Hallett is the director of ThedaCare Orthopedics Plus Sports Medicine and a certified consultant for ImPACT, a computer software program that tests patients who have suffered concussions.
Hallett and ThedaCare have used ImPACT for six years. ImPACT, which stands for Immediate Post-concussion Assessment and Cognitive Testing, is a 20- to 25-minute computer-based test that gauges athletes on a number of aspects, including memory, concentration, processing speed and reaction time, according to Hallett.
"We have completely moved away from guidelines to individual management of injuries," Hallett said. "There are studies that have been done that show that concussions can take much, much longer to heal than previously known. These injuries frequently take weeks to heal, rather than days. One thing you have to remember is that concussed athletes are a lot like drunk drivers in that they don't understand how impaired they are or they can't express it. Therefore, we have to treat them differently knowing that.
"We've under-diagnosed injuries. They take longer to heal, and with high schoolers, these kids are not only playing sports, they're trying to learn, take exams and take ACT tests all when they're not functioning at their best."
A team coach, athletic trainer or physician can administer the test with minimal training, according to the ImPACT Web site impacttesting.com. When an athlete suffers a concussion, defined as an electrical stunning of the brain tissue due to an impact, his or her post-testing can be referenced to the pre-testing, and an accurate assessment can be made as to whether an athlete is ready to resume playing.
The program, in conjunction with Hallett and ThedaCare, is used at the three Appleton public high schools, as well as Fox Valley Lutheran, Kimberly, Kaukauna, Menasha, Neenah, New London and St. Mary Central.
Hallett wants to take the testing a step further than the local level. ThedaCare is the pilot site for Hallett's program, which is partnered with Wisconsin Youth Soccer, as well as a network of sports medicine physicians throughout the state. The plan is to provide baseline testing for all WYS member athletes 10 years old and older, according to Hallett.
"Our center is the leader of this," Hallett said. "But it also involves Bellin in Green Bay, Ministry Rice Clinic in Stevens Point as well as Froedtert Sports Medicine in Milwaukee, Madison Sports Medicine and Gundersen Lutheran Sports Medicine in La Crosse."
Typically, athletes who suffer a concussion are given a certain amount of time to rest before resuming athletic activities. Those lengths of time are usually managed by a series of guidelines, none of which is based on medical evidence, according to Hallett.
Grade 2 concussions also have no loss of consciousness, but the symptoms are noticeable, with the athlete having poor concentration and the inability to process information.
Diagnosing concussions in the Grades 1 and 2 becomes tricky. In many instances, the concussion is under-diagnosed or not considered a concussion at all.
This is particularly dangerous, because concussions have a cumulative factor, which would leave that athlete more susceptible to a second concussion, or in rare cases, Second Impact Syndrome, which is sudden severe brain swelling.
"All concussions are unique," Hallett said. "It's artificial to try and sort them into three grades of concussions and then try to manage them on a arbitrary set of time limitations. So we're trying to manage them in a completely different way."
Lisa Armstrong, who has worked as an athletic trainer at Appleton East the past eight years and is also a physical education and health teacher there, has 19 years of experience in dealing with sports injuries. She says that the post-treatment of young athletes with concussions has changed significantly.
"It was very standard that usually within a week, we would set them free with a lot of the symptoms that we didn't recognize," Armstrong said. "There was anxiety and other things that kids also wouldn't even recognize in class, along with the lack of concentration and irritability.
"In most cases, one of the major things that we used was determine whether or not they had headaches. Usually, the last day they had headaches, we would wait a whole week before they could return. But those were just general guidelines and didn't address the other things that could have been going on."
The ImPACT program is also used in many professional sports organizations, such as the NFL, NASCAR and the NHL, as well as many major colleges and universities.
Eventually expanding the program to encompass as many sports as possible at the high school level and even lower is one of Hallett's missions.
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