Debate Over Baseline Testing Continues, Even As Use Spreads

By SCOTT LAUBE
Capital News Service

COLLEGE PARK – Dr. Robert Graw, medical director of HeadFirst Sports Injury and Concussion Care, is a strong proponent of using baseline testing to help diagnose concussions — especially in high school athletes.

The tests measure multiple aspects of cognitive function, including attention span, working memory, nonverbal problem solving and reaction time.

“If used correctly, it’s absolutely a valuable mechanism to have when clearing concussed athletes to return to competition,” said Graw, who is also chief pediatrician of Righttime Medical Care. A baseline test is first given when an athlete is healthy; it’s repeated after a suspected concussion.

Michael Lerner, athletics and activities manager at Hammond High School in Howard County, is among those unsure of its usefulness.

“My thoughts are that it is a piece to the puzzle, but I am not convinced of the relevancy of the test as there are too many variables involved,” Lerner said.

The two represent arguments in a larger debate about how to best diagnose and treat student athletes with head injuries.

Graw and his medical team at HeadFirst have been providing free ImPACT baseline testing as part of their education outreach program for sports teams and individuals between the ages of 10 and 24 since opening in 2011. The group, in conjunction with Righttime Medical Care, operates 10 urgent care centers in Anne Arundel, Frederick, Howard and Montgomery counties, 365 days a year, Graw said.

Last year, Graw said he provided 10,000 people with baseline tests — many of them high school athletes in counties across Maryland that currently do not mandate the testing. While he is pleased to see the growth of baseline testing awareness among parents, Graw said the purpose of it is still unclear to many.

“One thing I have noticed is that there is a lot of confusion about the process,” Graw said. “Parents hear their son or daughter passed the post-concussion baseline test, and they automatically think that means they’re cleared to return to the field. … Same thing happens with coaches. Then they’ll ask, ‘Well, what’s the purpose of the test if it it doesn’t clear them to play?’ A lot of them simply don’t understand it’s only one step in the recovery process — and not the final clearance.”

Free ImPACT testing acts as a hook to attract children, teenagers, parents and coaches to come to HeadFirst care centers to learn more about baseline testing and the risks and signs of head injuries, Graw said.

If an athlete is believed to have suffered a head injury during competition or a practice, ImPACT testing is recommended to help determine the severity of the head injury and if the injury has fully healed. “It measures something medical professionals can’t see — cognitive brain function,” Graw said.

Howard County Public Schools’ system has used ImPACT testing for high schools athletes participating in collision sports since 2007. Hammond High School’s Lerner said the test isn’t foolproof.

“Depending on the mood of the athlete, it can negatively skew their responses and the time it takes them to answer the questions. Since both correct responses and time are testing components of the baseline, the accuracy of the results can be misleading,” Lerner said.

Graw said some testing procedures are more effective than others. “Putting 20 to 30 kids in a room at a time to take the test one by one, like the counties who have it are doing, is not the proper way to go about it,” he said. “In order to get the best results, athletes need to be screened individually with just them and the medical professional monitoring the exam in the screening room.”

Graw said HeadFirst emphasizes that baseline testing “is just one small part” of the return-to-play process. When an athlete passes the test, he or she should then undergo a physical, neurological and neck exam before finally undergoing an academic evaluation from teachers to see how they are functioning in a classroom setting.

John Davis, coordinator of athletics for Howard County Public Schools, said that while there was some skepticism of the test from his colleagues prior to the launch of baseline testing, the district is pleased with how the program has fared.

“The program has been a huge success with regards to awareness, diagnosis and safely returning to play,” Davis said. “Before we implemented the program, an athlete would go see their doctor and they would commonly write a note saying the athlete could return to practice in two weeks and that was that. Now, baseline testing provides us with a clear indication, instead of an estimation date, for when an athlete can begin the return-to-play process.”

“I don’t believe any program is without flaws, but I believe ImPACT has been very helpful, and I do not see us moving away from it in the near future,” Davis said.

Brian Gallagher, University of Maryland assistant athletics director and director of sports medicine, said many colleges around the country are adopting baseline testing. At Maryland, Gallagher said all athletes are given assessments using ImPACT or BioSway.

“Neuropsych tests such as ImPACT are a valuable tool, but they should not be the determining factor in return to play following a concussion,” Gallagher said. “I have seen more than a few athletes still suffering from signs/symptoms of a concussion that have completely aced their baseline test. It’s very important for everyone to realize further evaluation needs to be done following a baseline test, regardless of the results.”

Graw said until schools do a better job explaining the purpose of baseline testing to parents and coaches, the program will continue to be looked at with skepticism.

But, he added, “Within the next five years, I expect the majority of high schools in Maryland to institute or require some form of baseline testing,” Graw said. “Counties are fooling themselves and doing a disservice to student-athletes if they doubt the effectiveness of the program.”