Interesting Find This Morning

NFL Screen Shot 9.17.13The 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 Continue reading

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Next Level… In Concussion Care

As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue.  If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm.  Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises.  Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports).  Short of that, education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.

Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring.  In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing.  The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water?  Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?

I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”).  Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care.  It is Continue reading

Panacea: nearly impossible in the concussion realm

Definition of PANACEA: a remedy for all ills or difficulties.  Even though there are many products and claims out there finding a panacea for the concussion issue is impossible at this point.  Recently we have been examining the faulty claims made by companies about how they feel they can solve the concussion issue, mainly in sport.  Realistically it is an exercise in misinformation and even borderline fraud; and the reason why is simple.

Every brain and individual is exactly that; unique.  How can a product or protocol even come close to addressing the billions of people on this planet, let alone the millions that play sport.  Bluntly, the only panacea for mTBI is to live in a bubble and don’t move, seriously, don’t move.

Peter Keating of ESPN has been on the forefront of the concussion issue in the NFL and everywhere else since at least 2007 and as part of the World Wide Leader’s series on concussions he recently wrote what me and other feel is a pure journalistic masterpiece.  Before anyone starts claiming that I am against neurocognitive testing remember that I utilize this platform as well.  The most decisive point I can make is that what we have now at our disposal are just a myriad of tools that can help us do the job.

Let us break down the Keating article a bit here;

Concussions have become big business in the football world. With 1,700 players in the NFL, 66,000 in the college game, 1.1 million in high school and 250,000 more in Pop Warner, athletes and families across the country are eager to find ways to cut the risks of brain injury, whose terrifying consequences regularly tear across the sports pages. And a wave of companies offering diagnostic tools and concussion treatments are just as eager to sell them peace of mind.[…]

There’s just one problem. Many scientists who are unaffiliated with ImPACT don’t think the thing works.

“Through amazing marketing, the ImPACT guys have made their name synonymous with testing,” says William Barr, an associate professor of neurology and psychiatry at New York University and former team neuropsychologist for the New York Jets. “But there’s a growing awareness that ImPACT doesn’t have the science behind it to do what it claims it does.”

Marketing is a huge business, affecting the thoughts and processes of potential customers drive sales, period.  The issue becomes Continue reading

UPMC Responds to TCB Questions

On February 29th we posted about the “Cut-Off Indicator” for ImPACT(TM) and recovery periods; in that post I had some open-ended questions regarding this information/press release.  Apparently these questions were noticed by UPMC and Chuck Finder, formerly of the Post-Gazette, now part of the media relations of UPMC sent me answers.

The answers were written by Brian Lau, co-investigator of the study/paper, here are my questions and below is the actual response sent to me.

  1. Why would you neurocognitive test anyone with symptoms, while still recovering?
  2. Are the numbers based upon the ImPACT “norms” or a baseline calculation?
  3. Is this experiment repeatable with other measures?
  4. Where are the control groups?
  5. Is the accuracy of ImPACT that sensitive (is there even one accurate enough to make this assessment)?
  6. What did each individual do for management of the concussion in the two days?

Full unedited responses below; Continue reading

UPMC and Recovery Predictor?

The University of Pittsburgh Medical Center and its concussion program have released what they think is a new model to predict how long each individual may take to recover.  Lead researcher on this topic is Dr. Micky Collins who stated in a press release that this information is a “game changer”.

The study involves the ImPACT neurocognitive testing platform (developed by UPMC) and its results two days after injury.  Although the actual score has not been released publicly; it will appear in the next issue of Neurosurgery.  The benefits of such a specific diagnostic indicator would be tremendous for a lot of interested parties.

At the end of the press release/story Dr. Collins indicated something that is similar to what we posted yesterday; “Eighty percent of concussed people recover inside of three weeks.”

This information is all well and good but I would like to speak to some initial “wait a second” thoughts I have regarding this study; Continue reading

Clincal Utility of ImPACT: Mayers & Redick

A new article on the review of ImPACT and it utility of use in determining return-to-play status of a post concussed individual has been published in the Journal of Clinical and Experimental Psychology.  (Lester B. Mayers & Thomas S. Redick (2011): Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues, Journal of Clinical and Experimental Neuropsychology, DOI:10.1080/13803395.2011.630655)

The abstract reads; Computerized neuropsychological testing is commonly utilized in the management of sport-related concussion. In particular, the Immediate Postconcussion Assessment and Cognitive Testing 2.0 program (ImPACT) is widely used to assess the cognitive functioning of athletes before and after a concussion.We review the evidence for the clinical utility of this program in terms of validity, reliability, and use in return-to-play decisions. We conclude that the empirical evidence does not support the use of ImPACT testing for determining the time of postconcussion return to play.

The authors mention the other used computer tests, but chose to focus on ImPACT because of its wide use; from professional sports all the way down to youth sports.  The over all impression is that the current studies from independent sources Continue reading

Playing With Fire

We have discussed how playing with a brain injury can be dangerous; more immediately dangerous for the younger athlete.  However, continually disturbing the brain while it is recovering only prolongs the issue and is a detriment to long-term brain health.  This is the part of sports that gives credence to the awareness and education initiative.

Apparently the NFL, specifically the Pittsburgh Steelers, does not fully grasp everything involved with and around concussions.  I would think that of all the teams that should be well versed in the history of concussions and health risks it would be the former employer of Mike Webster.  Along with Webster, the Steelers have been on the cutting edge of research, perhaps not the team – rather those that are associated with them: Continue reading

Exclusive Story from Irv Muchnick

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. Continue reading

More Research For Multi-Faceted Approach

Jacob Resch an assistant professor at the University of Texas – Arlington just presented his findings about ImPACT testing and its reliability.  I was privy to a media release of the information, here it is in full (bold is my emphasis);

Media contact: Traci Peterson, (817) 272-9208, tpeterso@uta.edu

ARLINGTON – A computerized testing system commonly used to evaluate sports-related concussions misclassified up to 29 percent of healthy participants in a recent test by a University of Texas at Arlington kinesiology researcher.

The results from the study of the ImPACT computerized neuropsychological testing system emphasize the need for multiple types of assessments, said Jacob Resch, an assistant professor of kinesiology and director of the University’s Brain Injury Laboratory. During the study, the system had “only poor to good reliability” in 45 healthy participants, he said.

Resch’s findings were presented this week at the National Athletic Trainers’ Association annual meeting and clinical symposia in New Orleans.

Concussion assessment and management has become a national concern in recent years as former National Football League players and their families have come forward with personal tales of the lasting impact of hard hits. Legislators, Continue reading

Validity of Neurocognitive Tests

Matt Chaney has blogged about it many times, we have posted about it, now it is beginning to find its way into the mainstream media; validity of the neurocognitive tests more specifically ImPACT.  Dr. Chris Randolph of the Loyola University Health System has become one of the “loudest” when it comes to this issue, the main concern being the false-positives.  This is when the testing indicates that the affected athlete is “OK” but is still having post concussive effects.  From USAToday and Robert Preidt;

Randolph analyzed the scientific literature and could not find a prospective, controlled study of the current version of the most common baseline concussion test, called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Athletes take the 20-minute test on a computer. Continue reading

Matt Chaney: Concussion Testing

Matt Chaney is a former football player and even self-described “juicer” during his time in the game.  He used his first hand experience to write a book about steroids in football “Spiral of Denial: Muscle Doping in American Football“, and now has taken his focus on the concussion issue.  Chaney is what I like to call a “pseudo contributor” to The Concussion Blog, he has helped with finding many articles and topics on this blog.  Behind the scenes Matt is one of the most profound people to spark conversation, and has very “real” views on this issue; not to mention that Chaney is a very good journalist.  (This post is an excerpt preview for a pending analysis on Chaney’s Blog, ‘Brain Trauma Stalks Football Players, Dictates Impact Game Reform,’ which will include independent experts’ recommendations for constructive steps imperative to the sport’s survival at public schools and colleges.)

In his most recent post on his blog concerning concussions, Chaney takes a run at neruopsychological (NP) testing and the issues that he and others, including myself, have had with them.  As I told Matt and still believe; NP testing serves a vital role in the spectrum of concussions such as assessment, management and even some awareness regarding the injury.  The issue that I personally have is one of reliability and the “standard of practice”, each NP test can be done and analyzed differently.  How these tests are used is the biggest issue and Chaney says it in his style;

Current purveyors of the theory, led by Chris Nowinski and Dr. Robert Cantu of the Sports Legacy Institute, and NFL commissioner Roger Goodell—who funds the Nowinski nonprofit with $1 million—propose action reminiscent of the plug-in electric football game, with plastic players bumping across the vibrating surface, hooking at shoulders in ring dances.

And that’s only the beginning of hocus-pocus remedy for rampant head injury in American football.

While mysteries are daunting for the problem, like positive diagnosis of concussion, mere clinical intuition guides the varied protocols of diagnosis and judgment for when players are fit to compete again. No random clinical trial of legitimacy has been attempted.

“It is scary,” said Dr. Lester Mayers, concussion researcher of Pace University athletics, who joins experts like Dr. Bennet Omalu in sounding alarm over football’s touting concussion testing, which is parroted by media.

These critics warn football conducts dangerous “concussion management” based on incomplete research for assessing symptoms, and many brain-injured players are prematurely returning to contact, all ages, typically within days.

Chaney takes clear aim at ImPACT during the article; Continue reading

ADD Drugs and Neurocognitive Testing

Irvin Muchnick written about a topic that is starting to become more evident in the “underground” of neurocognitive testing, the use of Ritalin and similar drugs in its class;

Here’s a story you may be hearing a lot more about in six months or six years: National Football Leaguers – followed by college, high school, and youth league football players – soon will be gaming corrupt Pittsburgh Steelers/World Wrestling Entertainment doctor Joseph Maroon’s “ImPACT” concussion management software system by taking the amphetamine-family drug Ritalin before being retested to assess their recovery from head injuries.

It is quite evident from my perspective that any drug that can help with focus and attention will help with attenuating symptoms of concussions, therefore helping a person on the neurocognitive testing.  If you have taken these tests you will know that mental sharpness is needed for an extended period of time; as the tests look for deficits over time, Ritalin and the likes would certainly help.

Muchnick, like myself and his source have the same “love-hate” relationship with neurocognitive testing (although he focuses on ImPACT); Continue reading

ImPACT Review

We have spoke about neurocognitive testing on here, even highlighting some of the tests like Concussion Vital Signs and Axon Sports.  But the test/technology really has been thrust forward by the ImPACT program.  It is of my opinion that each test provides unique advantages, what is key to remember is that these are “tools” that health care providers (athletic trainers) can use to identify both the severity and lasting effects of the injury.  To help explain it a bit further is an article from mysuburbanlife.com.

Bednerek is excited to have the software as another tool. She estimated that Glenbard West has given 300 to 400 baseline tests and five to 10 post-injury tests.

Perhaps, the greatest benefit it she no longer has to rely on the word of an athlete, who often will say anything to get back on the field or court.

“Even now, so many kids lie to you so they can come back and they say ‘I’m fine, I’m fine’ and that they don’t have headaches or anything,” said Bednarek. “But then they take the test and their reaction time is slower and their memory is slower. The test really gives you a more concrete answer to when a kid can return.”

The common theme amongst all the different tests is to find out how the cerebral function of the brain is handling the insult/trauma.  These tests can measure core functions like visual and verbal memory but they also go deeper into brain function and assessing reaction time and deeper level memory.  As the article states and I want to make perfectly clear, this is not a “golden bullet” in determining severity or return to play status, but it sure is handy to have a good tool to assess where they person is at a given time.

If you are interested in using these tools you should “shop” around and find what product will suit you the best; both in terms of time/usage and cost.  We will continue to run stories and highlight the products as the get passed along to us.

The Winter Wednesdays

Courtesy of Airman 1st Class Kerelin Molina

OK, it’s not winter yet, and not a “catchy” title, but with football over I thought I would amuse the followers of The Concussion Blog with the continuation of real stories.  Both on the concussion front and in athletic training.

Time to roll out the balls & mats

With the end of fall sports… Oops…The transition to the winter sports (as our volleyball team is in the Sweet 16 of the state series, sorry gals).  It is time to get ready for some gym madness, either on the court or in the circle.  Basketball practice has begun and wrestling is about to get underway, so it’s time to change gears.

People tend to think that athletic trainers and concussions go into “hibernation” just like the bears of North America, but they could not be further from the truth.  Sure, at the professional level you see both occurring year round, but at the high school level there is a stigma attached to the winter, non-bladed, sports about the incidence of concussions and need for an athletic trainer.  The traditional sports of basketball and wrestling are CONTACT sports, and injuries, including those to the head, occur all the time.

This week we are pre-testing our athletes with the ImPACT neurocognitive system to get baseline results in the unfortunate case of a concussion.  The school where I work is pretty small, so most of the kids that play in the winter have played a sport in the fall and have been tested prior.  However, with incoming freshman and those that chose not to play in the fall, the tests are mandated at our school.

My head hurts

I always get a kick out of those taking this exam for the first time.  After some serious rules are laid down about taking it seriously and letting them know they cannot fail the test, I always have one or two kids who need help understanding where to put their name on the computer screen.

Upon getting to the task of putting in information about any current symptoms, the athletes learn some of the common signs and symptoms of a concussion.  “So you mean that if I am in a ‘fog’ after hitting my head I might have a concussion?”  “What does it mean by trouble concentrating?”  “What if tests give me headaches?”  And so begins the early stages of educating the athlete about concussions. Continue reading