Concussions and Computerized Neurocognitive Testing

A great article on the use of neurocognitive testing was published on espn.com this morning.  If you haven't had the chance to read it, you should check it out here, most especially if have an interest in concussions, sports, or if you have kids.

Mild traumatic brain injury, aka concussions, have exploded on to the scene over just the last few years.  I think this is a particularly interesting phenomenon to doctors such as myself, who have been practicing sports medicine for many years.  I can still recall the era that I might send a high school athlete back into a football game after halftime if the symptoms from the concussion he sustained in the first half had abated.  I can still recall trying to 'grade' a concussion based on elaborate scales, the Cantu Scale or the Colorado Scale.  I can still recall as recently as two years ago trying to educate people about the importance of recognizing and managing this injury correctly, and feeling I was preaching to deaf ears.

And I can recall as recently as two years ago managing every concussion I saw without the use of computerized neurocognitive testing.

These tests, and ImPACT is only the biggest one on the market (they include Axon Sport, which my group uses, Headminder, and others) purport to demonstrate an athlete's function in many domains affected by concussion:  attention, memory, learning, reaction time.  They can be useful at times, but honestly, they are best used sparingly, in the same manner as imaging (which is to say, not every kid who gets concussed gets a CT scan, nor should they!).

A nexus of fear, uncertainty, money and marketing have created a huge windfall for the companies that run these tests.  Parents are worried.  There is still much to be understood about the injury:  how many concussions are too many?  what is the long term prognosis for pediatric sport related concussion?  why do some people get concussed and others, hit more violently, don't?  should we be just as concerned about so-called subconcussive blows (e.g. lineman getting smacked in the head)? what is the role for equipment to prevent this injury?

And the money!!!!  I am conducting on-going research into concussions (above) and am writing a grant with colleagues to conduct other research.  The research interest and money being focused on this problem is astounding, especially when one considers the myriad other injuries young athletes are at risk for.  Furthermore, companies such as the one which owns ImPACT, in Pittsburgh, are marketing their tool aggressively; I do not know their financials, but I have to believe they are making very good money.  If they go public, I would suspect they'll outperform Facebook!!!

This is an evolving story.  I suspect the pendulum has swung very hard from one end (indifference) to the other (disproportionate fear).  I'll be treating concussions, researching them, monitoring the public health dimensions of the issue, and blogging, blogging, blogging for some time.

Exercise Deficit Disorder and Dr. Avery Faigenbaum

A couple of media links were sent my way that reminded me of my good friend Avery Faigenbaum and the talks/work he did with our organization on his visit to Columbus in May.

Here is Avery on YouTube talking about the issues surrounding pediatric resistance training, and here he and I are discussing the same issue on a special podcast known as Pediacast.

Or you can go here to check out both the video, the podcast, and grab further detailed information on how to safely have your child pursue resistance training.  With supervision, this activity can be done as early as you'd consider getting your child into any organized sport.

For all of you out there inspired by the Olympics and see visions of glory in your kids, or for the many more of you who simply want to prep your children for a life of healthy, safe activity, you can go ahead and get them started in resistance training with appropriate supervision.  The links above will help.

To your kids' health!  (and yours, too).