsham, Maine

Dr. Franks: There are numerous studies that focus on girls’ sports or female athletes in particular. I do not know of any specifically dedicated to girls’ ice hockey, however, that isn’t a large portion of my patient base. In New Jersey, where I practice, boys’ ice hockey is a club sport and we see very few girls who are ice hockey players.

We’ve seen plenty of data out there on female athletes—we know that women are more vulnerable to concussions, and we’re doing numerous studies to figure out the causes of that vulnerability. Most likely, it’s multi-factorial—different neck structure, muscle strength, and possible hormonal influence. Just like the increased incidence of ACL tears in women, there are a number of contributing factors.

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