The title and the article is nothing new, we have known for some time that computer based neurocognitive testing is not perfect. Some have even concluded that these type tests are not worth the time and money. More and more I am hearing from professionals that feel that they HAVE to give this tests or others like it, even though it’s not precise enough in cases.
What is interesting to me is the website it appeared on, NFL.com, the one league that has propelled this product more than any other.
The timing of this article is also curious to me as well. Lately I have been getting many emails regarding computer based testing and the need for it and my overall thoughts on them. Perhaps there is a wave of skepticism regarding this tool, which is nothing new, or perhaps there have been more and more issues with these tests, now that they are being used by so many.
There is no doubt there has been an impetus upon baseline testing; the most time efficient is the computer based model. However if you look at the most recent Consensus Concussion Statement there it is rife with confusion about this as well;
Baseline NP testing was considered by the panel and was not felt to be required as a mandatory aspect of every assessment; however, it may be helpful to add useful information to the overall interpretation of these tests. It also provides an additional educative opportunity for the physician to discuss the significance of this injury with the athlete. At present, there is insufficient evidence to recommend the widespread routine use of baseline neuropsychological testing.
Before that paragraph the Statement notes the use of cognitive assessment as a part of the recovery constellation and how it should also be used to get a better picture of the recovery of the injured. Nothing in the Consensus Statement mentions the use of computer based, mass testing platforms to help with concussion assessment or recovery. So why are we using them?
That is an awful good question.
To me the best picture of recovery, in my opinion, can be gained by assessment of symptoms, cognitive, balance, visual and well-being of the injured person. That last piece is the most important, again in my humble opinion, if the kid/person is “not right” then they are not right.
I have seen plenty of concussed individuals that have passed the “needed” exams for all the other portions, but are still not themselves. Worse, I have had parents and kids a like struggle and counsel with me about why Jimmy/Sally is not doing well in school after the injury when the doctors and tests are saying they are fine. Worser (not a word) yet, is the personality and social changes I have seen with kids after a concussion that is often overlooked or not even mentioned by a physician when working on a recovery timetable.
The expectation of those taking the tests, computer based neurocognitive in particular, is that if they pass the test they are good to go. This has led to many concussed and caregivers of concussed to be frustrated with recovery. I know it has been told to us over and over that these are not clearance devices but most places have policies that require one to be back to baseline before being able to return to play. Heck if you just sprain an ankle your neurocognitive tests can show a deficit. For many others return to baseline is possible but for some it just cannot happen; hence the need for the variety of assessments.
My thought regarding baselines and effectiveness are simple; if we don’t have a “gold standard” quite yet then why spend all the money to get unreliable results? Moreover, if there is no correlation between scores and severity/recovery time then why use them at all? They are a good tool but, simple paper and pencil tests can provide the picture necessary to get a grasp on recovery.
The overriding theme of this post and approach on concussion recovery is to use all the tools one has, sometimes the best tools are those closest/know the person to make a clinical judgement. We have yet to produce a test that can give us definitive measures of both severity of injury and of full recovery. Because of this we need to be conservative with the youth and make the most informed decisions possible when someone is returning.