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IndyCar drivers get ImPACT baseline test
J.R. Hildebrand
Ryan Hunter-Reay and JR Hildebrand crossed paths a few times in the narrow main hallway of the IU Health Infield Medical Center at the Indianapolis Motor Speedway as IZOD IndyCar Series and Mazda Road to Indy drivers completed mandatory physicals last week.

The preseason tests serve as a baseline for the year, according to Speedway medical director Dr. Geoff Billows.

“They receive a comprehensive physical that includes a 12-lead electrocardiogram, blood testing, hearing testing, drug screening, vision screening, and they also perform the ImPACT (computerized neurocognitive assessment),” he said.

Ryan Hunter-Reay
“We have a medical record on every driver, and actually medical records travel with us to racetracks so if the driver comes into the infield care center we have their medical history so we know medications they’ve been prescribed and past injuries, which is very helpful for the treating physician.”

Developed in the early 1990s, ImPACT is a 20-minute test that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages.

“The ImPACT we can do anywhere with a laptop,” Billows added. “It looks at your cognitive abilities and reaction time, verbal skills. Especially in comparison with the baseline, we can tell how far off they are.”

Supplementing the ImPACT baseline this year is the NFL Sideline Concussion Assessment Tool -- a 6-8 minute cognitive test utilized soon after an incident. The league instituted standardized sideline concussion assessment protocol, which includes the tool, for the 2011 season.

The tool, which supplements a focused screening neurological examination, assesses orientation (questions relating to what day/month/racetrack/what happened), immediate and delayed recall, concentration as well as balance -- with a grade attached to each exercise to compare it to the preseason baseline.

“Managers, coaches, owners, whatever, ‘When are they going to be ready?’ is the question they want answered,” said Dr. Henry Feuer, an Indianapolis-based neurosurgeon who’s a longtime consultant to IMS and the Indianapolis Colts. “We put these things together so we can be objective.

“What you’re faced with in a race weekend is if the car wrecks in a race it usually can’t go back out, but if a driver wrecks in practice the question becomes can they go back out the same day? That’s where it’s critical – to evaluate whether the driver has the cognitive abilities to return to the track.”

Concussion is complex in its presentation. Unlike a fracture or ligament injury, the initial evaluation is not always abnormal, and there are often no obvious findings from a physical exam. Feuer said while the IndyCar is designed to dissipate energy in a crash, protecting the driver, other sports such as football, soccer and lacrosse carry a higher incidence of concussion. Pro football players, for example, can record helmet-to-helmet impact of 100Gs (100 times body weight). More than 160 concussions were reported during the 2010 NFL season.

"It's good to have something (the test) that’s simple,” said Feuer, who served as a member of the NFL Committee on Concussions. “This test is good for 24 hours. To make your final answer, that’s where the ImPACT comes in. Professional athletes, for the most part, understand how important it is to be honest in reporting how they feel after an incident. They understand their bodies.” IndyCar.com

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