‘Baseline’ Neurocognitive Gimmickry Is Nothing More Than ‘Teaching to the Concussion Test’

As the old NPR comedy radio segment “Dr. Science” used to demonstrate, you don’t need “a master’s degree in science” on your resume in order to have a beakerful of common sense. A new study of neuropsychological (NP) testing as a tool of concussion management – soon to be published in The American Journal of Sports Medicine – provides further evidence that Dr. Joseph Maroon’s ImPACT software has little going for it except its University of Pittsburgh Medical Center team’s tainted National Football League connections, plus a doctorate in B.S.

In “The Influence of Musculoskeletal Injury on Cognition: Implications for Concussion Research,” four University of Toronto researchers conclude that athletes recovering from orthopedic injuries, which have nothing to do with traumatic brain injury, “also display a degree of cognitive impairment as measured by computerized tests.” The clinical relevance of this finding: “[A]thletic injury, in general, also may produce a degree of cognitive disruption. Therefore, a narrow interpretation of scores of neuropsychological tests in a sports concussion context should be avoided.”

(The article’s abstract is at http://ajs.sagepub.com/content/early/2011/07/16/0363546511413375. Thanks to Dustin Fink’s Concussion Blog, http://theconcussionblog.com, for the tip.)

On top of everything else we now know about how savvy athletes game the ImPACT system – by taking Ritalin to improve superficial cognition post-concussion, or simply by tanking their initial “baseline” tests to come off as naturally stupider than they are – we can see what the Maroonization of concussion management is all about. Like standardized testing of academic achievement, it is creating its own ecosystem of gimmicks, which measure mental acuity far less accurately than they measure how resourceful and well-prepared the taker was in having been “taught to the test.”

With iPads, that principle is fine for developing a new-tech economy of “killer apps.” With public health, it’s just a killer.

No matter how you slice and dice it, when it comes to youth concussions there is no substitute for reasonably knowledgeable and concerned people – coaches, trainers, doctors, parents – making sure their kids are OK … really really OK … through use of their own powers of observation. Standardized NP testing misses the point badly, lets the NFL’s multibillion-dollar marketing off the hook, and, not incidentally, further lines the pockets of doctors like Joe Maroon who brought us to this pass.

Which reminds your humble blogger that Dr. Richard Ellenbogen, co-chair of the NFL’s concussion policy committee, still hasn’t gotten back to us on the dangerously mixed messages at the website nflhealthandsafety.com. In Maroon’s video there, he shows off getting a concussed player back to action “efficiently and expeditiously” with a “two-minute drill” evaluation. In Ellenbogen’s video, he emphasizes that you need to evaluate the head-injured athlete across time.

So … which one is it, Dr. Chairman?

FoxSports.com’s Alex Marvez reports that last night the league held mandatory conference calls with team officials to review new tightened-up protocols promulgated by Ellenbogen and his co-chair, Dr. Hunt Batjer. The slogan is “When in doubt, keep them out,” according to Gene Smith, general manager of the Jacksonville Jaguars.

“When in doubt, keep them out” is also the mantra of Ellenbogen’s NFL safety video for the general public. But as long as phony solutions like ImPACT continue to cast a falsely reassuring shadow on the national concussion conversation, Ellenbogen’s words are empty.

Irv Muchnick