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.