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Q&A: Dr. Mark Lovell, ImPACT

Pittsburgh Steelers running back Merril Hoge was faced with a major decision in 1994 after he suffered two concussions in five weeks--stop playing in the NFL, or continue to do so at great risk of severe brain injury.

Dr. Mark R. Lovell of Mt. Lebanon was the man who sat across from him and helped him make the tough call--hang Ďem up while you still can--and Hoge retired. Lovell has counseled numerous pro athletes and treated many more for concussion-related injuries, but is more concerned with other lower-profile athletes--namely college, high school and younger--getting the proper testing, diagnosis and treatment.
Lovell, an international concussion expert and founding director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program, and Dr. Joseph Maroon created ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The software is used by the Pittsburgh Steelers--Maroon is the teamís neurosurgeon--and more than 4,000 college and high school sports teams, including nearly half of all high schools in Pennsylvania . Lovell, who developed and implemented league-wide neurocognitive testing for the NFL and NHL during the 1990s, currently serves as a consultant for those leagues, NASCAR, Indy Racing League, Major League Soccer and the US Ski/Snowboard teams.

Lovell himself has had three concussions, one of which was sports-related, and is one of the issueís most important advocates. With players of all ages getting bigger, stronger, and faster, and a national spotlight on concussions growing more intense, Lovell figures to play an even bigger role. ImPACT is increasingly focused on educating parents, athletic trainers and doctors. Schools can purchase ImPACT for about the cost of a modern football helmet, which as Lovell notes, is a small price to pay for such an important (and irreplaceable) piece of equipment.

Keystone Edge (KE): How did the development of ImPACT begin?
Mark Lovell (ML): About 20 years ago I was working at the Abington Trauma Center. My area of expertise is brain trauma and I had the opportunity to start working with the Steelers through one of my collaborators, Dr. Joseph Maroon. This is before computers were commonly used and we were doing what I would call paper-and-pencil testing, where you sit across from an athlete, give them a list of words to learn and remember, and have them connect the dots as fast they can. But using that info to help make a decision about when an athlete was truly recovered from a concussion is tricky.

One thing led to another and there were some critical injuries in the NFL, and the NFL formed a Mild Traumatic Brain Injury Committee, which Iíve been a member of since the mid-1990s. I recognized early on that doing any kind of baseline paper-and-pencil testing has real limitations in terms of you can only do one person at a time and there arenít enough neuropsychologists around that you would never get down to the high school level or below. Thatís when I started thinking about taking the concepts of memory and reaction time and turning it into a computer-based test.

KE: How does imPACTís computer-based testing do a better job?
ML: The big advantages are two-fold. First, you can actually install or have the computer software in a school environment, where you can actually test kids at a school, where they spend most of their time. Most schools have computer labs so you can basically test an entire football team in a matter of hours if you do it right. It would be impossible with paper-and-pencil testing.  Even with the NFL and Olympic teams using this, the real driving force has been to get it down to kids. Pro sports can afford to hire a neuropsychologist, but a high school canít.

The other advantage is with a computer you can measure things a lot more accurately. We can measure reaction time to a hundredth of a second and can detect very minute changes in how fast the brain is working by using a computer that you really canít do with a stopwatch.

KE: What does the testing measure?
ML: Weíre measuring what we call verbal memory, memory for words and letters, and also measuring abstract design memory where weíll show very abstract blobs to people, and itís actually a difficult task and itís much harder when your brain is injured. The other thing we measure is the interaction of memory and reaction time, both accuracy and how quickly you are learning something. What happens with a brain injury is that people generally become less efficient in how they learn. Itís essentially like giving the brain a stress test.

KE: Concussions have received a lot of attention recently because of reporting by the New York Times, but why has it taken it so long?
ML: Youíre talking about fundamental culture changes and those things donít happen overnight. Back when I started doing this in the early- to mid-90s the concept of doing this kind of thing was very foreign even to the NFL and itís literally taken that much time to have this become one of the principal components of the evaluation process. There are always some people who publish papers saying itís not a problem and others say it is. Iíve been kind of in the middle of that.

I have to say I am very happy that this has received all this attention because the primary reason we do what we do is for kids. I think everyone would acknowledge that pro sports is inherently dangerous and risky, and I know talking to hundreds of pro athletes in my career that most of them are certainly willing to take that risk if the incentives are good enough. My issue is more with kids and a lack of understanding of the ramifications or dangers involved. I think we have an obligation to make sports as safe as possible for them.

Joe Petrucci is managing editor of Keystone Edge. Send feedback here.

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