A couple of weeks ago a team and league management technology provider and a neurocognitive testing company announced a partnership to provide online testing for athletes. The announcement prompted emails to MomsTEAM from parents asking for my opinion on how and where to have their children's baseline neurocognitive tests done, and whether they could do them at home. While I have been fielding similar e-mails for years, the uptick in emails prompted me to do some digging to come up with an answer.
In formulating a response, as with so many other aspects of youth sports, I was able to draw on my own personal experience as a sports parent and the past 12 years of covering the concussion beati. Back before they were computerized, one of my sons (the one who played football) took the old "paper and pencil" neurological exam. The test was administered by a neuropsychologist who had been trained to give the tests, and who had given them to hundreds, if not thousands, of children before she switched over to using a computerized exam. I also asked MomsTeam's concussion experts for their opinions.
I recalled a conversation I had with my son's pediatrician when he explained why he was referring him for testing in Boston by a neuropsychologist. He told me that, when it comes to matters involving the brain - the most delicate and important of all organs - one needed to "work with those who are highly trained in the field of neuropsychology; that even we [pediatricians] defer to their results."
The more things change ...
Yes, a lot of time has past since then, and a lot has happened over the past decade in terms of what science knows about concussions, and in technological advances. We know so much more than we ever did.
But, in some ways, things haven't changed all that much. Yes, paper and pencil tests have largely given way to computerized tests (you may have heard of the Immediate Post-Concussion Assessment and Cognitive Testing, or ImPACT tests, for short), which are now being administered in stand-alone concussion treatment centers all across the country or in a hospital setting.
We also know that, increasingly, baseline tests (which can include, not only computerized neurocognitive tests, but balance tests, and of vision) are being administered by trained personnel at the nation's high schools, especially those that have an athletic trainer on staff. And now, a child can even log on to a website of a youth sports organization, testing company, or a sporting goods store to take a baseline test, and he and his parents can get the results with a click of a mouse. It is these tests, taken online without any supervision, which seem to be the ones parents are asking me if they are "safe" and "ok" for their children to take.
It is not up to me, of course, to tell parents what they can or cannot do. The "dash board" types of tests are an option. But based on the research I have studied, the opinions of experts I have consulted, and, frankly, my own personal experience, I come down strongly on the side of those who feel the taking of an online baseline test is not the way to go.
Looking back on the time and care that my own sons' neuropsychologist took in administering the test, interpreting the results, and then going over them with me and my son in detail, and how much I counted on the reliability of the test results, which I needed not only in working with his school on an individualized education plan (IEP) but to compare against the results obtained after he suffered concussions, I cannot square in my mind how a "dash board" take at home test can achieve the necessary degree of reliability to be of much use, beyond perhaps giving parents a sense that the blow to the head their child suffered in yesterday's soccer game wasn't so bad because, comparing his baseline to post-injury test results doesn't show much of a difference.
... the more they stay the same.
My recommendation to parents is to leave the concussion testing where it has always been: in the hands of concussion professionals. While it may be tempting for parents to think that the technology has advanced so far as to eliminate the need for trained professionals in administering and interpreting neurocognitive test results, and while home concussion testing may be all the rage, I don't think we have reached that point. We may someday, but, in my view, we aren't there yet. Not by a mile. I just don't think parents of athletes in contact and collision sports can afford to take a chance. We're talking about our kids' brains, here, after all.
Should every child playing sports or engaging in activities in which concussion is a possibility, such as winter sledding or even riding their bike, have access to affordable, reliable neurocognitive testing? You bet. I hope to see a day in the not too distant future when periodic baseline computerized neurocognitive testing will become a routine part of a child's pre-participation or sports physical. But neurocognitive tests need to be administered by professionals with appropriate training and experience (e.g. Credentialed ImPACT Consultant). Period. End of story.
Don't have to take my word for it. If you aren't inclined to believe me (after all, while MomsTeam and I have been at the forefront of concussion prevention and education for more than a decade, I don't have any initials after my name), I invite you to read what Rosemarie Scolaro Moser, Ph.D., a leading sports concussion neuropsychologist, MomsTeam expert, has to say about the challenge, even for trained experts, of obtaining valid baseline test results, and why parents should exercise caution in buying baseline tests on line for their child to take at home. *
Look before you leap, so the saying goes. In the case of neurocognitive testing, it couldn't be more true.
Questions/Comments? Reach me at email@example.com
*Important April 18, 2012 update: The Centers for Disease Control and Prevention's recently issued "FAQs about Baseline Testing among Young Athletes1 supports my position stating that: (1) Baseline tests should only be conducted by a trained health care professional; and (2) "[o]nly a trained health care professional with experience in concussion management should interpret the results of [a] baseline exam. When possible, ideally, a neuropsychologist should interpret the computerized or paper-pencil neuropsychological test components of a baseline exam."
1. http://www.cdc.gov/concussion/pdf/baseline_testing_FAQs-a.pdf)(accessed April 16, 2012)