A software program that helps health-care providers evaluate the effects, severity, and longevity of concussions, especially in athletes, looks to be catching on here, eight years after its introduction.


The software, developed by researchers at the University of Pittsburgh Medical Center and now is owned by East Amherst, N.Y.-based ImPACT Applications Inc., can help detect subtle concussion symptoms that otherwise might go unnoticed when a doctor examines a patient, providers here say.


Longtime Spokane physician Dr. John Plastino says he began using the software, which is called Immediate Post-concussion Assessment and Cognitive Testing, or ImPACT, in 2001, but has been disappointed with how slowly its use has grown here.


Yet, Daniel Dami, a physicians assistant in the sports medicine department at Rockwood Clinic PS, says the softwares use has grown dramatically here in the last year. Dami says that a year ago, Rockwood Clinic was conducting about two tests with the software per month, but now is employing the test on a daily basis. He expects that volume will increase even more once football season gets under way here later this year.


Both Plastino and Dami say that by using the softwares 20-minute test, health-care providers can have an additional tool in assessing head injuries, though they stress that it doesnt take the place of physical examinations and stress tests.


I wont release an athlete to return to a sport until they pass a physicians clinical exam, an ImPACT test, and have those results stand up under stress tests such as sprints and weight lifting, says Dami.


Currently, few Spokane-area health-care providers use the software, according to ImPACT Applications, but several schools here do, including Eastern Washington University, Whitworth College, and Cheney, North Central, and Lewis & Clark high schools, it says.


The company says that nationally, the tests are used extensively by teams in the National Football League and the National Hockey League and by the U.S. Ski Team, among others.


Dami says that the software, which runs on a desktop computer, provides analysis primarily by asking patients to recall numbers and symbols that have been shown on earlier computer screens. At the end of the test, an eight-page printout provides test results. ImPACT Applications conducts a one-day seminar to health specialists for help them learn how to interpret the data.


The software scores patients in six basic categories: manual and visual reaction time and numerical, verbal, visual, and design tests that relate to memory. Often, those scores are compared with established national norms to gauge the extent of a head injury, Dami says.


Sports teams that compete on the national level, as well as the Spokane Shock arena football team and some collegiate sports programs, conduct baseline studies of individual team members to provide comparative data in the event those athletes later sustain a concussion, Dami says. He says that approach is ideal, but it wouldnt necessarily be practical to conduct baseline tests on all high school athletes here.


Dami typically will have a concussion patient repeat the ImPACT test on a weekly basis until the patient has passed the ImPACT test, a physical exam, and a stress test as well. After that, hell approve the athletes return to full physical activity.


Plastino says hes frustrated at how slow the ImPACT technology has caught on here. He says hes worked to educate physicians and received interest from them, then nothing ever happens.


Use of the software nationally is growing, though, says Dr. Micky Collins, a co-developer of the software and an administrator for ImPACT Applications. Collins says about 2,000 copies of the software are in use worldwide, though mostly in the U.S. ImPACT charges users about $1,800 a year to use the software.


Dami asserts that the common definition of concussion has changed dramatically over the past 20 years. Concussions once were considered to be any injury to the head, including what now are called contusions, as well as injuries that didnt result in a loss of consciousness.


In the past five years, a major change has occurred in how physicians view the severity of a concussion, Dami adds. Earlier, it was believed that the length of time a person was unconscious after suffering an injury was the most important factor in weighing the extent of the injury. Now, how long symptoms last is seen as the most important indicator.


A head injury now normally is classified as a concussion if symptoms last more than two hours, even if a patient didnt lose consciousness when he or she was hurt, Dami says. He says concussions are graded from 1 to 3, with 3 being the most severe.


Symptoms of a concussion can include loss of consciousness, dizziness, and headaches, plus a partial loss of cognitive skills. Plastino says subtle losses of cognitive skills often are more easily detected by use of the ImPACT software than through medical examinations.


Dami says two physical consequences typically associated with concussions include a swelling in the brain and the disconnection of neurotransmitters that carry nerve impulses there.


He says symptoms from a concussion typically last longer for adolescents and women, and people whove had concussions before are more prone to sustain them than those whove never had one.


Theres clear evidence now that repeat concussions can cause long-term mental impairment, he says.


Through Rockwood Clinic, Dami treats athletes with the Spokane Shock, EWU, and many high schools here.


He says about 65 percent of the 200 or so concussion patients hes treated over the past few years have been males, and more than 90 percent of all concussion sufferers he treats have suffered a sports-related injury, with more of his concussion patients having been hurt in football than any other sport.


Other sports that yield a large number of concussions include baseball and womens soccer and softball, Dami says.


He says theres a growing awareness that its important to protect concussion victims from additional injury before theyre healed.


He says he wont allow anyone who has suffered a concussion to return to sports activity for at least a week after sustaining their injury.


Plastino likens an individual whos reinjured while healing from a concussion to pulling away a scab from a surface wound. He says in such instances the brain normally will stop healing, and a toxic substance will be released in the brain that can do more harm.


Although parents have the legal authority to allow their children to resume playing a sport before theyre released from a doctors care, that rarely happens today, says Dami.


I dont know of any Greater Spokane League coach that will allow a kid to play without medical clearance, no matter what the parents want, he says.


Dami attributes that gradual change in philosophy over the past decade or so to a strong educational push in which athletic directors, sports trainers, and coaches have attended free clinics and received information about the risks involved with head injuries.


Plastino says the lengthy time it used to take to conduct neuropsychiatric exams following concussions was the impetus that caused Collins and others at the University of Pittsburgh Medical Center to develop the ImPACT evaluation testing system in 1999.


Dami says ImPACT Applications first user was the Pittsburgh Steelers National Football League team.


Contact Rocky Wilson at (509) 344-1264 or via e-mail at rockyw@spokanejournal.com.