This is unfortunate, as these neurocognitive assessments are capable of detecting incomplete recovery.
These findings, reported by William Meehan, III, MD, of the Sports Concussion Clinic at Children’s Hospital Boston, along with R. Dawn Comstock, PhD and colleagues at Nationwide Children’s Hospital, stem from a national study of injured athletes at US high schools and a survey of athletic trainers employed by those highs schools soon to be published in Pediatrics.
Awareness of the problem of concussions in young athletes has grown dramatically in recent years, as medical practitioners realize the potential for long term effects of sustaining multiple concussions. Computerized neurocognitive assessments offer an objective means of monitoring recovery. The study by Meehan and his colleagues showed that athletes who are managed with computerized neurocognitive assessments are less likely to be returned to sports within 10 days of their injury, presumably because the computerized assessments detect persist symptoms or problems with brain functioning that the remainder of the clinical assessment does not reveal.
Despite such a benefit, most US high schools are not using computerized neurocognitive assessments. But Meehan is optimistic. “Our study shows that the proportion of US high schools using computerized neurocognitive testing has increased from 26% in the 2008-2009 academic year to 41% during the 2009-2010 academic year. I suspect this number will continue to rise,” Meehan said.
Although Meehan notes that there are several computerized neurocognitive assessments available, the current study shows that 93% of the schools employing these tests use a progam developed by scientists at the University of Pittsburgh Medical Center known as “ImPACT,” (ImPACT Applications, Inc, Pittsburgh, PA).
There is some controversy regarding exactly who should be interpreting these tests. Some neuropsychologists feel that these tests should only be interpreted by neuropsychologists. However, the study by Meehan and colleagues shows that the vast majority of these assessments are being interpreted by physicians and athletic trainers, while only 17% are interpreted by neuropsychologists. On this point, Meehan is unambiguous. “Ideally, every concussed athlete would be assessed by an athletic trainer, a physician, and a neuropsychologist,” Meehan said. “But given the large number of athletes sustaining concussions, and the relative scarcity of neuropsychologists, that is simply not possible.” Thus, the study emphasizes the need to train other medical professionals to administer and interpret computerized neurocognitive tests for the limited purpose of assessing sport-related concussions. However, Meehan cautions, “no athletic trainer, physician or neuropsychologist should attempt to interpret these assessments without first undergoing proper training.”
The study was supported by the national Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the U.S. Center for Disease Control and Prevention (CDC), the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, EyeBlack, and Don-Joy Orthotics.