Baseline brain testing grows in popularity
Neurological exams for student-athletes can later help with treatment of concussions
Amy Knappen talks to Sean Poole and his father Tim Poole about his test. (Gene Sweeney Jr., Baltimore Sun / August 10, 2012)
Baseline tests can be used for comparison to neurological exams after an athlete suffers a concussion to help choose the best treatment.
The tests, on the market for a few years, are used mostly by school athletic programs and collegiate and professional teams.
This summer, HeadFirst began offering the test to patients at concussion centers in Gambrills and Annapolis. HeadFirst, an affiliate of Crofton-based Righttime Medical Care, uses the ImPact test.
But even as use of the tests grows, some say the tests are unreliable and that athletes could be allowed to return to play before their concussions are fully healed.
Parents who took their kids to the Gambrills center recently said they know the tests can't prevent concussions, but it gives them an added level of comfort.
Tim Poole's son Sean, 13, is playing football for the first time this fall. When Poole heard about baseline testing while picking up his son's equipment, he quickly made an appointment for Sean. Poole used to coach basketball and remembers how frequently his players suffered concussions.
"With the prevalence of concussions in the news, I just wanted to be safe," Poole said. "It's smart to have a baseline test so you know the severity of the concussion and where he started from."
The computerized test is administered free by HeadFirst, and takers are given 30 minutes to complete it. It involves exercises that test a wide range of cognitive functioning, including attention span, memory and reaction time. On one part, test takers are shown shapes and then asked to recall them when listed in a different sequence.
Awareness about concussions has increased in recent years, particularly as NFL players have been shown to have suffered permanent brain damage from multiple concussions. In 2011, the General Assembly passed a law requiring coaches in Maryland to watch training videos about concussions. It also requires that athletes with concussion symptoms be kept from playing until cleared by a physician. Students and their parent or guardian must sign a letter saying that they received information on concussions before the student can play a school sport.
The Maryland State Board of Education recently appointed a task force to study what else it should be doing to reduce the number of concussions among young athletes.
Baseline testing has critics, and even those who use it say it should not be the only tool for detecting and treating concussions. A researcher at Loyola University Health System wrote in a paper last year that the use of baseline tests can result in "false negatives" that indicate that an athlete has recovered even though he or she is still experiencing concussion symptoms.
Dr. Kevin Crutchfield, director of the Comprehensive Sports Concussion Program of Lifebridge Health in Baltimore, said doctors shouldn't rely too much on baseline tests for diagnosing a concussion. He said he prefers the Standardized Concussion Assessment Tool, a written test that asks athletes to rate symptoms, such as degrees of pressure in the head, feelings of confusion and drowsiness. He said it's important to have a neurosurgeon or someone familiar with brain concussions to analyze a hurt athlete.
Baseline testing is "a decent tool, but I would not rely heavily on that because it's only one metric," Crutchfield said.
Patients who show signs of a concussion after a follow-up test at HeadFirst will be referred immediately to their primary-care physician and a neuropsychologist. At HeadFirst, athletic trainers review the results before turning them over to a doctor.
"The nature of a student athlete is to say 'I'm all better,'" said Amy Knappen, HeadFirst program director. "I like to think of a baseline test as truth serum."
Knappen said one group of athletes being targeted is those in recreation leagues, who might not have access to the same caliber of trainers as a school program might have.
Heather Fowler took her two teenage sons recently to the HeadFirst center in Annapolis. Jedidiah, 15, and Noah, 17, play soccer at Rockbridge Academy in Millersville. Both boys know others who have suffered concussions playing sports, and the family thought it wouldn't hurt to take the precaution of baseline testing.
"This will help give proof if something is wrong," said Fowler. "If something happens, I want to make sure they're treated right away."