Nicco Baggetta has suffered his fair share of concussions.

“Your head hurts. Everything’s fuzzy. (There are) stars in the sky,” the Butler junior quarterback/linebacker said. “That kinda stuff.”

Golden Tornado senior boys wrestler Sutton Stoner hasn’t been diagnosed with one, but he’s “definitely had moments where I hit my head and maybe I’m a little dazed for a second or two. But I used to play football for a while and every once in a while, I’d get a big crack and I was like, ‘Wow, that was (disorienting).’ ... You see little speckles moving around.”

“You’ve heard the terms probably,” Karns City head athletic trainer John Burnett said. “Back in the day, they would just say, ‘Oh, you got your bell rung. You got your clock cleaned. You got the cobwebs knocked off.’ Those were all concussions.”

Butler, Freeport, Karns City, Knoch, Moniteau and Seneca Valley are all among the Butler County schools that administer ImPACT concussion testing in an effort to protect their student-athletes from head injuries.

Over a span of approximately 20 minutes, ImPACT tests gather data and information on student-athletes’ short-term memory and reaction times to “assess for brain function and development,” Butler head athletic trainer Holly Forbes said. Beginning in seventh grade, Butler administers baseline tests, which measures the brain’s functioning in a healthy state, every other year for its athletes.

Karns City has been using the program since 2004. It administers the test for seventh, ninth and 11th graders, largely because athletes’ brains are still developing.

“It does it more in a fun way, so it seems more like a game than it is just a standardized test to collect the data,” Forbes said.

The computer screen flashes a series of words at the outset of the test to measure memory function. Later in the exam, it will show a word and ask if it was mentioned earlier. To gauge reaction time, Nos. 1-25 are displayed in a different order. The athlete has to click through, counting down as quickly as possible. Another section requires quick-twitch recognition with colors and words.

“Whenever the word ‘red’ flashes on the screen, it might be in blue,” Forbes said. “So you have to associate quickly — on an impulse — if the (word) is ‘red’ and it’s showing up in red.”

When an athlete displays symptoms of a concussion or athletic trainers suspect one, they’re put through the test again, allowing for an accurate comparison to the baseline. The slightest differences — such as milliseconds of reaction time — can be key indicators.

Stoner believes the ImPACT test is a good gauge of where a student-athlete is at.

“At the end of the day, they’re gonna be able to tell pretty clearly, from the before and after, if something’s not right,” Stoner said.

“It’s worked for me,” Baggetta said. “Every time I’ve failed it, I guess, I’ve definitely had a concussion. ... If you do great on the test, clearly you’re doing all right.”

Burnett stressed ImPACT tests aren’t the “sole determinant” in diagnosing a concussion. He views the program more as part of a tool kit. Along with the ImPACT data, Burnett keeps an eye on how the affected athlete is faring at home and in the classroom.

On the field, Forbes is vigilant for big hits — or a string of them. Burnett watches for any stumbling and reminds that concussions aren’t only caused by forceful collisions, but incidental contact, as well.

Some concussions are more obvious than others.

“I’ve had kids go to the wrong huddle,” Burnett said.

If either spots a concussion symptom, the athlete is pulled to the sideline for evaluation of concentration, memory and reaction time. The athlete is asked to answer a series of questions to feel out “what their memory recall was like before the impact, after the impact — even during it,” Forbes said.

Burnett quizzes the athlete on where they are, what day it is and what team is on the opposite sideline. He then gives them a handful of numbers or words to remember and parrot back.

“Now the adventure begins,” Burnett said. “Then I say, ‘All right, so can you tell me who we played last week? Can you tell me the days of the week in reverse order? ... If they make a mistake, that’s considered a miss. So that’s kind of a red flag.”

Certain types of amnesia are telling in diagnosing the injury.

Balance tests — such as standing on one leg or heel to toe — are also useful, watching for any swaying or inability to stay put. When it comes to sideline assessments, the eyes don’t lie.

“If you ever see a medical professional moving their finger up, down, left and right while the patient is keeping their head still, pupil tracking is a big thing,” Forbes said.

“Their eyes are a direct path to their brain,” Burnett said.

Pupils should move smoothly, without twitching or a mistake in following the traced path in air. Abnormal dilation also gives away concussions.

Burnett added a gut feel is part of recognizing.

“I could give you specific case situations where a kid might’ve done really good on all those things, but here’s a kid whose very, very quiet normally and they’re just following me on the sideline like a chatterbox,” he said.

Pennsylvania’s Safety in Youth Sports Act says any minor-aged athlete who exhibits concussion-like symptoms must be pulled from play and cannot return until seen and cleared by a concussion specialist, who administers the ImPACT test in-office and establishes a plan of care based on the results.

Core and balance exercises and plyometrics also factor into the process of returning. Forbes is transparent and adds challenging activities that help show athletes how far along they are in their recovery.

More athletes than not, Forbes said, get frustrated with being held back.

“A lot of times, they feel like they’re ready, but say as soon as they start doing burpees or hill sprints, those symptoms will start to spike again — and then they start to realize, like, ‘Oh, wait, maybe I’m not feeling as great as I thought,’” Forbes said.

When Burnett first started as an athletic trainer, he was the one with final say. Now that it’s out of his hands, he hears his fair share of grumbles.

“At the end of the day, it’s what we have to do,” Burnett said.

In June, Burnett attended the National Athletic Trainers’ Association Clinical Symposia. He left with the takeaway the recovery process is viewed differently nowadays.

“I think we know more about what’s going on in space than we do our brains,” Burnett said. “So many things have changed and are still changing.”

About a half-decade ago, athletes used to be removed from school entirely as they recovered from a concussion. That train of thought has changed.

“Now we have a consensus, it seems to be, that it’s really important that they’re in school because there’s a socialization part of it,” Burnett said. “And a lot of times, the physician will incorporate accommodations.”

Deadlines for school assignments can be extended and workload lightened. Meanwhile, watching television, using a cellphone and playing games should be in moderation, rather than not at all. Sleep patterns factor in, as well.

“It’s never going to be a linear process to recovery,” Forbes said. “Every single concussion is different, so we really need to just individualize the care for each athlete.”

Forbes said children can begin ImPACT testing at 5 years old. A pediatric version of the exam gathers the same set of data. The Pittsburgh Penguins Foundation’s “Heads UP Pittsburgh” program offers free baseline concussion testing throughout the summer.