Ask Nick Bernards about some of the most pivotal moments of his hockey life, and the 16-year-old from London, Ont., gets unintentionally vague.
"Well, the first time, I was going into the corner and -- I'm not entirely sure, my memory isn't too good -- but I think I got an elbow in the jaw," he says. "I think I just kept playing, but I don't really remember."
Or: "The last one was the worst one. I was going into the corner and went headfirst into the boards. I think I got pushed, but it's kind of a blur."
Rather than goals and wins, some of Mr. Bernards' biggest moments in club and high-school hockey have involved concussions, in particular the three he suffered within a nine-month stretch beginning in April of 2004. The last of those forced him to sit out the rest of the 2004-05 season.
"This injury occurs much more frequently than you think," says Michael Collins, assistant director at the University of Pittsburgh Medical Center's Sports Medicine Concussion Program. "One in 10 contact-sports athletes per year will sustain a concussive injury."
Starting today, however, recreational athletes in Ontario, their parents and their doctors will have the opportunity to understand better the nature of the common brain injury that is often tricky to diagnose and trickier yet to treat.
A joint venture being launched by Bauer Nike Hockey and the university's concussion program, called Headsmart Hockey, will provide subscribers Internet access to the same cutting-edge diagnostic tests previously available only to elite athletes.
For a $50 fee, athletes gain entry to a Web portal where they can record brain functions such as reaction time, memory and focus, all measured through a 20-minute, on-line test.
The program, known as ImPACT (Immediate Post-Concussion Assessment and Cognitive Test) was developed by Dr. Collins and Mark Lovell, director of the concussion program, and is the same one used by players in the National Hockey League and National Football League.
If successful in Ontario, Web-based access to the test could be broadened to other sports and regions, Dr. Collins said.
The key to successfully managing concussion is having the baseline data available. In the event of a suspected injury, subscribers will be directed to physicians in their region who are trained in ImPACT.
In addition to a clinical evaluation, the patient will take another test, the result of which his doctor will compare to baseline test scores.
Comparing the two tests allows for a more precise assessment of an injury that comes with symptoms that often vary from one individual to another and are easy to misinterpret. They include headaches, dizziness and occasional memory loss. "There's a lot of mismanagement of this injury," Dr. Collins said. "Parents will take their kids to the emergency room and they'll get told when the headache goes away they can go back to play.
"And if you're a junior in high school and you've got dinged, and three days later someone asks, 'How do you feel? ' you'll say, 'Fine, when can I get back on the ice?' "
If a return to competition comes too soon, the consequences can be serious, and in rare cases, even fatal.
Properly managed, however, concussions can heal completely, with the victim no more prone to subsequent injury than someone who has never had a concussion. The only treatment is time.
"When you have a concussion, and it can be very mild or very significant, the thing to remember is if you let it recover, it will," Dr. Collins said.
Mr. Bernards took the ImPACT test in October, 2004. Because his first concussion was relatively mild and six months had passed, his results were normal.
A month later, he suffered a second concussion, this one more serious. He took the test again and it indicated that his brain functions were dulled and slower. He was held back from playing for about three weeks, until his symptoms were clear and his tests were normal.
He wasn't so lucky the third time. While his symptoms -- headache, dizziness and nausea -- were similar, they took longer to clear. Most importantly, his test scores didn't improve quickly or significantly: he found it hard to focus in school and even light exercise brought on more headaches.
By early February, he was told his hockey season was over.
It's at this point that young athletes are most vulnerable, experts say. One of the key benefits of having test results to show concussion victims is that it provides tangible evidence of an injury that is otherwise hard to detect or quantify.
"Without the test I definitely wouldn't have sat out the rest of the year," said Mr. Bernards, who is back playing this season. "If you really want to play, you can lie about your symptoms, but you can't really cheat the test."