Archives for April 2013

Baseline Testing is a way for athletic trainers and physicians to gauge how well an athlete was recovered from a concussion. This is nothing new, as pen and paper baseline testing has been occurring since the mid 1990s1. Computerized Neurocognitive testing enables health care providers to do a number of things. It helps determine a safe return to play (RTP), identify lingering effects of concussion and potential catastrophic injury, and quantify the injury with a highly sensitive measure of brain function2. Baseline neurocognitive testing also allows for sports medicine professionals to track the recovery of each athlete instead of using a cookie cutter approach.

There are many commercial neurocognitive tests out on the market today. The most common 4 are: ANAM, CogSport, HeadMinder CRI, and ImPACT. ImPact is the probably the most well known baseline testing software out there today. Partnerships with the NFL, NHL, MLB, MLS, along with various colleges and Dicks Sporting Goods have helped to make it popular. Researchers at the University of Pittsburg Medical Center developed ImPACT. It was developed to allow for an objective assessment of concussion and recovery2 Jeremy Tjarks, athletic trainer for Mercy Sports Medicine and Central High School, presented on ImPACT. He presented that ImPACT works by reporting concussion history, symptom scale, eight neurocognitive measures (Memory, working Memory, Attention, Reaction time, Mental speed, verbal memory, visual memory, and Processing speed), and detailed clinical report2. Once the test is completed the sports medicine professional can compare the results from a previous test (baseline) or to normative data that is available.

Introductory article – What is a Concussion?

There are a few drawbacks to ImPACT. In a 2012 study on age related differences in neuropsychological testing it was found that age could play a role in the results on ImPACT4, 5. Of all the tests only ImPACT was found to have an age related differences with processing speed composite scores with college athletes scoring better than high school students4. This adds to the current literature that shows results consistent with the changes in cognitive maturity and decline in scores4. Because of these differences it is recommended that high school athletes be tested annually

Given the price of ImPACT this raises questions of cost effectiveness. It is also been found that these test results can vary across testing sessions. This can be due to a practice effect or a lack of effort on the athletes’ part3, 4.

There is one other concern about ImPACT. Mark Lovell, one of the founders of ImPACT, along with co-founder Joseph Maroon, are members of NFL’s Committee on mild traumatic brain injury, which conducts research projects designed to help understand concussions. Mr. Lovell has a tendency to leave out this financial interest when authoring research concerning ImPACT. In 2007 Commissioner Goodell ordered all teams to implement baseline testing, 30/32 teams use ImPACT. All of this is done while two members of the mTBI own the testing software. It should be noted that the League does not tell the teams to use ImPACT, each team gets to decide. This relationship is a hotbed of discussion as almost all the research on the companies website has been done by Lovell concerning reliability and validity6.

Second article in the series – Return to Play

The take home message can be this. Baseline testing of some sort can be in that it allows the sports medicine professional to take an objective of the recovery a concussed athlete. However, it is one TOOL in the bag regarding concussions. It is not a clearing mechanism for allowing athletes to return to competition. Baseline testing does not come with concerns. The primary concern is test-retest reliability and validity of the tests. Athletic trainers using these systems should themselves be testing the validity of each baseline test they perform.

Concussions are complex and hard to predict. Athletes need to be honest with the athletic trainers and sports medicine professionals when reporting signs and symptoms.

Andy has been a certified athletic trainer since 2007 when he graduated from Missouri State University. He went on to get his Master’s degree from Emporia State University in Emporia, Kansas. Andy has been working in the secondary school setting since 2008. During that time he has been a part of implementing policies and procedures. Through research and continuing education, he has been able to help put together policies that athletic trainers can use to treat concussions.

Andy’s began playing soccer when he was 5. He played for Firestorm SC in Southwest Missouri. During high school he played goalkeeper for Neosho High School from 1999-2003. Andy began refereeing in 1997. He has progressed to a State 5 referee, participating in the Midwest Regional tournament for 5 years, attending the ODP national Championships in 2010. When the Women’s Professional Soccer league was in St. Louis he was on the list of referees. Along with being a USSF referee Andy is also a MSHSAA referee and a college official.