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Parent Testimony to MCPS BOE Recommending Funding for Athletic Trainers Instead of ImPACT Baseline--June 24, 2013

Parent Testimony to MCPS BOE Recommending Funding for Athletic Trainers Instead of ImPACT Baseline--June 24, 2013

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Parent Testimony to MCPS BOE Recommending Funding for Athletic Trainers Instead of ImPACT Baseline--June 24, 2013
Parent Testimony to MCPS BOE Recommending Funding for Athletic Trainers Instead of ImPACT Baseline--June 24, 2013

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Montgomery County [Maryland] Board of EducationPublic Comment Testimony of Parent Tom HearnJune 24, 2013
Good evening. Tonight, the Board of Education for Montgomery County [Maryland]Public Schools will consider Supt. Joshua Starr’s recommendation to authorize spending$99,140 in 5 contract for ImPACT baseline concussion testing of 16,000 MCPS studentswho play sports at MCPS’s 25 high schools.Actually, the contracts appear to be for $59,680 for such testing, with the remaining$39,460 going to provide limited athletic trainer services at 12 MCPS high schools as a pilot for more athletic trainer services in future years.
 I respectfully request that the Board reject these contracts and request that staff revisethem for the vendors to use the $99,140 to fund athletic trainers for the 2:00 pm-to 6:00 pm window at 5 high schools. Budget savings should be sought to fund similar athletictrainer services at the remaining 20 high schools.
 ImPACT Baseline Not NecessaryBOE Member Pat O’Neill had been a steady advocate for systemwide ImPACT baselineconcussion testing and I applaud her for her commitment to student safety to studentsafety that this advocacy reflects. Ms. O’Neill has based her advocacy on her experienceseveral years ago as a parent at Walt Whitman High School where she says the schools boosters club began funding ImPACT baselines on the advice of a parent pediatrician.Recent developments, however, indicate that ImPACT baseline testing is no longer considered necessary. In November 2012, the leading worldwide group of physiciansand neuropsychologists who treat sports concussions met in Zurich, Switzerland, and inthe consensus statement they issued in March 2013 stated:
 At present time, there is insufficient evident to recommend thewidespread routine use of baseline neurological testing.
http://www.scribd.com/doc/149394421/Zurich-Nov-2012-Consensus-Statement-On-Concussion-in-Sports-Br-J-Sports-Med-2013-McCrory-250-8(page 3 of 12) (emphasisadded)And ImPACT indicates at its own website that such baseline testing is unnecessary:ImPACT's comprehensive normative data includes more than 75,000 (andgrowing) results, which provides reliability and validity of testing,
evenwithout a baseline.
 http://impacttest.com/about/(emphasis added)Questions About ImPACT’s Validity When Used Post-InjuryPerhaps more troubling are concerns that have been raised about the validity of ImPACTand the risk of its use in making return to play decisions.http://espn.go.com/espn/otl/story/_/id/8297794/neuropsychological-testing-concussions-not-panacea The ESPN story quoting William Barr, PhD, an associate professor of neurology at NYU:Through amazing marketing, the ImPACT guys have made their namesynonymous with testing. But there is a growing awareness that ImPACTdoesn’t have the science behind it to do what it says it claims it does.The ESPN article goes on:It’s easy to feel that doing something to fight concussions must be better that doing nothing. But American football is in the midst of replacing onegiant, uncontrolled experiment (letting young men [and boys] play aviolent game) with another—diagnosing them en masse and on the cheapwith a test that many experts deem unreliable.Similarly, Education Week recently reported a study showing that ImPACT misidentifiedhealthy participants up to 46 percent of the time.
http://blogs.edweek.org/edweek/schooled_in_sports/2013/06/impact_concussion_tests_f ound_to_generate_false_diagnoses_sometimes.html 
Emerging research raises questions about whether a clear ImPACT post-injury test and other currentstandards such as gradual return to play procedures are adequate to keep athletes safe. Scientists at PurdueUniversity released a report in February 2012 of a study that had followed a high school football team for two seasons.http://www.purdue.edu/newsroom/research/2012/120202NaumanFootball.html Each player’s helmet was outfitted with an accelerometer to measure impacts and each player given a functional MRI (fMRI) of his brain doing certain tasks both at the beginning of the season and atthe end."The most important implication of the new findings is the suggestion that a concussion is not justthe result of a single blow, but it's really the totality of blows that took place over the season," saidEric Nauman, an associate professor of mechanical engineering and an expert in central nervous system and
ImPACT Encourages Use of Test Post-Injury That Conflicts With ExpertsRecommendation for Cognitive RestImPACT’s recommendation that students take the test 24 to 72 hours after a concussion.Taking the test this soon may make the concussion worse.A cornerstone of concussion recovery is cognitive rest during the first 48 to 72 hoursafter a concussion is suspected. This means no computers, no texting, no TV, becausethese activities are suspected to tax a brain that is working desparately to regain itsmetabolic equilibrium.Taking the test during the first 24 to 72 hours is cognitive stress not rest, yet this is whatImPACT recommends at its website.http://impacttest.com/about/?Concussion-Management-Model-3In fact, in most cases, ImPACT should not be taken post injuryuntil a student is symptom free.So physicians who a concussed student visits in the days after the injury will likely havethe student take the 20-minute test at a time when recovery depends on getting rest.The Onion Aces ImPACTAs it often does, the satirical magazine the Onion appears to nail some of the limits of ImPACT.http://www.theonion.com/articles/doctors-sidney-crosby-has-greatly-improved-ability,29394/?ref=auto Use $99,140 to Fund Athletic Trainers, Not ImPACT BaselineIn any case, such ImPACT baseline testing is a priority that falls far behind having at
musculoskeletal trauma. "The one hit that brought on the concussion is arguably the straw that broke thecamel's back."The Purdue Study’s results show that even players who had not been identified as havingsustained a concussion showed altered brain function on their fMRIs from the beginning of the season tothe end. The Purdue study’s findings are consistent with findings reported back in December 2012 in theJournal of Neuroscience that changes in a student’s brain after a concussion still persist even if the studentis symptom-free.http://blogs.edweek.org/edweek/schooled_in_sports/2012/12/concussions_alter_childrens_brains_for_months_after_injury_study_finds.html Functional MRI technology used in the Purdue study is not available in clinical settings. Theimplications of the Purdue and other studies for gradual return to play procedures is that, were fMRIavailable, it would likely show in some cases that a student who had a clear ImPACT test post concussionand was symptom free even after completing gradual return to pay, still had altered brain function.For football, given that studies show that a high school football player averages 650 subconcussive blows to the head during a season, 1,000 for a player in a line position, health professionals need to takethis into account when clearing a football player for return to play after a successful completion of gradualreturn to play. For example, in clearing a student to return to football mid-season, physicians and other health professionals need to be mindful that their patient’s brain may still not have resumed pre-concussionfunctioning and that they are clearing the student to resume the remaining 325 subconcussive blows to thehead, 500 if the student is on the offensive or defensive line.

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