Cognitive testing important for athletes with head injuries

Whenever athletes are involved in sports that include physical contact, there is a dramatic increase in the rate of injury. The more contact that occurs, the greater the frequency and severity of injury.

Coaches, athletic trainers and parents have recently become more aware of traumatic brain injury. Among the symptoms of even mild brain trauma are amnesia and difficulty processing new information. The athlete begins to do poorly in class, has personality changes and slower motor responses.

These symptoms relate to an athlete’s cognitive ability and indicate a serious concussion. Unfortunately, these deficits can become permanent.

One challenge facing physicians has been finding a diagnostic tool to assess these deficits. Imaging studies like a CT scan or MRI are often normal. Typical neuropsychometric testing involves the administration of a series of IQ tests over several hours.

Today there are two diagnostic series that can be administered quickly and with accurate results:

• IMPACT, designed by neuropsychologists at the University of Pittsburgh, has been used for several years in the United States and has a large database.
• CogSport, developed by a group of Australian behavioral neurologists, can be administered from any Internet-accessible computer and takes only eight minutes.

CogSport is based on the use of playing cards, thus it is not language-dependent. This is a big advantage when working with non-English-speaking athletes.

Dr. Jeffrey Kutcher, Director of Michigan NeuroSport, is responsible for the evaluation and treatment of neurologic injuries involving athletes at the University of Michigan.

“Obtaining a pre-season baseline test on every athlete is crucial to the validity of any cognitive testing,” Kutcher said. The University of Michigan recently converted from IMPACT to CogSport because of its ease of use.

Parents should inquire whether these tests are being utilized as part of their children’s athletic programs.

These new methods of cognitive testing add a significant piece to the puzzle of when an athlete should return to contact sports, if ever.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Women's soccer serves as beacon of hope in Haiti

In the past few weeks, we have seen photos and video footage of the poverty and hunger that has besieged Haiti for decades. While on a recent medical mission to hurricane-ravaged Haiti, I came across one of the most inspiring and unexpected sports stories I’ve ever witnessed.

Haiti, located only ninety miles off the coast of Florida, is the poorest nation in the western hemisphere. Although slightly smaller than the state of Maryland, Haiti has a population of seven million.

The Haitian Health Foundation (HHF), of Norwich, Conn., has been caring for the poor of Haiti since 1982. Dedicated workers have built schools, medical clinics, and housing for the people of Jeremie, Haiti, and 105 surrounding villages.

HHF’s founder, local orthodontist Dr. Jeremiah Lowney, leads physicians, dentists, and willing volunteers from all walks of life to work with the people of Haiti four times a year for one week. “Over 90 percent of volunteers return to spend additional weeks among the poor,” Lowney said.

These pilgrimages are designed to benefit the poor but it is often the volunteers who find themselves invigorated both physically and spiritually.

While evaluating a young girl in an HHF clinic, I was surprised to discover that she was accompanied by her soccer coach. I couldn’t believe that in this remote area of a third world country, with people struggling simply to exist, women’s soccer had been organized and was thriving.

Ordinarily, women do not play soccer in Haiti; it is considered a “male” sport. Haitian girls, especially those in outlying villages, grow up believing that playing games like soccer will deform their reproductive organs and prohibit them from bearing children.

In 2006, HHF started a soccer league for girls between the ages of 13 to 19. Before being allowed to compete, they must complete a one-week course on responsible sexuality. At that time, they receive a uniform and shoes. The course is designed to empower women through knowledge. Classes consist of topics like reproductive anatomy, sexually transmitted diseases, and a woman’s rights under Haitian law. These young girls also learn that obtaining a firm educational base will lead to increased opportunities.

This year, almost 1,300 girls were educated in the program and 830 played in the league. Callie Kaplan, a young woman from Chicago, has served as the soccer program’s director for the past year. Kaplan played varsity soccer at Colgate University in New York. “Participation in the HHF soccer program has become a source of pride for the girls and their parents,” Kaplan said. Many of the girls’ teams train with the local boys’ teams.

On September 3rd, I attended the HHF soccer championship between the villages of Gobin and Fondrouge Dayere. The “field” was nothing like the plush, grassy surfaces we are accustomed to seeing here in the United States. Instead, it was an accumulation of rocks and shells. Scrapes, bruises, and bloodshed are commonly seen after a fall. Soccer balls wear out quickly and typical equipment like soccer shoes and protective shin guards are nowhere to be found.

Approximately 1,500 fans attended; many walked for hours from their villages to the city of Jeremie. There were no bleachers or chairs and many of the younger spectators climbed trees to get a better view. The team from Fondrouge Dayere won a hard-fought and exciting contest by a score of 2-1. From the standpoint of sheer entertainment, the cheering fans knew there were no losers.

When it comes to sports, much is taken for granted in the United States. It is comforting to know that women’s sports prevail despite extreme poverty. HHF has given young women an opportunity to learn about their bodies and the importance of fitness.

“The only way to curtail incidences of sexually transmitted disease and early pregnancy is through education,” Lowney said. “Often, this is best accomplished by linkage to athletics.” In Haiti, these sporting events have become a forum for athletes and spectators to communicate messages regarding responsible sexual practices through the use of banners and announcements.

I was amazed to find such a superb combination of health and sports in a third world country. This women’s soccer league serves as a beacon of hope for many young women living in despair.

Unfortunately, the HHF soccer program is losing its major grant support, potentially ending this worthwhile program. It costs only $1,000 to fund a team, including the most basic equipment and the educational component. While any donation will be gratefully accepted, I encourage any individual or business to join me in adopting a team. All donations should be sent to Haitian Health Foundation at 97 Sherman Street, Norwich, CT, 06360, or through its website at

Preventing football concussions starts with helmet design

Among the injuries of greatest concern for coaches, players, and parents are those involving the brain.

Football season is now underway and many young athletes will be participating at all levels from Peewee to the NFL. Interest in these injuries has heightened to the point where many collegiate and high school football programs have followed the lead of the NFL by including neurologists as part of the medical staff.

While much has been written about the diagnosis and treatment of concussions, little has been publicized about the prevention of concussion.

Any discussion of preventing concussion centers on improved football helmet design.

Until recently, football helmets have undergone few design changes since the conversion from leather to plastic and the addition of the facemask in the 1950s. Current research and development of safer helmets focuses on better fit and a shock-absorbing liner. Various combinations of air, water, and foam have resulted in more effective and comfortable helmets.

In 2002, the Revolution helmet was introduced. The Revolution as well as the ION 4D now dominate the market. Both emphasize improved cushioning, especially in regard to side impact. The Revolution uses an air suspension plus dual-density foam.

“Seventy-five percent of our helmet inventory consists of the Revolution, with the remainder being ION-4Ds,” said Bob Howard, head athletic trainer for the University of Connecticut football program.

This year UConn will also be using a specialized facemask designed for rapid safe release that allows easy removal of the helmet in case of neck injury.

New studies are being performed that involve the insertion of accelerometers in helmets to record the force and direction of impact during a football collision. This information can be immediately downloaded to a computer and analyzed.

Despite difficult economic times, the benefit of new technology in football helmets far outweighs the complications of a traumatic brain injury.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at

Virtual realty workouts are gaining popularity

Virtual sports are nothing new for those of us old enough to remember the game “Pong.” The Nintendo Wii sports system, and its newest addition Wii Fit, reflects how far computer science has come in 30 years.

Virtual reality is a way humans can interact with a computer-generated environment. This technology has existed for many years in the form of flight simulators used to test the capabilities of pilots or astronauts in critical situations.

This interaction is accomplished by stimulating various regions of the brain. Recent studies show that the more sophisticated a virtual environment is, the greater the activity in the prefrontal region of the brain. A sense of presence leads to a more realistic interaction.

Recently, a friend showed me a picture of her 92-year-old grandmother who, along with several octogenarians, won a Wii bowling competition at the assisted living facility where they live.

Nancy Michaud, recreation director at the Harrington Court Rehabilitation Center in Colchester, uses the Wii sports system regularly with patients undergoing rehabilitation. The system provides a variety of sports simulations including golf, bowling, and boxing. The object is to swing the upper extremities appropriately while pressing and releasing a button on the hand control. Interestingly, boxing is among the more popular programs.

The Wii Fit system has become a favorite with people who wish to forgo a gym membership and get a quick workout at home. Nikki Fennikoh is a 24-year-old who balances a busy home and work schedule. She regularly does push-ups, sit-ups, and yoga with this system.

“The feedback from the fit system regarding progress and correct form is encouraging,” Fennikoh said.

Variety is crucial to a good workout program. Virtual sports have clearly evolved to the point where they provide an adequate option. Most importantly, this technology has just begun to scratch the surface.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at If you wish to learn more about sports health topics, listen to the podcast or go to the Healthy Sports blog at