Irvin Muchnick is a writer and investigative journalist who previously mainly focused on the WWE. Muchnick has changed gears a bit and started Concussion Inc, a website focusing on the brain injury issue.
Yesterday on his website Irv posted an article about the neurocognitive test ImPACT; specifically about the statements from the company that baseline tests are unnecessary;
In a finding that exposes just how aggressively, misleadingly, and perniciously ImPACT concussion management software is being marketed, Concussion Inc. has uncovered ImPACT and University of Pittsburgh Medical Center documents advising potential purchasers that not even baseline neurocognitive tests are needed in order to safely use their expensive, for-profit product.
I will freely admit that early on I truly believed that the need for a baseline was secondary due to the wealth (or lack there of) of information regarding normative data. Normative data can be useful for a myriad of issues but I have since corrected my thinking and fully understand that a baseline test is needed for proper clinical evaluation of a concussion. It could be a baseline for balance or the SAC or the combination of the two; the SCAT2. If you don’t have information about the injured brain prior to injury how would one truly know where he/she stands? In the case of not getting baseline information on an athlete (which can be as subjective as knowing the individual) there is nothing to refer to for return to activity other than the patients subjective responses.
Every persons brain is different, you can try to normalize the data to an age, gender, grade in school, sport group but it will never take into account the little idiosyncrasies that we each possess. No, I don’t have my own research information to back up my claim, but I do have various articles written by some very profound people to reflect upon; really it boils down to logic/common sense.
Can you truly compare a John Gold apple to a sampling of all red colored apples of the same general size? No, you can only compare the greatest apple ever to another just like it. The same goes for brains;
I don’t think UPMC and ImPACT would be able to find many, if any, experts who were not already on their payroll who would be willing to assert that a “normative database” could responsibly substitute for individual baseline tests. Young people’s brains are still growing and changing, and their responses to standardized tests fluctuate year to year, even month to month, with variances that make the UPMC and ImPACT claims here almost criminally unsupportable.
Whether or not the computer based testing is actually sensitive and valid enough to produce an accurate representation of brain wellness is still up in the air, scientifically speaking. However these tests still have some value, especially if the athlete has a set of data on file to compare it to.
There are other options out there, other computer based testing platforms, and really its not a matter if you like a white or red Corvette, it boils down to efficiency, reliability, ease of use, and sandbagging protection. All clinicians, schools, and people in general should know a bit about this and not just nod their way through it.
The Concussion Blog 
While omitting the baseline is seriously negligent and the ImPact explanation is ludicrous, I have also heard some other ImPact representations that are questionable medically.
Students are being told to take a baseline over the summer at home (this is not valid when not supervised) – If Marty Rohlings study is accurate this only invites greater opportunities to sandbag;
Baselines can be given every two years – well not in a high school setting.
I know everyone blanches at the concpet of baselining but in order to assist medically sound judgments one must follow a standardized drill. Coaches seem to understand this on the field, they should be compelled to follow it in the training room.
Concussions are not a joke. Wake up. By following the marketing pitches of ImPact you are leaving you institutions open to massive law suits. So either follow a correct protocol or stop testing all together.
Mark Lovell, PhD Mickey Collins,PhD Joe Maroon, MD and UPMC need to explain themselves now. This is misleading medical professionals and ATCs and endangering adolesents. Money is not more important than childrens minds.
Note: UPMC pays to be the Steelers official medical staff.
Lovell and Maroon served on the concussion committee.
I would like to comment personally on the use of neurocognitve testing at the high school level, specifically using ImPACT online software. We have only recently been able to implement such a tool due to the recent passing of legislation in the state of Louisiana. This legislation does not mandate such testing, but we all know that without some sort of objective information PROPER concussion management is damn near impossible! This one important tool combined with other testing batteries as recommended by international guidelines at least gives us a fighting chance to make the best possible informed decision when returning an athlete to practice and competition. Although subjective data is by far the most unreliable information we can obtain in order to make that return to play decision, human clinical judgement and common sense must still prevail when managing this injury, even in combination with ImPACT testing. Chris Carter said it best on Mike and Mike in the morning yesterday when he said of NFL players that sometimes we must “protect ourselves from ourselves”. He is absolutely correct! This doesn’t just go for the athletes, but for the coaches, athletic trainers, and even physicians. ImPACT is a great way to confidently take the guess work out of a high school athletes subjective reasoning. When you show the athletes the coaches and even the parents the concrete data is before them it brings the injury “to life”. Just as the swollen ankle or the dislocated shoulder that you can physically see with your eyes.
With all this being said, I feel ImPACT is the only company that is doing the research to help better manage this injury, and like the athletic trainer on a Friday night who has to be the one to tell a coach that his star athlete can not play due to a concussion and not an obvious broken bone, will sometimes be “unpopular” in the eyes of the general public because they are doing what is right. I haven’t seen anything on Axon or Headminder or any other company for that matter putting out research literature yet. And trust me, I’m not on ImPACT’s payroll. As a matter of fact, I owe them quite a bit of money because we have baseline and post injury tested a whole lot of athletes this year and I’m glad we did.
Without the use of ImPACT this year there would have been a whole lot of athletes being cleared by physicians and returning to play to soon who have no idea of modern concussion management strategies. Which is in my opinion one of the potential problems why we see some of these catastrophic injuries.
Even ImPACT claims that “it” is not the “end all, be all” of concussion management, but just like the seat belt I’m sure we’re all glad we have it on in case of an accident.
Your comment does not seem to address the Muchnick article.
On the other hand, your boast that ImPact is behind useful research is laughable:
Please see:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472639/
or
http://www.riddell.com/research-studies/2917/researchstudies_neurosurgerystudy/
So poor that the FTC is investigating the study exposed during this hearing
http://www.c-spanvideo.org/videoLibrary/event.php?id=198061&timeline
or
Between the years 1994 and 2009 Maroon and Lovell denied the long-term consequences of concussion.
or
The allegations set forth in Hardman v. NFL – http://www.scribd.com/doc/68799275/NFL-Concussions-Complaint-w-Exhibits-10-13-11 against Collins and Lovell by former NFL Players for cooking research.
Caveat Emptor. I hope you are using Impact consistent with proper use of NP tests not as it is promoting their use.
Finally, Impact feigns doing real research. Cogsport (Axon) and Headminder actually have real scientists behind their products not charlatans.
PS: If you concerned with the term charlatan being associated with team ImPact look into Joe Maroon’s fountain of youth nutraceutical business.
Tommy,
Appreciate the comment and feeling… I to was once a ImPACT proponent, and full disclosure we still use it, however it is only used with a baseline. As for the research behind ImPACT, there is a ton, but a lot of the “good” is authored by UPMC. ImPACT and all computer based tests for that mater have been called into question by independent researchers. One thing Joe has exactly correct is that Axon (formerly CogState) and Headminder have been put though the indpendent ringer and have addressed most of the issues that remain with ImPACT (language, length, sandbagging checks).
I have given the ImPACT, Axon and Concussion Vital Signs to my athletes here and there is a clear favorite amongst those taking the test, and there is a clear favorite of mine. Regardless, none of them are used for clearance, rather a small piece of the puzzle for me to make decisions and report out to doctors…
Dustin has hit the nail on the head. I am a firm advocate of using the correct tools, the correct ways in the correct siutations. Concussion is often subtle and difficult to assess. NP tools are suited to clear subjects from cognitive symptoms (often the most difficult to assess) but symptoms are broad in spectrum. Balance, sleep, anxiety as well as the complete sypmtoms list that is well established. It drives me crazy to hear someone like Michael Vick say, I past my ImPact I can play. Well what about the rest of work-up. I am still curious why the NFL has not released his baseline, scores and work-up because he was not right and it was obvious.
Players conceal because they want to or feel they need to play and coaches are often pushing kids out on the field without recognizing the potential long-term consequences. It is the reason to have trained medical personnel present who know the players. A good nurse, doc, or ATC is a walking lie detector. It is the same reason the baselines and follow-ups should be monitored by a medical professional who knows the player.
As far as the limitations of computerized NP tests, the study by Broglio is seriously flawed because it was beyond his math. Chris Randolph doesn’t like computerized tests. If computerized tests are used within their limitations, they are good to screen players that may have serious issues to be dealt with through full examinations.
Again Joe brings up a good point; cognitive recovery is only a small portion of the brain injury. As Don Brady harps on, the emotional recovery is often overlooked and is just as or more important going forward…
I just recently initiated the IMPACT process and will beginning its use with my student-athletes in the near-future. I know now is now the ideal time to start, but things take time. Dicks Sporting Goods has donated the package to our school, but it took quite awhile for us to get to this point. Now I have to learn to use the system and get it started with the basketball team and go from there!
If anybody is interested, the PACE project by Dicks Sports Goods will pay for your school to use the software for one year. Check out their website to see if it’s still available..
Am curious, Mike:
1- What type of training will you obtain for learning the administration and interpretation of the ImPact system?
2- What are all the procedures that you employ for assessing the presence of a concussion?
3- Who determines when the student-athlete may return to play?
4- Who determines when the student-athlete returns to school?
Thanks for your time.
What do people think about the Concussion Vital Signs testing program? I am trying to compare this program to Impact, and would welcome any feedback and experiences with the two. Thank you.