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Study: Concussion recovery time prognoses possible

| Tuesday, Feb. 28, 2012

Kaylee Amend, 16, is coping with a sixth concussion in seven years. The latest, she learned Monday at the UPMC Sports Medicine facility on the South Side, will prevent her from attending classes at Mt. Lebanon High School for the next four weeks.

"That made me feel better," Amend said.

Her reaction did not surprise Michael Collins, a clinical psychologist with extensive neuropsychological training who heads the UPMC concussion program.

Amend — a cheerleader injured from a fall during a stunt drill Jan. 30 — is one of several youth athletes Collins said he has confidently provided a recovery-period prognosis over the past few weeks. His confidence stems from data provided by the University of Pittsburgh/UPMC joint study on concussion prognoses.

"Some kids just don't do well," Collins said. "I knew that all along. This just helps have scientific support."

Collins authored the study along with his predecessor at the UPMC concussion clinic, Mark Lovell, the software developer for the ImPACT test and CEO of ImPACT Applications Inc. Collins serves on ImPACT's board.

The study's third author was Dr. Brian Lau of the Pitt School of Medicine and a clinical psychology fellow.

Collins is part of the concussion team treating Penguins center Sidney Crosby, who has played in just eight NHL games since Jan. 6, 2011, when he was first diagnosed with a concussion.

This study, conducted from 2002-06, focused on 108 high school football players who took the computerized ImPACT test within two days of a concussion diagnosis. Of those players, 50 required a recovery period of 33 days (on average) before gaining clearance to play.

Collins said those players showed similar physical symptoms in addition to low scores in two of the four ImPACT categories: visual/memory and processing speed.

A normal score in those categories is 40, Collins said.

"If you score 24 on processing speed, you have an 85 percent chance of taking more than a month to recover," he said. "Also, patients that have migraine headaches, sensitivity with light and noise, and that fogginess — those are highly consistent symptoms with patients that take longer to recovery."

Armed with this data, Collins said he is "getting a lot more confident in saying which patients aren't going to do well" with concussion recovery.

"Nobody has really ever talked about prognostics," Collins said, predicting that researchers and clinicians are "getting closer to a concrete prognosis" regarding concussion recovery time — previously an unimaginable possibility in the opinion of most experts.

"I don't think that goal is that far off," Collins said. "We have a lot of work to do, but I see it as a possibility within a few years for return to play prognosis."

Finding a consensus on how to best diagnose a concussion remains a hot subject of debate in the medical field, said Dr. Jeffrey Kutcher, an associate professor of neurology at the University of Michigan and head of the NBA's concussion program.

"I don't think we're very close at all to having a test specific for concussions," he said.

Kutcher said the Pitt/UPMC study results "are not surprising given the nature of those tests in the situations in which they're administered."

Crosby, who has not played since Dec. 5 because of neurological symptoms including headache, has not failed his most recent ImPACT test.

"The observation that somebody who is having symptoms, most likely from a concussion, has a 'normal' impact test underscores my point," Kutcher said.

"A lot of things can impact these tests. ImPACT tests and (baseline) tests like it should not be used to diagnose. I feel very strongly that a return to play decision is a medical decision and needs to be made by physicians."

The Youth in Safety Sports Act, passed by the state Senate last Nov. 1, mandated concussion protocol in Pennsylvania youth sports for the first time. It allows a licensed physician to designate "a certified health care professional trained in the evaluation and management of concussions" to treat youth athletes, along with a licensed psychologist with neuropsychological training.

Amend said she had never been evaluated by Collins before yesterday, though she was treated by Lovell while he was at UPMC.

She said Mt. Lebanon High School athletic trainers administered an ImPACT test two days after her injury in late January. She was told to see Collins because the trainers said they could not clear her, she said.

Amend's ImPACT scores after taking the test yesterday "were worse," she said.

Neither Amend nor Collins would say if she would return to cheerleading given the total of her concussion diagnoses.

She will undergo vestibular and physical therapy, the former because her eyes start "losing focus at 27 centimeters," she said.

"(Collins) said I would feel better, that I would recover," Amend said. "But he did say it would take at least a month. When he said that, I felt better. At least I kind of know what to expect for how long."

Recovery road

A recent joint study by the University of Pittsburgh and UPMC produced results that showed some youth athletes can take at least a month to heal from a sports-related concussion. Details of the study, published in the February issue of Neuropsychology magazine:

> > 108 high school football players underwent ImPACT cognitive baseline testing within two days of a concussion diagnosis.

> > 50 players' recovery lasted 33 days (average) before gaining return-to-play clearance.

> > The longer rehabilitation periods could be predicted by specific cutoff scores from visual and processing speed components of the ImPACT test.

> > Players who scored above the cutoff levels recovered within a median of seven days.

> > Consistent predictive lengthier rehabilitation symptoms included migraine headaches and disorientation.

Source: UPMC Sports Medicine Concussion Program

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