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Should Schools Make Baseline Concussion Tests Mandatory?

With more and more states passing concussion legislation targeting student-athletes, it appears that it will only be a matter of time before every state has some sort of concussion law on the books for young athletes. (Remember, the NFL is actively encouraging all states to pass new concussion laws.)

One area that's largely unexplored in these new concussion laws: concussion baseline tests.

Most of the new legislation revolves around a few key principles: Student-athletes suspected of concussions must immediately be removed from competition and obtain a doctor's clearance before returning to play; and coaches/parents/student-athletes must be educated about the concussion risks of athletics before being allowed to play. Of the new laws being passed, virtually every state's rules only apply to school-based athletics leagues.

Certain states, such as New York and Colorado, have gone above and beyond the norm in their new legislation. Colorado's law extends to nonschool youth-athletic programs, such as Pop Warner football, and in New York, even if an athlete receives a doctor's clearance, he/she can't return to play until at least 24 hours after suffering a concussion.

To this writer's knowledge, not a single state requires all its schools to conduct baseline concussion tests on student-athletes, though. And with neurological baseline tests available like ImPACT—which takes only 20 minutes per test and would cost a school $1,000/year for 1,000 student-athlete tests—it's becoming more difficult to understand why more schools haven't implemented mandatory testing programs.

As a matter of fact, EdWeek reader Sue Klund made that very suggestion to us last year in a letter to the editor.

Bethesda Hospital, in St. Paul, Minn., specializes in brain injuries. It has an online test that anyone can take to document what his or her healthy brain looks like. After the viewer takes the test, no one examines it, but it is saved. If the test-taker later has a brain injury, doctors will have a record of what his or her "normal" brain looked like before the injury. Treatment can be much more specific if medical personnel have a baseline with which to compare changes.

Ms. Klund said that while baseline tests wouldn't prevent concussions, they'd give medical professionals an idea of where to start treatment—something she called "paramount" in the field of medicine.

ImPACT, which stands for Immediate Post-Concussion Assessment and Cognitive Testing, is a 20-minute battery of computer-based questions that measures the attention span, working memory, and reaction time of student-athletes. Student-athletes would take an ImPACT test before the start of a season (the baseline test), and when suspected of a concussion, would retake the test to compare results.

The NHL and MLB require all players to take the ImPACT test. The NFL put all 329 attendees of its draft scouting combine through the ImPACT test earlier this year.

More importantly (at least, in terms of K-12): A number of high schools have begun administering the baseline tests to student-athletes. Some states (here's looking at you, Pennsylvania, Wisconsin, New York, and New Jersey) certainly deserve more praise than others in terms of early adoption of the baseline tests. But there's little reason more districts haven't jumped aboard.

Considering the low cost and high availability of these tests, it's hard to fathom why only one high school in Mississippi or two in Arkansas currently put them to use. Given the increased attention being paid to concussions throughout the sports world these days, it's likely the popularity of neurological baseline testing for student-athletes will only expand throughout K-12 schools.

There's an app for that: Then again, for the schools that don't feel like plunking down the $1,000/year for ImPACT, Gerard Gioia, chief neuropsychologist at Children's National Medical Center, and Jason Mihalik, concussion specialist for the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, have come to their rescue.

Gioia and Mihalik designed the "Concussion Recognition & Response" application, which was released last month for the iPhone, iPad, iPod Touch, and Android devices for just $3.99. The app takes users through a checklist of possible concussion symptoms in less than five minutes, then alerts the users whether or not a concussion is suspected.

Granted, Gioia told the Washington Post that his app is "really built for the nonmedical provider." In fact, the app allows users to email their results to health-care providers. So, it's unlikely that schools will eschew neurological baseline tests for the iPhone app any time soon.

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