George Mason HS Takes on Concussion Research

Third of three parts
By Christine Kilgore
Special to the Falls Church Times
Sept. 4, 2014

Concussion diagnosis and management at George Mason High School continues to advance, with the Athletic Department set to begin its second school year with a new neurocognitive testing system that it believes is more reliable and comprehensive than the formerly used ImPACT system.

The department also will continue its foray into research aimed at improving concussion diagnosis and the tracking of recovery.

A concussion diagnosis is based primarily on symptoms, but neurocognitive testing is widely regarded as a useful tool to aid in the diagnosis and management of concussions in youth. The computerized tests assess areas of brain function such as memory, thinking speed, and reaction time, all of which can be impaired by concussions.

In high school athletics, the tests are most often used to assess possibly-concussed athletes against a baseline established prior to the sports season. Testing can then be repeated periodically post-injury to help guide recovery. (While not ideal, the test can also be performed in the absence of baseline results, with findings sometimes useful.)

In addition to being offered through a growing number of high school athletic programs, neurocognitive testing is done at some sports medicine clinics and hospitals, such as the SCORE program at Children’s National Medical Center in Washington; it is not a part of routine primary care practice.

In the 2013-14 school year, Vicki Galliher, George Mason’s athletic training coordinator, put aside the ImPACT test, which she had used for nine years and which became the gold standard in high schools and colleges, in favor of another neurocognitive test battery called Concussion Vital Signs (CVS). She had pilot-tested CVS in the spring of 2013 with George Mason’s cheerleading squad.

The CVS test assesses additional domains such as executive function and the ability to shift attention. It also provides a more detailed look at reaction time and includes a “clinician portal” by which-with parental permission-a physician or other health care provider can see Ms. Galliher’s test results and notes, and vice versa. This portal was a “big sell” for her and has been viewed favorably overall by involved families so far, Ms. Galliher said.

Athletic director Tom Horn said the test has embedded validity indicators and appears to be providing more reliable results, giving Ms. Galliher and the department more confidence in interpreting and utilizing test scores. “If it appears there is a poor effort or an abnormality for some reason, for example, we’ll get an invalid result rather than just a lower score,” he explained.

Indeed, neurocognitive testing is only one piece of the diagnostic pie, and it’s not perfect. Many factors-from test setting to fatigue to various psychological factors-are believed to influence test performance, and researchers are working to improve the tests’ ability to accurately measure concussion-induced changes in brain function.

George Mason High School became involved this year in some of this research through a partnership formalized in the summer of 2013 with Pearson Education, which developed the CVS test, and Anthrotronix, an engineering and research development firm based in Silver Spring, that works with the U.S. Department of Defense on its concussion assessment protocols. (The military’s main tool, DANA, is similar to Pearson’s CVS).

Anthrotronix approached George Mason after learning of Ms. Galliher and was “instantly impressed with the breadth of her knowledge and expertise as a leader in the field,” said a company spokesperson.

Results of a first pilot study involving sideline and classroom assessments of George Mason’s football players last fall included the finding that testing conditions did not impact median reaction times. Another pilot study being planned for the upcoming school year will look at how cognitive functioning varies during the course of the school day. As with the first pilot study, data will be made anonymous and informed consent will be obtained.

“Already,” said Ms. Galliher, “the information we’ve given [Anthrotronix and Pearson] has led to refinements in the neurocognitive test protocols that are being used to test our own students.”

Said Mr. Horn, “To have our staff and kids participate in a research project that will benefit both military personnel and future athletes-it seems like the right thing to do.”