Montgomery County [Maryland] Board of Education Public Comment Testimony of Parent Tom Hearn June 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 students who 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.1 I respectfully request that the Board reject these contracts and request that staff revise them 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 athletic trainer services at the remaining 20 high schools.2 ImPACT Baseline Not Necessary BOE Member Pat O’Neill had been a steady advocate for systemwide ImPACT baseline concussion testing and I applaud her for her commitment to student safety to student safety that this advocacy reflects. Ms. O’Neill has based her advocacy on her experience several 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 physicians and neuropsychologists who treat sports concussions met in Zurich, Switzerland, and in the consensus statement they issued in March 2013 stated: At present time, there is insufficient evident to recommend the widespread routine use of baseline neurological testing.                                                                                                                 1  See  Attachment  A  to  this  Testimony  for  an  analysis  of  the  proposed  5  contracts  to  implement  
ImPACT  baseline  testing.     2  Similar  concerns  about  funding  ImPACT  baseline  testing  were  raise  in  this  February  7,  2013   Rockville  Patch  blog  shortly  after  Supt.  Starr  proposed  to  include  such  funding  in  the  MCPS  FY  2014   Operating  Budget  request  to  the  Montgomery  County  Council.­‐mcpss-­‐blog/p/bp-­‐-­‐mcps-­‐concussion-­‐baseline-­‐ testing-­‐mcps-­‐athletics-­‐h4d9982a673 (page 3 of 12) (emphasis added) And ImPACT indicates at its own website that such baseline testing is unnecessary: ImPACT's comprehensive normative data includes more than 75,000 (and growing) results, which provides reliability and validity of testing, even without a baseline. (emphasis added) Questions About ImPACT’s Validity When Used Post-Injury Perhaps more troubling are concerns that have been raised about the validity of ImPACT and the risk of its use in making return to play decisions. The ESPN story quoting William Barr, PhD, an associate professor of neurology at NYU: Through amazing marketing, the ImPACT guys have made their name synonymous with testing. But there is a growing awareness that ImPACT doesn’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 one giant, uncontrolled experiment (letting young men [and boys] play a violent game) with another—diagnosing them en masse and on the cheap with a test that many experts deem unreliable. Similarly, Education Week recently reported a study showing that ImPACT misidentified healthy participants up to 46 percent of the time. 3 ound_to_generate_false_diagnoses_sometimes.html                                                                                                                 3  Emerging research raises questions about whether a clear ImPACT post-injury test and other current
standards such as gradual return to play procedures are adequate to keep athletes safe. Scientists at Purdue University released a report in February 2012 of a study that had followed a high school football team for two seasons. 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 at the end. "The most important implication of the new findings is the suggestion that a concussion is not just the result of a single blow, but it's really the totality of blows that took place over the season," said Eric 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 Experts Recommendation for Cognitive Rest ImPACT’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 hours after a concussion is suspected. This means no computers, no texting, no TV, because these activities are suspected to tax a brain that is working desparately to regain its metabolic equilibrium. Taking the test during the first 24 to 72 hours is cognitive stress not rest, yet this is what ImPACT recommends at its website. In fact, in most cases, ImPACT should not be taken post injury until a student is symptom free. So physicians who a concussed student visits in the days after the injury will likely have the student take the 20-minute test at a time when recovery depends on getting rest. The Onion Aces ImPACT As it often does, the satirical magazine the Onion appears to nail some of the limits of ImPACT.,29394/?ref=auto Use $99,140 to Fund Athletic Trainers, Not ImPACT Baseline In 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 the camel's back." The Purdue Study’s results show that even players who had not been identified as having sustained a concussion showed altered brain function on their fMRIs from the beginning of the season to the end. The Purdue study’s findings are consistent with findings reported back in December 2012 in the Journal of Neuroscience that changes in a student’s brain after a concussion still persist even if the student is symptom-free. hs_after_injury_study_finds.html Functional MRI technology used in the Purdue study is not available in clinical settings. The implications of the Purdue and other studies for gradual return to play procedures is that, were fMRI available, it would likely show in some cases that a student who had a clear ImPACT test post concussion and 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 take this into account when clearing a football player for return to play after a successful completion of gradual return 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-concussion functioning and that they are clearing the student to resume the remaining 325 subconcussive blows to the head, 500 if the student is on the offensive or defensive line.



least one part time athletic trainer at each of MCPS’s 25 high schools. And athletic trainers pay dividends beyond managing concussions. Four years ago this week, Edwin “Dekonti” Miller, then a rising Northwest High School junior, died of heat stroke during a no-pad football conditioning practice. Four years later, MCPS’ Athletics Department still gives flawed advice to coaches about managing heat stroke that an athletic trainer would likely spot and fix in minutes. In the past, Pat O’Neill has shown the grit to change course in the face of new information. MCPS families need Ms. O’Neill, the other BOE members, and Supt. Starr to show such grit here. Therefore, I respectfully request that the Board reject the recommended contracts and instruct staff to revise them so that the vendors use the entire funds to provide part-time athletic trainers at 5 MCPS high schools. (These 5 high schools should be those where students’ access to the health care system are most challenged, perhaps using Free and Reduced Priced Meals (FARM) data as a proxy for such access challenges.) Also, Supt. Starr recently unearthed $220,000 in savings in the FY 2014 budget that that allowed him to hire a second senior advisor. I encourage the Superintendent to vigorously continue his search for budget savings to find $400,000 by August that could be used to fund athletic trainers at the remaining 20 high schools. Perhaps somewhere in one or more of the other contracts being considered today, totaling $7.5 million are savings that could fund this $400,000 shortfall for athletic trainers. By the way, $220,000 for one additional senior advisor could have funded athletic trainers at an additional 11 high schools. Having a second advisor probably makes Supt. Starr feel more at ease about how MCPS is run, but having 11 athletic trainers would have actually made 9,460 high school students who play sports at 11 high schools more safe.   Conclusion     While high school sports provide many benefits, they also represent the school-sponsored activity that poses the most serious risk of personal injury to students. Sports are also the school-sponsored activity that is most remote from the school system’s sole purpose of academic education. Among the risks of high school sports are injuries, including concussions. The injury to a student’s brain, along with the cognitive and physical rest essential for recovery, significantly impair a student’s ability to participate in academic education. The risks of concussions are greatest in high school football, which accounts for half of all concussions in a high school sports program. President Obama weighed in about



brain injuries in football in two interviews leading up to the Super Bowl.4 Obama said that if he had a son, he would have to think long and hard about letting him play football.    

If the President lived in Montgomery County, he would have to think longer and harder about letting him play football than he would if he lived in neighboring Howard, Frederick, or Fairfax County Virginia, each of which has athletic trainers at its high schools. If MCPS is not going to fund athletic trainers, yet still operate a sports program, it needs to disclose this to parents so that they can make informed choices about whether to allow their children to participate in school sponsored sports. Back in January, MCPS’s 25 high school football coaches hosted meetings with parents of eight grade boys to invite them to let their son join the team next year. I attended one of these meetings and the coach never mentioned the absence of athletic trainers and the significance of not having trainers for their sons’ safety.    




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