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.
Though some lay readers might be tempted to slough off this development or allow their own eyes to glaze over the technical arcana, it is difficult to overstate its importance. Baseline testing is the holy grail, the sine qua non, of the “concussion awareness” pushed by the National Football League and used as a legal fig leaf by high school officials who don’t understand the problem – either willfully or because they are confused or powerless in the face of an astronomically popular sport that is silently maiming a generation of American youth.
The evidence, as usual, is hiding in plain sight. Examples:
- In talks at medical conferences, neuropsychologist Jamie Pardini of the UPMC Concussion Program discusses “How I Manage Concussions.” At http://muchnick.net/pardini.pdf, you can download a PDF file, which appears to include slides shown to the audience, perhaps a PowerPoint presentation. Look at slide number 8, “Clinical Protocol: Neurocognitive Testing.” The first point on the timeline, pre-concussion, states, “Baseline Testing (Not necessary for decision making).”
- The lead story of the December 2005 issue of The CIF News, the newsletter of the California Interscholastic Federation, was a promo for ImPACT under the headline, “ImPACT Technology Ensures Safe Return to Play After Concussion.” The article was written by the company’s director of sales and marketing. It states, “[I]n the event that baseline testing is not possible, ImPACT has a normative database of thousands of non-injured athletes, and such data can be used effectively for adequate comparison and deciding safe return to play. Thus, ImPACT may now be used effectively in a clinical setting when baseline data is not available for comparison.”
- ImPACT Applications, Inc.’s own website tackles the question head-on (so to speak). Here’s the explanation on the FAQ page (http://impacttest.com/faq): “Yes, the program can, and should, be used even without a baseline. In the report summary scores (composite scores), the norms are printed out and automatically tabulated. The raw score is accompanied by a percentile which indicates where they fall relative to healthy age and gender-matched controls. For example, if the composite score falls at the 5th percentile…that would indicate 95 out of 100 non-concussed individuals would perform better than the athlete that is being tested. By understanding their pre-injury status, this data can be extremely informative and helpful. For example, a typical A/B student should be around the 60th percentile or higher on all composite scores, those that are C students should typically fall around the 40th percentile or higher and those with learning disability or very poor students could fall as low as the 20th percentile or so and be considered within normal limits. We use the program all the time without baselines and the data is very helpful for clinical management.”
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.
(All of this is not even to get to the general flaws of subjective neurocognitive tests, which have already been widely discussed: the reality that test-takers sandbag the baseline tests with deliberately dumb answers, and boost their scores on repeat tests with the help of Ritalin.)
ImPACT owners Dr. Joseph Maroon and Mark Lovell, and UPMC Concussion Program spokeswoman Susan Manko, did not respond to my requests for comment. That is par for the course.
Equally disturbing is that Dr. Robert Cantu of Boston University also did not respond to a query submitted through the BU Medical Center’s spokeswoman, Maria Ober. Sources inside the concussion-research world tell me that Cantu privately disparages ImPACT’s hype; according to one source, Cantu was appalled that UPMC and ImPACT make the claim that you can get away with not even conducting baseline tests (which are labor-intensive and expensive, and a deal-breaker for many high school athletic departments on the fence over whether to buy the product).
But as with Cantu’s murky call for an end to youth tackle football – a recommendation floated in a Boston television interview, then recanted on ESPN’s Outside the Lines – his work and voice have become too detached, political, and beholden to the NFL establishment in order to have the kind of “impact” we all really need in the public debate over the future of collision sports involving young people.