Because of this, school districts en masse are adopting new procedures for dealing with blows to the head. The most popular is the ImPACT test. A simple computer program designed by a pair of Pittsburgh doctors in the early 1990s, the exam finds an athlete's "baseline" — his mental aptitude and quickness of reflexes when he's not suffering concussive symptoms — which can be used later in a comparative test to see if a collision has caused a lag.
But the test has hit real-world snags. The first is its price: At packages costing roughly $600 per school for the first year, ImPACT is deemed too expensive for some districts. And even when they spring for the program, few schools can afford to pay a specialist to administer it. That duty tends to fall on coaches or trainers, who are often unqualified to conduct the test. As shown in a litigious case in the 'burbs of New York City, the results can be tragic.
In 2008, Ryne Dougherty, a 16-year-old high school linebacker in Essex County, New Jersey, sat out three weeks following a concussion. But after taking an ImPACT test, he was cleared to play. During his first game back, he suffered a brain hemorrhage and slipped into a coma. Dougherty died within a week.
But Dougherty's ImPACT results were ominously low, the family has claimed in a lawsuit against the school district. Additionally, according to the test results, Dougherty reported feeling "foggy," but he was still cleared to play.
"Fogginess is the lead predictor of lasting head trauma," says Beth Baldinger, the attorney representing Dougherty's family in a suit against the district. "[The trainer] ignored the test results in front of her. This case screams ignorance."
Michele Chemidlin, the trainer who administered the test, ignored phone messages and an e-mail requesting comment for this story. She claimed to Sports Illustrated that Dougherty's test was interrupted by a "disruptive" teammate, which made the results "invalid." But Baldinger claims that the trainer retracted that story in a recent deposition.
"She testified that she never even bothered to see Ryne's test results," says the attorney. "It was one of the most brutal depositions I've ever been involved in. She left the room crying several times."
Kenneth Podell, a Detroit neuropsychologist and one of the creators of ImPACT, declined to comment specifically on Dougherty's case. But he says "in ideal circumstances," the test should be administered not by a trainer but by a medical professional.
"It's better than nothing," says UCLA's Hovda about ImPACT. "I don't mean any disrespect, but neuropsychological tests, which require responses and performance from individuals, are always going to have problems because there's always going to be variances."
One of those variances is that an athlete can cheat the system. In April, Indianapolis Colts quarterback Peyton Manning flippantly admitted he intentionally performs poorly on baseline exams. When and if he takes post-concussion tests, the results won't look as bad, which means he (or anyone else who employs a similar baseline-test strategy) may be able to return immediately to play. NFL Commissioner Roger Goodell later fessed up that concussion-test cheating is an issue the league needs to address.
Complicating head-trauma detection is a recently released Purdue University study that concludes that youth athletes who aren't clinically diagnosed with a concussion still are experiencing fundamental brain changes that may be detrimental.
For two seasons, three Purdue professors tracked every practice and game hit sustained by 21 Lafayette (Indiana) Jefferson High School football players. "That's when we started to see that about half of the kids had some level of easily measurable neurophysiological change without any concussion whatsoever," says Purdue's Eric Nauman.
"What we think is probably happening is that since these kids don't have any symptoms, nobody ever takes them out of the game or makes them sit. They probably keep racking up more and more hits and it tends to affect more and more of the brain."
Nauman and his colleagues are looking for funding so they can study soccer players, wrestlers and participants in activities that aren't usually thought of as dangerous. "Anecdotally, the cheerleaders at Purdue had almost as many concussions as the football players," says Nauman.
"No bill is better than a bad bill," says Senator Dennis Jones, a working chiropractor who, in May, helped to kill a concussion law in Florida. "As chiropractors, we've been treating head injuries since 1931. The symptoms of a concussion are not that difficult to diagnose."
Florida is one of the only states to balk at concussion legislation for youth athletes, a nationwide trend that started in 2009 when Washington gave a thumbs-up to the Zackery Lystedt Law. A prototype for dozens to come, the act requires any athlete under 18 who suffers a suspected concussion to receive written consent from a medical professional before returning to play. (There is no similar federal law.)