Concussions detectable on the sidelines in children as young as 5

A vision test that can be done on sidelines to detect concussions was shown effective in children as young as 5 years old.

New research from the NYU Langone Concussion Center finds that a simple eye test, which can be administered in less than two minutes, can effectively diagnose a concussion and help determine whether a student athlete as young as 5 years old should return to a game.

The new study, published online in the Journal of Neuro-Ophthalmology, was conducted on 89 NCAA athletes and a younger subset of 243 youth athletes under age 17, and shows how the eye test, known as the King-Devick test, could help mitigate the problems that face concussion diagnosis in youth sports.

Study author Steven Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of Neurology at NYU Langone Medical Center, says the test can easily be administered on the sidelines by parents and non-health care professionals when athletic trainers and doctors are not available to monitor sidelines at youth sports games.

"Our findings in children and collegiate athletes show how a simple vision test can aid in diagnosis of concussion at all levels of sport," says Dr. Galetta, who is also a professor of ophthalmology at NYU Langone. "Adding the King-Devick test to the sideline assessment of student athletes following a head injury can eliminate the guesswork for coaches and parents when deciding whether or not a student should return to play."

As part of the King-Devick test, athletes read numbers off of three pieces of paper while being timed with a stopwatch. A worsened performance from a baseline reading suggests a concussion has occurred.

"Given that concussions may cause devastating short- and long-term cognitive effects, tools like vision testing that can objectively diagnose a concussion are critical," says Laura Balcer, MD, co-director of the NYU Langone Concussion Center, and a professor of neurology, ophthalmology and population health at NYU Langone.

Some sideline tests only measure cognition and balance, but visual testing is rarely performed, despite longstanding evidence that vision is commonly affected by concussion, according to a review article published by Dr. Galetta and Dr. Balcer in the March 3 print issue of Journal of Neuro-Ophthalmology. Previous research suggests about 50 percent of the brain's pathways are tied to vision.

The King-Devick test was developed in 1976 by optometrists Dr. Alan King and Steven Devick. Previous studies have looked at the test for neurological conditions that can affect vision like multiple sclerosis, before the researchers began testing it on athletes.

While earlier studies by the NYU Langone researchers looked at the King-Devick test on college athletes, this is the first to administer the test in children.

For the new study, researchers recruited 243 male and female athletes between the ages of 5 and 17 years old participating in a local youth hockey and lacrosse leagues, and 89 athletes who played these sports at the collegiate level. All of them underwent a baseline King-Devick test before the start of the sports season.

As part of the test, participants read numerical on cards from left to right as quickly as possible. Times for all three reading cards are added together, and then that number is compared with the baseline score: higher testing times suggest a worsening of performance consistent with a concussion.

All the student athletes were also given a brief cognitive test called the Standardized Assessment of Concussion (SAC) which measures memory, concentration and recall, and a Timed Tandem Gait Test, which is a timed walking trial.

Researchers determined 12 athletes sustained a concussion during the season. After matching them to control subjects of the same age and sport who did not experience a head injury, the study showed the King-Devick test outperformed the other two tests in distinguishing a concussed athlete versus an uninjured control subject with 92 percent accuracy (compared to 87 percent for Tandem Gait and 68 percent for SAC test).

Among concussed athletes, K-D scores worsened by an average of 5.2 seconds compared to baseline scores, while non-concussed athletes improved their times by 6.4 seconds compared with baseline.

Up to 3.9 million sports-related mild traumatic brain injuries, or concussions, occur annually in the United States, according to the Centers for Disease Control and Prevention, but researchers say that number is likely higher since the CDC only tracks emergency room visits.

Experiencing a concussion in a game increases an athlete's risk for sustaining a second condition in the same season by three times. Other complications include the dangerous second impact syndrome, or other short- and long-term side effects.

The group next plans to study the underlying mechanisms of the fast eye movements required for rapid number naming using electronic quantitative eye movement recordings in collaboration with Janet Rucker, MD, the Bernard A. and Charlotte Marden Associate Professor of Neurology and J.R. Rizzo, MD, director of the Visuomotor Integration Lab at Rusk Rehabilitation. According to Dr Balcer, these observations may permit more precise anatomical correlations of performance data and concussive symptoms.

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Vision tests may help spot concussions

Research shows that a vision testing on the sidelines at games can help determine if a player has had a concussion or not. Caution if the athlete has a reading disorder. JR

A simple vision test given on the sidelines can help identify athletes who've suffered a concussion, a new study finds.

Researchers found that the test -- known as the King-Devick, or K-D -- was able to detect 79 percent of concussions among college athletes who were followed over a season. When the results were combined with those of two other screening tests, all of the concussions were caught.

The findings were released Wednesday by the American Academy of Neurology (AAN), ahead of its annual meeting this spring.

Experts said the study bolsters evidence that the K-D is a reliable way to help spot athletes' head injuries -- though the test, by itself, is not enough.

"People have been looking for quick, on-the-field screening tests," said Steven Broglio, an athletic trainer and director of the NeuroSport Research Laboratory at the University of Michigan in Ann Arbor.

The new findings suggest the K-D is "one option," said Broglio, who was not involved in the study. "But it's not definitive, and you wouldn't want to rely on this alone," he added.

The K-D takes a minute or two, and it can be given by an athletic trainer, coach or even a parent right on the sidelines. It requires test-takers to read a few rows of single-digit numbers that are unevenly spaced, as quickly and accurately as possible. If they are slower to finish than they were on their "baseline" test -- taken before the season starts -- that's a potential sign of a concussion.

There are other sideline screening tests already in use, including ones that test balance and short-term memory.

But the K-D test "fills a gap" by looking for vision-related problems, explained study co-author Dr. Steven Galleta, chair of neurology at NYU Langone Medical Center in New York City.

Concussions can cause a wide range of symptoms that are often subtle at first. Symptoms like worsening headache, dizziness, nausea, fatigue and confusion might not become obvious until hours after the knock to the head. Plus, even when athletes are suffering immediate problems, they might not tell anyone.

"Some athletes don't recognize the symptoms, and some try to hide them because they want to stay in the game," Galleta said.

A number of professional groups, such as the AAN and National Athletic Trainers' Association, say that athletes who've potentially suffered a concussion should be taken out of the game or practice immediately.

For the new study, Galleta and his colleagues followed 217 athletes at the University of Florida -- including male football players, and female lacrosse and soccer players.

At the start of the season, they all took the K-D, as well as two other sideline screening tests: the BESS, which measures balance; and the SAC, which measures abilities such as short-term memory (asking the athlete to memorize and recall five words) and "orientation" (asking the player to name the day, month and year).

Over one season, 30 athletes were diagnosed with a concussion. And when the researchers looked at their sideline test results, 79 percent showed slower times on the K-D, compared with their pre-season performance. Adding the SAC and BESS results improved the detection rate to 100 percent.

Part of the appeal of the K-D is its simplicity; it can be used by "laypeople," including coaches and parents, Galleta noted. That raises the question of whether it can be used in high school and youth sports -- where there is often no athletic trainer or other health professional on the sidelines.

Studies are currently testing the K-D's usefulness for kids as young as 6, said Dr. Laura Balcer, a professor of neurology at NYU Langone who also worked on the study.

But regardless of what the K-D or other screening test shows on the sidelines, Balcer said there is "no substitute" for parents' judgment. If they notice any potential signs of concussion after a game or practice, they should take their child to the doctor immediately, she said.

"Parents know their kids best," Broglio agreed. "If you notice a change in their behavior, it's probably worth it to have them evaluated."

According to the U.S. Centers for Disease Control and Prevention, more than 173,000 U.S. children and teens land in the ER each year because of a concussion suffered during sports or recreational activities, like bike riding.

But the overall number -- including kids not seen in the ER -- is probably much larger: the CDC estimates that across age groups, up to 3.8 million Americans sustain a sports-related concussion each year.

In general, experts say kids with concussions should be symptom-free and get a doctor's OK before returning to sports. The biggest concern is that, if they sustain another knock to the head while they are still recovering from the first concussion, they could suffer so-called second-impact syndrome -- which can cause potentially fatal bleeding inside the skull and brain swelling.

The data and conclusions of research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

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A blood test may help diagnose concussions

This article discusses research that claims that a blood test could be a non-subjective way to diagnose a concussion.

A report Monday in the journal Pediatrics says kids who suffer concussions should lay off reading, homework and video games. By giving their brains a rest, most can recover in 20 to 50 days, about twice as fast as those who keep doing those activities.

We also have news regarding how concussions are diagnosed. Researchers are developing a test that could be a game changer.

Quarterback Taylor Kelly of the Arizona State Sun Devils understands the mindset of college football players when it comes to injuries: They are going to want to keep playing.

"Guys just want to go out and play it, you know?  They don't care if their heads are a little banged up," Kelly said.

Neurologist Dr. Javier Cardenas specializes in brain injury. He says overcoming the reluctance of athletes to admit symptoms is only one of the problems in diagnosing concussions.

"Right now when we identify a concussion it is purely subjective. We look at symptoms. Do they have headaches? Do they have dizziness? There is no objective information. Having something objective is the holy grail of concussion," said Cardenas.

This season, Kelly and his teammates took part in a study trying to find a better way to detect concussion. Riddell, the athletic equipment company, supplied the team with helmets that measure all head impacts during practices and games. Then, after every game, the players gave samples of their blood, saliva and urine.

These are now being analyzed at the Translational Genomics Research Institute in Phoenix to see whether evidence of head trauma shows up in body fluids as a so-called biomarker.

Brain cells contain generic material call microRNA. Normally, tiny spheres containing that material break off and make their way into the spinal fluid, then the bloodstream. During a concussion, the bran actually bounces against the skull, and researchers believe the impact can cause changes in the microRNA, changes they hope can be detected in blood tests.

TGen scientists are comparing the RNA in each player's body fluids with the impact data from his helmet to see if they match up.

"It might be that we can actually protect players. So identify players who are at risk but have them take it easy, sit out more, based how their biomarkers are rising over time," said Kendall Van Keuren-Jenses, a member of the research team.

The scientists have data illustrating how the technology might have helped one of the players in the study.

The graphic shows the head impacts recorded in his helmet over several weeks. One hit was the equivalent of four times the punch b a heavyweight boxer – the hardest impact received by any player in the study. He continued to play, and was diagnosed with a concussion 10 days later.

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Concussion tests are outpacing scientific research

Computerized concussion testing is becoming more common in sports even though there is little scientific research regarding the tests' effectiveness. Professionals should learn the benefits and limitations of the computerized tests they use.

Computerized neurocognitive testing for concussions is widely used in amateur and professional sports, but little research over the past decade proves its effectiveness, a paper published this month in the journal Neuropsychology Review says.

Jacob Resch, director of the Brain Injury Laboratory at The University of Texas at Arlington, is lead author on the review, which updates a 2005 look at the available research on computerized neurocognitive testing. In 2005, researchers said not enough evidence existed to support clinical use of the then relatively new assessments.

The more recent work acknowledges that computerized tests, such as those marketed under the name ImPACT, HeadMinder, CogState, and ANAM, have become extremely commonplace across the sports world. But, the authors still urge caution with their use and point out a need for more peer-reviewed studies.

"Limited data has been published since 2005 to assist clinicians in determining the clinical value of this form of testing," Resch said. "While these products are an important component of concussion management, their development, marketing and sales seem to have outpaced the evidence. So, some caution is needed."

Co-authors are Michael McCrea, an author of the 2005 study and director of brain injury research at the Medical College of Wisconsin, and C. Munro Cullum, professor and head of the neuropsychology program at UT Southwestern Medical Center.

"Given the attention that concussion in sport has gained in recent years, it is surprising there has not been more research into the some of the newer computer-based methods used to evaluate post-concussion symptoms," Cullum said. "Since there is no single brain-test or biomarker for concussion at this point, the diagnosis of concussion remains a challenge in many cases, as it relies upon reported and observed symptoms."

Resch, McCrea and Cullum found 29 peer-reviewed articles since 2005 have addressed the characteristics of commercially available computerized neurocognitive tests. After a detailed analysis, they concluded that evidence on reliability and validity of the tests wasn't consistent.

For example, in a May 2013 study published by the Journal of Athletic Training, Resch and other researchers found that the ImPACT test misclassified healthy study participants as impaired as much as 46 percent of the time for some evaluation factors. ImPACT stands for Immediate Post Concussion Assessment and Cognitive Testing and is by far the most used computerized neurocognitive test for concussion management.

An Institute of Medicine report early this year said that the number of people 19 and under treated in U.S. emergency rooms for concussions and other non-fatal, sports and recreation-related traumatic brain injuries increased from 150,000 in 2001 to 250,000 in 2009. With the recent settlement of a landmark lawsuit filed by former NFL players, concussions remain in the headlines and on the minds of athletes, parents, coaches and others in the sports world.

Recently, nearly 40 percent of athletic trainers reported using a computerized neurocognitive tests as part of their response to a sports-related concussion, according to the new paper. The convenient computerized tests are typically used, just as pen and paper versions were in the past, to establish a baseline to use as a point of comparison after an athlete is injured. But, because concussion symptoms can vary widely across individuals and may be subtle, clear documentation of mild brain injury can be difficult.

The findings of the new survey should serve as a caution to those utilizing and interpreting computerized cognitive test results, the researchers said.

"Neurocognitive testing is an important component of the concussion assessment, but should not be used as a stand alone method to diagnose injury or determine an athlete's level of recovery and fitness to return to play," said McCrea. "A multi-dimensional approach is supported by the evidence as best practice."

Until more research is done, the new paper from Resch, McCrea and Cullum recommends healthcare professionals who use the tests take some precautions, including:

• Making an informed decision when choosing a test and investigating its limitations.
• Making sure the test is part of a multi-faceted concussion management approach.
• Incorporating a clinical neuropsychologist into the sports-related concussion management team to assist in interpretation of test results.
• Ensure proper training of those administering the test.
• Conducting quality control reviews of baseline testing.

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Too little sleep skews concussion testing results

Garbage in, garbage out. 

I tell my patients that, if they are going to do computerized concussion testing, make sure the testing setting is optimal AND interpreted by a neurologist or psychology specialist. 

Why would you want to compare your POST-CONCUSSION test to a poor baseline?

JR

A new study shows getting too little sleep the night before baseline testing for concussions can skew results and make future concussions seem less serious.

Getting too little sleep the night before undergoing baseline concussion testing can skew results, a new study finds.

Baseline concussion testing depicts an athlete's basic mental abilities, such as reaction time, working memory and attention span. Athletes who suffer a concussion retake the test, and if there is a large decrease in the score, they are typically banned from play until their score improves.

The study included more than 3,600 high school- and college-aged participants who were divided into three groups based on their amounts of self-reported sleep the night before baseline testing: fewer than 7 hours, 7 to 9 hours, and more than 9 hours.

The athletes who slept fewer than 7 hours the night before testing had significantly lower scores than expected on reaction time, verbal memory and visual memory. They also had significant differences in the total number of reported symptoms, compared to those in the other two groups, the study authors noted.

The study was scheduled for presentation Saturday at the annual meeting of the American Orthopaedic Society for Sports Medicine in Chicago.

"Understanding factors which modify baseline testing, potentially including sleep, will continue to help lead to more accurate concussion testing, which ultimately equips clinicians with the best judgment to avoid returning athletes to competition earlier than necessary," one of the researchers, Jake McClure of Vanderbilt University in Nashville, Tenn., said in a society news release.

The data and conclusions of research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

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A new study shows that females and males have no difference in testing after a concussion.

As female participation in sports grows rapidly, there is a popular notion that there are gender-related differences in athletes' responses to sports-related concussion, and prior research has supported these gender discrepancies.

However, a Vanderbilt University Medical Center study, conducted to review symptoms and neurocognitive findings in male and female high school soccer players, shows no gender-related differences.

"There has been good data that suggests girls score worse on neurocognitive testing following a sports-related concussion. Our hypothesis was that a tightly-controlled study would replicate what others have shown previously," said Scott Zuckerman, M.D., a neurosurgery resident who conducted the study with colleagues at the Vanderbilt Sports Concussion Center.

The researchers selected 40 male and 40 female concussed patients who were matched, as closely as possible, for age, medical/psychiatric history, years of education, lack of special education assistance, history of psychiatric treatment, number of prior concussions, timing of pre- and post-concussion testing, and sport (all engaged in soccer).

This is the first study to control for type of sport played when looking a gender differences, Zuckerman said.

"Prior studies have used mixed groups of athletes from a variety of sports. We suspected that since concussions vary from sport to sport (i.e., helmets vs. none, varying biomechanical forces, etc.), if the variable of sport was controlled, gender differences might disappear."

The only significant gender-related difference they could identify was that female soccer players reported a greater number of symptoms post-concussion. There were no significant differences in post-concussion neurocognitive scores.

"We were somewhat surprised and were not sure what to expect in such a tightly controlled population," Zuckerman said. "Our hypothesis was that females would experience greater levels of acute, post-concussive, neurocognitive impairment than males, fitting with what most of the prior literature says, but we found virtually no difference between males and females."

Zuckerman said this is a significant finding for the treatment of sports-related concussion.

"When we see any child after concussion, we don't want to make snap decisions based on gender. Gender may not be as big a modifying factor as previously thought."

This study is the first from V-SCoRe, or Vanderbilt Sports Concussion Research. Collaborators include Allen Sills, M.D., Gary Solomon, Ph.D., Andrew Gregory, M.D., Alex Diamond, D.O., and Jonathan Forbes, M.D., and medical students Mitchell Odom and Young Lee.

"This effort is just getting off the ground, and we're investigating many more modifying factors in concussion, including age, sleep, symptoms, prior history of attention deficit disorder," Zuckerman said.

"Our goal is to create new knowledge in this area and help providers better understand when a young athlete can return to play safely."

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Five Ways to Prevent a Concussion in Your Teenage Athlete - Pediatric Neurologists Share Tips to Help Reduce Concussions in Children and Teenagers

Five Ways to Prevent a Concussion in Your Teenage Athlete

 - Pediatric Neurologists Share Tips to Help Reduce Brain Injuries in Children & Teenagers

Houston, TX August 07, 2012

Your son leaves for his football game. Your daughter is off for soccer practice. Two hours later, the team trainer calls home to report that your teenager is in the ER, having suffered a concussion.

What can a parent do today to prevent a concussion in a child or teenager? Here is advice from four child neurologists, experts in the management of traumatic brain injury.

Dr. Joshua Rotenberg, a pediatric neurologist in Houston and San Antonio (http://www.txmss.com), advises parents, “Before letting your child or teen take the field, review your own game-plan for concussion prevention.”

Here are 5 Pre-Season Action Items for parents of athletes:

#5 Increase Subject Matter Knowledge - The presentation of concussion can be subtle and a child may not recognize it in themselves. With knowledge, one can prevent concussion or at least prevent complications.

Dr. Kevin Joseph of Valley Medical Center/University of Washington Medicine advises families and athletes to learn about the symptoms of concussion.

Concussion symptoms can take the form of almost any disturbance of brain function. These can include any combination of physical (headache, dizziness, ringing in ears, nausea/vomiting, blurry vision, weakness), emotional (depression, anxiety), cognitive (memory problems, focus problems) and sleep disturbances (insomnia, excessive sleepiness).

Concussion can be caused by a direct head trauma or indirectly by a sudden impulse of energy. That is, a concussion is not necessarily caused by a recognizable head-to-head impact.

Concussion does not only happen to male football players! Current estimates are that up to 20% of high school football players will sustain a concussion in a season. But, women’s soccer is the second most likely school sport to cause a concussion.

Other activities more likely to cause traumatic brain injury in teens are bicycling, basketball, volleyball and cheer. Even non-athletes are susceptible to falls and accidents.

Among athletes, who is at high risk? Concussion risk factors include prior concussion and neuropsychological problems such as Attention Deficit Hyperactivity Disorder (ADHD).

One study indicated that 26% of children with ADHD had sustained a head injury. Ensure that ADHD treatment is adequate to prevent impulsive or distracted performance.

Children who have sustained a previous concussion are up to 6 times more likely to have a subsequent concussion. For children and teens who have suffered multiple concussions, ensure that they have seen a specialist and they are cleared for full contact activity.

#4 Check Protective Equipment - Ensure that athletes have a current and highly rated helmet that also has an appropriate fit.

Dr. Marc Difazio, a child neurologist at Children’s National Medical Center, Washington DC, notes, “Safe helmet systems go far to prevent concussion. Football, lacrosse and hockey players can obtain effective helmets that greatly decrease the force of the impact of a blow.”

There are helmet systems for soccer players that do not interfere with the ability to head the ball (not a major cause of concussion by the way!). These systems can certainly be used in other contact sports (such as field hockey), which do not require a helmet.

Mouth guards are important for preventing oral trauma, but have not been shown to reduce concussion.

Consult a certified athletic trainer to ensure your equipment has an optimal fit.

#3 Ensure Adequate Training - Young athletes require general athletic training and sport specific technique

Dr. Marc Difazio observes, “Unrestricted head movement is one component of concussion physics. Strength training for head, neck and shoulders of young athletes helps to deliver more precise control of their bodies, possibly lessening the movements associated with impact, and potentially decreasing concussion risk.”

Proper training in football and rugby tackling is crucial. Tackling technique in football must be taught from the start, and dangerous head-on methods discouraged immediately.

Heading the ball appropriately in soccer has not been shown to cause concussion if done correctly. However, Dr. Difazio has observed that “novice players may not perform the technique appropriately, leading to excessive head movement and a resultant risk of concussion. Teaching correct heading techniques is therefore as important as kicking, dribbling and game strategy."

#2 Heighten Parental Vigilance - You are entrusting your child’s brain to coaches and trainers. Most are excellent stewards of this trust. But, even with the best trainer and coach, you are the expert on your child.

Be present and vigilant about your child’s participation. Ask about style and contact of practices and games. Valid questions include: Are freshmen scrimmaging with seniors? Who cares for the equipment? How do they fit?

Dr. Joseph advises, “Know who is responsible for responding to head injuries at the game....Know what the school or organization policy is regarding head injuries (what happens on game day and when can the child return to play).”

Youth sports can be less regulated than interscholastic school sports. Do youth football players have more aggressive collision in practice than in games? Perhaps! One recent study indicated that concussive head injury in youth football may be more common in practice than in the game. If you note atypical practice or game activities, discuss these with the coach and trainers.

Most importantly, you know your child best. You may detect cognitive, behavior or performance abnormalities before anyone else does. Keep a low threshold to suspect concussion. Parental observation and symptom identification are key to diagnosis.

In many states, there are concussion laws describing how school athletes must be removed from play or practice if concussion is suspected. Note that this is a low threshold.

If you suspect a head injury, for whatever reason, have your child evaluated and let the physicians sort it out. Missing one game or practice is better than missing weeks of participation.

# 1 Form an action plan in case of concussion!

Reassuringly, concussions most often resolve quickly and completely within a couple of weeks. The majority of children and teens suffer no long term implications.

At the same time, keep in mind what you would do following a severe injury or a deteriorating situation. An emergency evaluation may be necessary in severe or deteriorating head injury cases. Following a head injury, if the little voice inside you is telling you to go to the emergency room, listen to that voice.

Children with concussion should see a physician. Make sure to visit your primary care physician. The doctor who knows your child might also be able to detect differences that a parent missed.

To meet the need for rapid access to pediatric brain specialists, these neurologists offer expedited evaluations.

Dr. Rotenberg advises seeking the highest possible level of expertise in the identification and management of brain injury for children “The symptoms and signs of concussion are physical, neurologic and neuropsychological. It is important to seek a child and adolescent neurologist’s advice since a specialist can identify serious head injury, diagnose concussion and treat its complications”.

Remember, a computerized test alone can not establish a diagnosis of concussion. “You can purchase an online test or go to a retail store. But is it valid or useful?” asks Rotenberg. Variables such as the setting, motivation and the specifics of the test must be considered with the whole person

Finally, Dr. Rotenberg advises all parents, “Ensure that all children have an adequate pre-season physical examination by a physician who knows your child.”

Drs. Rotenberg, Joseph and DiFazio serve on a pediatric working group for sports neurology. Texas Medical & Sleep Specialists serves the Houston and San Antonio areas with pediatric neurology and specialty care. Contact Dr. Rotenberg at 713-464-4107 or read more at his blog http://www.pedzzz.blogspot.com.

http://www.chron.com/business/press-releases//business/press-releases/article/Five-Ways-to-Prevent-a-Concussion-in-Your-Teenage-3769750.php

2012 Football Helmet Ratings

Virginia Tech has just released the results of its 2012 rating for adult football helmets that is designed to assess a helmet's ability to reduce the risk of concussion. A total of three helmets achieved a "5 star" mark, which is the highest rating awarded by the Virginia Tech Helmet Ratings™. In addition to the Riddell Revolution Speed, which was the only helmet to receive 5 stars last year, the Rawlings Quantum Plus and Riddell 360 also earned 5 stars as the best available helmets.

The process used for evaluating the head protector involves performing 120 impacts on each helmet model at multiple locations and impact energies. To date, the Virginia Tech Helmet Ratings™ for adult football include 15 helmet models that were evaluated using more than 2000 laboratory tests. The ratings, first introduced in 2011, utilize the STAR Evaluation System to assess helmet performance. The STAR, an acronym for the Summation of Tests for the Analysis of Risk, evaluation system was developed using data collected from over 1.8 million head impacts experienced by football players throughout an eight-year span.

"This is a perfect example of a National Institutes of Health (NIH) funded project resulting in translational research. The NIH supported the development of the sensors and data collection that provided the foundation for our rating system. Specifically, you can see Riddell and Rawlings using this research to develop the very best helmets," said project director Stefan Duma, the Harry C. Wyatt Professor and Department Head of the Virginia Tech -- Wake Forest School of Biomedical Engineering and Sciences (SBES).

A total of five new adult football helmet models by Rawlings, Riddell, and Xenith have been released since the Virginia Tech Helmet Ratings™ were first made available in 2011. The Riddell 360 (5 stars), Rawlings Quantum Plus (5-stars), Rawlings Impulse (4-stars), and Rawlings Quantum (4 stars) were new models that are recommended by the researchers. "We recommend any of the 4 or 5 star helmets for players. The specific helmet a player chooses will be dependent on other factors such as a fit and comfort," said Duma. The remaining new helmet model included in the 2012 ratings was the Xenith X2, which earned a 3 star rating.

Seven helmets are now rated with 4 stars in the 2012 Virginia Tech Helmet Ratings™: Schutt ION 4D, Schutt DNA Pro+, Rawlings Impulse, Xenith X1, Riddell Revolution, Rawlings Quantum, and Riddell Revolution IQ. The remaining five football helmet models were rated with 3 stars or less. The complete ratings are publicly available onlinewww.SBES.vt.edu/nid so that consumers can make educated decisions when purchasing football helmets.

"The three lowest rated helmets from last year are now all off the market. It is encouraging to see this positive shift towards better head protection," said Steven Rowson, assistant professor of biomedical engineering at Virginia Tech. Rowson was responsible for the development of the STAR Evaluation System and testing of the helmets. "Four of the five new helmet models introduced in the last year earned a 4 or 5 star rating. This helps demonstrate that a data-driven approach can be utilized to optimize helmet design to reduce concussion risk," he said.

In the future, the researchers will expand the Virginia Tech Helmet Ratings™ to include other sports as well as youth football helmets. To this end, Duma and his team collected the first dataset on head impacts experienced by youth football players last year. In the fall of 2012, researchers at Virginia Tech and Wake Forest will expand this dataset by instrumenting over 300 youth football players from ages 6 to 18 in what is called the KIDS study (Kinematics of Impact Data Set). "As we learn more about youth head impact exposure, we can begin to develop methods to evaluate youth-specific helmet designs," Duma added.

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Computerized Tests For Concussions May Be Unreliable

Concussion testing is a neuropsychological test. Schools are collecting this data on children at baseline often using non-standard methods.  I have been advocating using post-concussive testing as one component of an expert medical examination. The results must be interpreted in light of the individuals neurologic examination.  Are you going to trust your child's brain to a computer program alone?  JR

Schools worried about concussions increasingly use computerized tests to tell if a student athlete has a brain injury. But new research says those tests aren't reliable enough to diagnose concussion, or to tell if it's safe to return to play.

The researchers looked at research on one computerized neuropsychologist test, called ImPACT, that is widely used by colleges and high schools. (Here's one NPR story on how high schools use ImPACT to assess concussions.)

It's also used by the National Football League and National Hockey League.

But very few studies have been done on the reliability of these tests in real-world situations.

So Lester Mayers, a sports medicine doctor at Pace University in Pleasantville, N.Y., and Tom Redick, an assistant professor of psychology at Indiana University-Purdue University in Columbus, Ind., surveyed the data. They weren't happy with what they found. They say computerized tests aren't reliable enough to serve as the sole measure of brain health.

"I'm not suggesting abandoning the whole practice," Redick told Shots. "But I do think that we want to be sure we're not using something just because it's popular." Theirwork is published in the current Journal of Clinical and Experimental Neuropsychology.

One issue with the computerized testing is the length of time that passes from when a healthy athlete takes a baseline test, and when they're tested after a suspected concussion.

After a few weeks, the test becomes increasingly unreliable, the review found. That's an issue because the manufacturers recommend testing athletes twice in high school, and once in college. "This increases the likelihood that a true cognitive impairment will be missed," the authors write.

Another issue is how reliable the tests are in determining when it's safe for an athlete to return to play without risking further brain damage. Just three studies looked at that. Those studies were very small, and the results inconsistent, the authors report. They write:

"We therefore question the rationale of using ImPACT for clinical management of sport-related concussion and specifically for determining the time of return to play."

There is no gold standard for figuring out when an athlete is safe to return to play, Redick says, which makes it hard for coaches, parents, and athletes to know what to do. But computerized testing is not the solution to that problem.

The U.S. military has invested millions into computerized testing service members for traumatic brain injury, but that program has been a debacle, according to aninvestigative report last November by NPR and ProPublica. Researchers say the computerized test used, called ANAM, isn't robust enough to screen for problems that could continue weeks or months after a brain injury.

Last August, the American Academy of Pediatrics said that parents shouldn't let children box, urging parents to recommend sports "that do not encourage intentional head injuries."

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