Starting this school year, National Rehabilitation Hospital and Fairfax County Public Schools are launching an exciting public health trial of computerized cognitive testing for concussion management. The project will use computerized cognitive tests developed by the Department of Defense to monitor recovery from concussion. This initial public health trial of the software, made possible by a cooperative agreement with the United States Army Medical Research and Materiel Command, provides testing at no cost to the school system.
The software, called ANAM, was originally developed by the Department of Defense to study cognitive effects incident to military occupational and deployment environments. Since 1996, Joseph Bleiberg, Ph.D. has been leading a team of National Rehabilitation Hospital researchers to develop ways of using ANAM for concussion management. “Many teams in the NFL and NHL use a battery of neuropsychological tests during the off-season to create a baseline for each player. Those tests then are repeated after injury to determine when the player has returned to their normal level of cognitive function. Unfortunately, such testing is expensive and time-consuming. The goal of our project is to use computerization to make the testing easy to administer, rapid, and inexpensive. Doing so is the most direct way to make the testing available to the tens of millions American children in contact sports,” says Bleiberg. ANAM has tremendous public health potential since the software can be Internet-based.
“It is rewarding to see publicly funded technology used for the public good,” comments Colonel Karl Friedl from the Army’s Medical Research and Materiel Command. When Fairfax County Public School athletes compete this fall, they will be the first high school students in the nation to pilot the new concussion program. “Fairfax County has always sought to be a leader in student safety,” says Jon Almquist, a certified athletic trainer for Fairfax County Public Schools. “We see approximately 50 concussions a year among our athletes and though we tend to see fewer concussions than the national average, we hope that this program will give our certified athletic trainers and medical staff yet another tool to help them continue making safe return to play decisions,” he adds.
Approximately 1,000 students from soccer, cheerleading, football, and other contact sports will be assessed using the ANAM Sports Medicine Battery (ASMB) before the season. After a concussion, the ASMB will be re-administered at regular intervals to monitor recovery. It thus will be possible to compare each injured athlete to his or her performance prior to injury, providing for highly personalized monitoring of recovery. Because assessments are self-administered by computer and can be completed in roughly 20 minutes, the cost is minimal, even for so highly personalized a health service. “If we demonstrate that ASMB can be used effectively and inexpensively in Fairfax County, NRH will address sports concussion at a public health level by making an Internet version available to schools across the country,” states Bleiberg.
Having already partnered with Fairfax County Public Schools using more traditional paper and pencil cognitive measures for concussion management, a team from the Brain Injury and Sports Concussion Institute at the University of Virginia also is collaborating on this project. “The importance of knowing when an athlete has recovered enough for a safe return to competition has been well documented and we well know the risks of making the wrong decision,” according to the Institute’s director, Jeffrey Barth, Ph.D.