Check Your Head
Does testing athletes for concussion with fancy software do any good?
Photograph by Streeter Lecka/Getty Images.
The ad has all the elements of an after-school public service announcement: somber adults reading scripted messages, wholesome kids urging their peers to take a looming threat seriously, and a clever slogan—“Together, we can bench concussions.” At first glance, the Protecting Athletes through Concussion Education program looks like an earnest attempt to raise awareness about the dangers of head injuries in team sports. The campaign highlights the problem and provides athletes, parents, and schools with something tangible that they can do—sign up their kids for a 20-minute test of their cognitive abilities, as a baseline measure in case they ever get conked on the head. The Dick’s Sporting Goods retail chain will donate the costs of ImPACT testing for to up to one million at-risk kids around the nation.
On closer inspection, though, the whole thing begins to fall apart. “It’s a huge scam,” says physician Robert Sallis, past president of the American College of Sports Medicine. “They’ve done incredible marketing, and they’ve managed to establish this test as the standard of care with no evidence that it has any benefit.”
ImPACT was developed by neuropsychologist Mark Lovell, the CEO of ImPACT Applications Inc., along with University of Pittsburgh neurosurgeon Joseph Maroon. Their test is taken on a computer and begins with a health history and inventory of concussion-related symptoms such as headache and mental fogginess. Then participants must remember various words and shapes, and click the mouse button in games designed to measure their reaction time.
The idea is that each student or professional athlete would take the test once before the season starts, and then again after a head injury. If he scored substantially lower on the second try, he’d be kept off the field until he could match his baseline score or otherwise get full clearance from a doctor.
There’s nothing particularly novel about the ImPACT test. Even its proponents admit that it’s essentially a fancier version of existing protocols like the Sport Concussion Assessment Tool (SCAT2), which also measures cognitive abilities, and can be downloaded for free. ImPACT costs $10 to $20 per exam, or comes in packages of, say, 500 baseline tests for $750. While Lovell acknowledges that his test is similar to SCAT2 (which he had a hand in creating) and others—they all measure short-term memory using word lists, for example—he insists that it’s more thorough and comprehensive. For instance, it doesn't just ask the taker to remember words, but also shapes. That means participants are measured on both their verbal memory and their spatial memory, which might be affected differently by a brain injury. Tests like SCAT2 are meant for an initial sideline evaluation, he says, and not as a way of testing whether someone is ready to return after an injury. (Both SCAT2 and ImPACT come with a disclaimer stating that they should not be used as a sole determinant of back-to-play decision-making; that call should be made by a trained professional.)
ImPACT isn’t the only company marketing souped-up concussion tests. At least three other companies sell their own commercial versions, but ImPACT’s partnerships with companies such as Wells Fargo Bank and Dick’s Sporting Goods, and its advertising campaigns with former NFL players Jerome Bettis, Dan Fouts, and Doug Flutie, have helped it grab the biggest share of a growing market. Its client list includes every professional hockey team, and most of the franchises in the National Football League and in Major League Baseball. Which is not surprising, since Lovell founded the neuropsychological testing program for the NFL and co-directed the National Hockey League's neuropsychology program from 1997 to 2007. (He still consults for the NHL.) Even the U.S. government has bought into Lovell's system: Over the past few years, his company has been awarded more than $150,000 in contracts from the Department of Defense.
What good are these tests? ImPACT, like the freebie standard tests, promises to ensure that athletes don't return to play before the concussion is gone. The scariest risk from sending an athlete back on the field too soon is a potentially fatal condition called second-impact syndrome, an uncontrollable swelling of the brain. But experts don’t even agree that the syndrome exists, and if it does, it’s exceedingly rare (a fact that Lovell readily acknowledges). In a paper published last year, neuropsychologist Christopher Randolph calculated that if the kind of brain swelling attributed to second-impact were preventable by such testing, it would require 18 million baseline assessments before a single case turned up.
Christie Aschwanden is an award-winning writer whose work has appeared in the New York Times, Mother Jones, Reader's Digest, Men's Journal, and Bicycling. She's a contributing editor for Runner's World and blogs about science at Last Word On Nothing . Follow her on Twitter or find her online at christieaschwanden.com.