If fall sports return after pandemic, baseline concussion testing is essential | Opinion


June 16, 2020

Due to the COVID-19 pandemic, returning to school in fall 2020 will be one of the biggest challenges educators, health care professionals, students and parents may ever face in their lifetimes.

Returning to sports will be no exception, and in many cases, maybe even more difficult or impossible. A number of organizations, such as the Centers for Disease Control and Prevention, The Aspen Institute, the National Federation of State High School Associations, and New York State Public High School Athletic Association (NYSPHSAA), have developed guidelines to help youth and high school sports come back in a safe manner. There is no doubt the guidelines will impact each school district’s athletic director, nurse, school physician and athletic trainer. Depending on the enrollment size, level of competition and number of sports, each school will have a different response.

Social distancing, mask-wearing, temperature-checking, practice structure and limits on how many athletes can be present will all be in flux, depending on the spread of COVID-19. Although many student athletes have tried to remain active on their own, reduced organized off-season activity may also place some students at a greater risk for various injuries, including concussions.

Prior to every sports season, students are required to have physical examinations and often baseline assessments if they participate in contact/collision sports. NYSPHAA recently announced that if physicals were unable to be conducted prior to the start of this season, then last year’s exam would be accepted. Baseline tests are often conducted by the school district’s athletic trainers, typically during the first week when students return to sports practices.

Over the last 30 years, the use of neuropsychological testing has provided an objective method in the evaluation and management of concussion. It has become increasingly useful in the realm of sports concussions, and baseline computerized testing is the most commonly used method by school districts.

With the increase in COVID-19 guidelines, safety rules and regulations, there may be a temptation to have student athletes complete baseline tests at home if they cannot find the time to do them at school, or to “streamline” the process. Conducting this assessment at home — without proper supervision, where the situation could not be controlled and/or the understanding of the assessment may be jeopardized — presents significant ethical and testing challenges. How can environmental control be guaranteed if someone were to take a baseline in their kitchen or living room with friends, cellphones, or family presenting as distractions? What about those student-athletes with learning disabilities or ADHD?

Concerns over brain injuries have expanded well beyond the pros. Studies have found the dangerous effects they have on the brain development of young athletes — and not just football players.

As schools contemplate returning to sports, this is a good time to examine how baseline tests are conducted and the importance of their proper use. Consistent with the Standards for Educational and Psychological Testing, in 2019 the Sports Neuropsychology Society (SNS) issued a Position Statement on Supervised Administration of Neuropsychological Tests in Sports. Supervised test administration by qualified individuals greatly increases the likelihood of accurate and reliable test results, which is essential to support clinical decisions to return an athlete to play and return to school. In a perfect world, the athletic trainer and sports neuropsychologist work together to ensure administration and test interpretation are accurate. Having access to professionals such as sports neuropsychologists, however, can be difficult in some rural areas. But if proper administration and interpretation of these tests is not available, then better to not have a baseline than one that is worthless. As we return to school and sports, adherence to guidelines and position statements such as these should be followed. Failure to do so may place the health and well-being our student athletes in jeopardy. Here is the position statement from SNS.

The position of SNS is that the administration of clinical tests, including computerized concussion baseline testing, should be supervised by a trained health care professional. Supervision of test administration by an appropriately trained health care professional is necessary when using any neuropsychological test, including those administered by computer, to ensure validity of results and comply with long-established test standards and ethical guidelines for practice.

After an athlete sustains a concussion, neuropsychological test results are compared often to pre-injury, “baseline” test results to help determine whether the athlete has returned to her or his baseline or pre- injury level of functioning. To make a valid comparison, it is essential that baseline test results are accurate and reflect the true pre-injury functioning of the athlete. Administration of baseline testing should be conducted in a consistent and standardized manner for all athletes and supervised by an individual with proper training and knowledge of the test. Supervised test administration by qualified individuals greatly increases the likelihood of accurate and reliable test results, which is essential to support clinical decisions to return an athlete to play. This also reduces the risk of endangering the health and safety of the athlete.

Proper supervision and administration of neuropsychological testing, whether baseline or post-injury, are necessary components for ensuring accurate test results by:

Validating the identity of the athlete

Ensuring that the test is being taken without undo or inappropriate assistance from others

Monitoring the testing environment (e.g., lighting, distractions, noise)

Assessing individual athlete factors that affect test results, such as fatigue, illness at the time of testing, mobility restrictions, etc.

Determining whether the computer and its accessories are working properly

Monitoring the athlete’s ability to read and follow the test instructions

Answering the athlete’s questions regarding the test and test instructions

Monitoring the athlete’s motivation and effort throughout testing

Reviewing the test results for accuracy and validity

Mark Herceg, Ph.D., is senior neuropsychologist at Phelps Hospital and assistant professor at the Zucker School of Medicine at Hofstra University.

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