This is abstracted from an article in ESPN: http://m.espn.go.com/general/story?storyId=8297794/
It is annotated and presented here without permission but complete attribution to ESPN. The whole article can be found above and is over 3500 words long. So, I’ve shortened it and made comments. In quotes is from ESPN author; Peter Keating, the rest is from me.
“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…
ImPACT, the maker of the world’s most popular concussion evaluation system, offers a 20-minute computerized test that players can take via software or online to measure verbal and visual memory, processing speed, reaction time and impulse control. The idea behind ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and similar batteries is that doctors or athletic trainers can give a baseline test to a healthy athlete, conduct follow-up tests after an injury and then compare the results to help figure out when it’s OK to return the athlete to play. Selling itself as “Valid. Reliable. Safe,” ImPACT dominates the testing market and has spread throughout the sports world.
On a broader scale, ImPACT, headquartered in Pittsburgh, sells tests and training to more than 7,000 pro teams, colleges, high schools and sports medicine centers from the University of Alabama to St. John’s College in Zimbabwe. In the past year, Dick’s Sporting Goods and Wells Fargo have announced initiatives to encourage widespread use of the test. In one ad touting Dick’s promise to help fund ImPACT testing of up to 1 million middle school and high school athletes, former Steeler Jerome Bettis says, “Using tools created by ImPACT … young athletes will know when to sit out.
There’s just one problem. Many scientists who are unaffiliated with ImPACT don’t think the thing works.”
Here is a critical point: when you ask an unaffiliated scientist, like myself, we say it does not work. So who says it works? I’m not saying it works. More from ESPN.
“Mark Lovell, the CEO of ImPACT Applications, Inc., the company that makes and markets the test, said in a statement to The Mag that “ImPACT has become popular because it has been extensively researched,” noting that it appears in more than 110 publications.
Yet a study — really a study of studies — published last year in Current Sports Medicine Reports reviewed the entire span of research on ImPACT and concluded: “[T]he false positive rate appears to be 30 percent to 40 percent of subjects of ImPACT.”
What that means is 30 to 40 percent of the time the ImPACT says you have a concussion when you do not. The weatherman/weatherwoman has a better success record than ImPACT. But there are a bunch of papers and tremendous marketing saying use ImPACT to assess concussion. Now what is happening a 20 minute computer program makes the decision for you. Does it make sense to use something that seems to be just a little bit better than a coin toss to determine someone’s future brain health? I don’t.
“Lester Mayers, who was once a captain in the Army Medical Corps and now describes himself as an “elderly clinician,” retired from private practice almost 14 years ago to become director of sports medicine at Pace University. … “I’ve seen more than 100 concussions since I’ve been at Pace, and there’s a mystery to them.” Mayers found, the vast majority of the studies evaluating ImPACT have been written by the very researchers who developed it. On the “Reliability & Validity” section of ImPACT’s website, for example, 21 of the 22 research papers listed are authored or co-authored by ImPACT’s inventors. And in the case of ImPACT, the people who created the test have used their various platforms to popularize it, all the while maintaining a financial interest in it.
While developing and promoting ImPACT, for example, Lovell oversaw neuropsychological testing for the NFL. That meant he was directing the NFL’s testing at the same time he was chairman of a company selling tests to the league’s teams. Lovell also sat on the league’s concussions committee and served as director of UPMC’s Sports Concussion Program, as director of the NHL’s neuropsychology program and as a consultant to the Steelers. (Today, he works full-time as CEO of ImPACT Application Inc. but remains a consultant to the NFL, NHL and several other organizations.).
“It is a major conflict of interest,” says Christopher Randolph, professor of neurology at Loyola University Medical Center near Chicago and former team neuropsychologist for the Bears.””
What Randolph, I think, is trying to say is that if you stand to make money when someone buys your product than being a paid consultant to sports organizations that you recommend to buy that product is a conflict of interest. It is like going to a furniture store and paying the sales person to tell you how great their store’s furniture is and when you buy something they get a commission. That is a conflict of interest.
“We found that ImPACT is just not fully reliable,” Mayers says. Now under new leadership, the Pace athletic department no longer uses ImPACT testing.”
Continuing with my furniture store analogy, this is like buying that chair and 1 out of 3 times you sit in the chair it collapses. But you cannot return the chair. Is that a great deal?
“Of course, there are good intentions behind those mandates and behind much of the testing going on around the nation. It’s easy to feel that doing something to fight concussions must be better than doing nothing. But American football is in the midst of replacing one giant, uncontrolled experiment (letting young men play a violent game) with another — diagnosing them en masse and on the cheap with a test that many experts deem unreliable.
The bottom line is this: Neuropsychological testing in general, and ImPACT in particular, can be part of an overall exam. Any athlete suspected of having a concussion needs to see a healthcare professional trained extensively to deal with brain injury and not just trained to administer a test.”
So my take from this is there is no simple way to assess reliably a concussed athlete. You need to take the time to do an examination and to understand what the results of the exam mean. Let’s please take some time to train Athletic Trainers and related health care professionals to evaluate the patient with a concussion and participate in their management. I strongly prefer and advocate for PEOPLE, not computer programs, to assess individuals work with those patients and decide what the risks are. The athletes need to tell the athletic trainers and coaches the truth about what is going on and then let medical professionals make decisions.
Do we need better MEDICAL devices, as opposed to ImPACT’s computer program to assess the brain of a concussed individual? Yes of course. We need more research on that subject. I’ve tried to get funding to do just that but research that will be objectively medically validated takes time and money. Writing a computer program and just selling it takes much less time, but we are now seeing why that is such a BAD way to go.