Richard Urquia spent about 20 minutes in front of a computer screen this week, trying to remember which squiggly line had just flashed on the monitor, or if the word "green" had been written in green or red.
"It was easier than I expected," Urquia, 16 and a junior football player at Goose Creek High School, said when the test was over. "I thought it'd be a harder test."
The exam Urquia and five other Goose Creek athletes took this week wasn't as difficult as the SAT or even a driver's license test, but it might be one of the most important they'll take in their lives.
The test was the ImPACT test, which is administered to high school athletes in Berkeley County and Dorchester County District 2 by Trident Sports Medicine.
ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing, and it was developed in the 1990s as one of the first computerized tools for managing concussions.
Trident began testing student-athletes in contact sports this school year and has tested 3,650 high school athletes in Berkeley and Dorchester counties in 2010-11, according to Guy Walker, sports medicine supervisor for Trident.
Trident administers the tests free of charge to athletes in football, basketball, baseball, soccer, wrestling and other contact sports, and recorded 117 sports-related concussions at those schools in the 2010-2011 school year, Walker said.
"The coaches and administrations at the schools have really gotten on board," said Dr. Joseph Calandra, medical director of Trident Sports Medicine. "We are realizing that concussions are more serious than previously thought.
"This test gives more objective, precise information on when to allow athletes to go back into play. It gives coaches more data to look at, and they are more apt to hold kids out until they are ready."
In Charleston County, school district officials are preparing to announce a testing program in conjunction with the MUSC sports medicine program, according to Dr. Jonathan Edwards, director of MUSC's sports neuroscience program. Charleston County will be using a test developed by Axon Sports, Edwards said.
No matter which test is used, Edwards said, the important thing is to establish a baseline in brain function that can be used in comparison after an athlete suffers a concussion.
The goal is to prevent a second concussion before an athlete's brain is healed from the first, Trident's Calandra said.
"There are two things you worry about," Calandra said. "The first is second-impact syndrome. That's what boxers get a lot, where maybe they get a concussion while sparring, then get hit again in a match and die. That's pretty rare.
"The second is post-concussion syndrome, and that's not so rare. The kids get a concussion, they get a headache, they feel foggy in school. They don't feel right, and maybe they don't know how to express it. It's kind of a slow, slippery slope."
Even when those symptoms subside, a young athlete might not be ready to return to action. That's where the ImPACT test makes a difference, and Calandra cited his own son as an example.
"He played soccer in college and got a concussion," he said. "After the symptoms went away, we started to get him ready to play, and he felt he was ready. But he took an ImPACT test, and sure enough his brain was not ready to play.
"We held him out another week. It's hard to say no to a kid who wants to play, and I think this happens a lot. But when you are able to show an athlete an objective test, everyone - coaches, players and parents -- can be on the same page."
Walker, also a certified athletic trainer, said that without a baseline test, deciding when to send an athlete back into action can be a bit of a guessing game.
"I don't think anybody who's been on the sidelines for any amount of time hasn't questioned a decision to put someone back in the game," he said. "An X-ray shows whether a bone is broken. You can't actually see when the brain is not functioning right, but this test helps us do that."'
Ernie Drews and Kelly Stratoti, certified athletic trainers at Goose Creek, have seen the ImPACT test help their athletes.
"We had a basketball player who sustained a concussion," Drews said. "When she came back with no symptoms, in the old days we'd have gone by outward appearance and sent her back to play. But now we have something we can measure, and when she did not pass the test, we erred on the side of caution."
No joking matter
Trident Sports Medicine has been using the ImPACT test with the South Carolina Stingrays hockey team for about six years, and baseline testing is becoming the norm in pro sports.
Also, the S.C. Legislature is considering a bill that would require the Dept. of Education to develop a concussion policy.
Indianapolis quarterback Peyton Manning joked recently about "flunking" his baseline test to make it easier for him to come back after a concussion.
But even young athletes such as Goose Creek's Urquia realize it's no joking matter.
"I think it's important," he said. "It helps the doctor see, if you have a concussion, whether your brain is impacted in some shape or fashion."