To power through a night of studying a couple of winters ago, senior Marie Kobler braved the dark and walked down the steep stairs of the Stanford house in Oxford to get a snack from the kitchen. Sporting socks that made treading on the slippery stairs difficult, Kobler slipped on the stairs and tumbled down, finally hitting her head on one of the last steps. Kobler lost consciousness briefly — she can’t remember exactly for how long — before waking up with a dull headache. She finally mustered her way into the kitchen and found help from her classmates, who helped her determine the severity of her concussion.

Kobler’s story is not unique. Every year, two million people sustain head injuries, according to the National Health Institute, or NIH. Most injuries are benign enough that people require nothing more than careful observation over a few days, but for those who are not as fortunate — half a million people every year — hospitalization is necessary.

A new diagnostic tool developed by Assistant Prof. Michelle LaPlaca from Georgia Tech and Prof. David Wright, assistant director of the Emory University’s Emergency Medicine Research Center may take the guessing out of the diagnosing game, providing a way to diagnose patients in a quick and efficient manner.

According to the NIH Medline online library, mild injuries usually require no specific treatment, but the person should be kept awake at least 24 hours in order to look out for serious symptoms. Such symptoms may include vomiting, loss of consciousness, abnormal behavior, a stiff neck, severe headache or unusual drowsiness. Acetaminophen (Tylenol) or ibuprofen (Advil) can be used to treat a mild headache, but aspirin use is discouraged because it can increase the risk of internal bleeding.

Milder symptoms common in people who have a concussion include difficulty concentrating; mild headaches; constant fatigue; sad, listless, anxious or irritated behavior, according to the Centers for Disease Control and Prevention. But the symptoms may persist even after the day of the injury for some people, said Jin Hahn, associate professor neurology and neurological sciences and of pediatrics at Stanford’s School of Medicine.

“Some patients develop post-concussive syndrome,” Hahn said. “They develop mild neurological symptoms such as headaches, decreased ability to concentrate or pay attention, dizziness — they may have a constellation of these symptoms where they are not able to function as well as they did before.”

Post-concussive syndrome, however, is not a common in the general population, explained Hahn.

“Many of the people who develop post-concussive syndrome may have an underlying migraine disorder — it maybe something in the injury triggers their migraine,” he said. Treatment for post-concussive syndrome can include stronger headache medication, as well as antibiotics if there is the possibility of a bacterial infection.

Injuries in the field: High-risk athletics

Athletes in certain contact sports are more likely to suffer from brain injuries. According to the American Association of Neurological Surgeons, 10 percent of college football players sustain concussions every year. Other-high risk sports include boxing, ice hockey, wrestling, gymnastics, lacrosse, soccer and basketball. Co-terminal student Matt Janusz, who used to play for the men’s soccer team, once got a concussion during a soccer game.

“Someone took a shot at the ball, it defected from another player’s foot and hit me square in the face,” explained Janusz. He was taken to the emergency room for a series of tests and told not to sleep for a couple of days. “They just told me not to play until I felt completely fine and it turned out to be a very mild injury.”

There is disagreement among athletic trainers, neurologists and physicians about when players should be put back in the game after a concussion. The American Academy of Neurology has developed guidelines that place injuries on a three-level scale.

“When should players be put back in the field?” Paul Fisher, associate professor of neurology and neurological sciences and of pediatrics at Stanford’s School of Medicine, asked rhetorically. “When they look normal to a trainer? To a physician? These are hard answers. The general rule of thumb is that the more severe the injury, the longer they should be kept out of the game. But there’s not even firm criteria to determine how to grade an injury — the field [of neurology] is nebulous and murky regarding diagnosis.”

Trainers and doctors usually run through a checklist to determine the extent of the injury, but trainers are still inconsistent when it comes to putting players back in the game after a concussion, explained Fisher.

Some neurologists believe that players who have suffered from several concussions should end their sports careers completely, subscribing to the theory that several concussions can lead to permanent brain injury,Fisher said.

“But there’s no evidence that mild brain injuries are really cumulative,” he said. “People theorize that over time, you can develop permanent cumulative brain injury, but you’ll find different opinions.”

Fisher points to the example of Jamie Carey, who started out at Stanford in 1999 as a star basketball player in her freshman year. In November of 2000, Carey suffered a series of concussions in a short period of time, and she suffered from post-concussive symptoms that took her out of the game for two years. Stanford’s doctors could not clear her to play again, but they referred her to doctors in Austin, Texas. Carey was finally cleared to play and started as a point guard at the University of Texas in 2002.

“If it had been my daughter, I would have allowed her to play again,” said Fisher. “Unless the injuries are extreme, there’s no reason why some doctors should refuse players to play a game they are passionate about.”

New tool aids injury diagnosis

Diagnosing the grade of head injuries can be difficult — and matters are only complicated when a trainer needs to make a quick decision about a player’s health in the middle of a game. Wright and La Placa’s, professor at Emory and assistant professor at Georgia Tech respectively,diagnostic tool may allow injured athletes to 0

Their sensitive screening tool, termed the Display Enhanced Test for Concussions and Mild Traumatic Brain Injury System, or DETECT, guides the patient through neuropsychological tests that measure brain function. Developed for use in athletic events, when the diagnosis must be made quickly in order to determine whether the player can jump back into the game after a head injury, DETECT takes only seven minutes to execute.

Patients put on a pair of wraparound goggles that fit over the face and place large earphones to tune out noise. They are then given instructions through the headphones and use a hand-held device to respond. The device tests response time, memory and concentration.

“It is an immersive environment, such that audio and visual distractions are eliminated / minimized,” wrote LaPlaca in an e-mail. “The novelty of DETECT revolves around the portability, immersiveness and short length [of the tests].”

The researchers are still validating the device against standardized tests that have been around for a longer period of time, but are hoping to have the device in the sidelines in the next couple of years.