"She testified that she never even bothered to see Ryne's test results," says the attorney. "It was one of the most brutal depositions I've ever been involved in. She left the room crying several times."

Kenneth Podell, a Detroit neuropsychologist and one of the creators of ImPACT, declined to comment specifically on Dougherty's case. But he says that "in ideal circumstances," the test should be administered not by a trainer but by a medical professional.

"It's better than nothing," UCLA's Hovda says of ImPACT. "I don't mean any disrespect, but neuropsychological tests, which require responses and performance from individuals, are always going to have problems because there's always going to be variances."

David Goldstein spoke to Florida legislators about devastating effects from multiple concussions.
Photo by Michael McElroy
David Goldstein spoke to Florida legislators about devastating effects from multiple concussions.
Natasha Helmick once played a game half-blind after sustaining a concussion.
Photo by Mark Graham
Natasha Helmick once played a game half-blind after sustaining a concussion.

One of those variances is that an athlete can cheat the system. In April, Indianapolis Colts quarterback Peyton Manning flippantly admitted he intentionally performs poorly on baseline exams. When and if he takes postconcussion tests, the results won't look as bad, which means he (or anyone else who employs a similar baseline-test strategy) might be able to return to play immediately. NFL Commissioner Roger Goodell later fessed up that concussion-test cheating is an issue the league needs to address.

Complicating head-trauma detection is a recently released Purdue University study that concludes that youth athletes who aren't clinically diagnosed with a concussion are still experiencing fundamental brain changes that might be detrimental.

For two seasons, three Purdue professors tracked every practice and game hit sustained by 21 Lafayette Jefferson High School (Indiana) football players. "That's when we started to see that about half of the kids had some level of easily measurable neurophysiological change without any concussion whatsoever," says Purdue's Eric Nauman.

"What we think is probably happening is that since these kids don't have any symptoms, nobody ever takes them out of the game or makes them sit. They probably keep racking up more and more hits, and it tends to affect more and more of the brain."

Nauman and his colleagues are looking for funding so they can study soccer players, wrestlers, and participants in activities that aren't usually thought of as dangerous. "Anecdotally, the cheerleaders at Purdue had almost as many concussions as the football players," Nauman says.

"No bill is better than a bad bill," says state Sen. Dennis Jones, a working chiropractor who helped kill a concussion law in Florida this past May. "As chiropractors, we've been treating head injuries since 1931. The symptoms of a concussion are not that difficult to diagnose."

Florida is one of the only states to balk at concussion legislation for youth athletes, a nationwide trend that started in 2009 when Washington gave a thumbsup to the Zackery Lystedt Law. A prototype for dozens to come, the act requires any athlete under 18 who suffers a suspected concussion to receive written consent from a medical professional before returning to play. There is no similar federal law.

In Texas, Natasha's Law, named for former soccer player Natasha Helmick, was signed by Gov. Rick Perry in June after the Senate passed the bill by a 31-0 margin. Beginning January 1, 2012, Colorado's Jake Snakenberg Act will take the Lystedt Law one step further by requiring every coach in youth athletics to complete an online concussion recognition course.

Florida, however, recoiled from its own version of concussion safety because Jones, a Republican from Seminole, was miffed that the language did not include chiropractors among "medical professionals."

On the Senate floor, Jones argued that standard MRIs can be used to detect concussions, which is a fallacy. Jones filed an amendment to include chiropractors, but the House refused to vote on the amended bill.

David Goldstein, the Miami high school soccer player, testified in favor of the bill in Tallahassee. After suffering three concussions, David had been told by doctors to "wait it out, never play soccer again, and good luck." It wasn't until he visited the University of Miami — one of the nation's top medical centers for head trauma in student athletes — that David's injury wasn't treated as some unfathomable affliction. The doctors slowly worked him back to the point where he could return to soccer wearing a rugby helmet. Now 16, he's a starter on varsity.

Last year, David organized a raffle at school and wrote letters asking for cash until he had raised $35,000, which will be donated to the Miami-Dade school district. It will pay for three to four years of concussion tests for every public school in the county.

As more states enact concussion laws, medical professionals, athletic trainers, and school administrators are wondering if these laws will help prevent a condition that's inherently difficult to detect.

In Arizona, on the strength of Gov. Jan Brewer's signature on House Bill 1521, the Mayo Clinic offers free online concussion tests to more than 100,000 high school athletes. In June, the Mayo Clinic issued a news release stating the Arizona Interscholastic Association had endorsed the baseline test, which was not true and caused an AIA attorney to threaten legal action. The two have since made up and are partnering to test all Arizona contact athletes during the 2011-12 school year, beginning with football.

Steve Hogen, athletic director of Mesa Public Schools, had concerns with Arizona's law even before it passed. According to him, if he and his cohorts hadn't been vocal about the bill's language (which was consequently amended), the law would have placed an impossible load on them.

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