Disclaimer: I have been involved in post grad neurology programs, fellowships, and research projects for close to ten years now. I know very little about the human brain. With approximately 85+ billion neurons tightly bound to 3lbs of gelatinous tissue, very few of us do.
That’s why it came as no surprise to read the fivethirtyeight.com article where author Christie Aschwanden rips into the massively growing “concussion care” community.
My wonderful city of Toronto is a perfect example. One major concussion care provider has a total of 23 clinics in just the greater Toronto area. Another concussion management company proudly boasts, 45 new certified providers! Does it make sense that Toronto has all of a sudden seen an explosion in brain specialists? That all of a sudden a multitude of wonderful clinicians with deep insight into the inner workings of the human brain are coming out of the woodwork to manage concussions? BULLSHIT!
These groups are nothing but profit based scams, operating on the basis of little to no scientific or clinical merit with an aggressive dose of fear thrown in for good measure. Let me illustrate my point with an example from a patient referred to me last week:
While I’d like to say that situations like this are an anomaly – an unfortunate statistical outlier in an otherwise progressing professional clinical environment, that is not the case.
Based on Science – the most damaging three words in concussion care today. Every time I sit with parents of a concussed child the words based on science inevitably show up at some point in the discussion. Here is an example from a phone conversation just the other day:
This is where a major distinction needs to be made. Based on Science has absolutely no meaning whatsoever. Based on Science is an unsubstantiated term that wonderfully compliments the fact that the brain is an incredibly powerful marketing tool today. What we need to do is determine whether or not claims made by these companies have been VALIDATED by science. Validation is the underbelly of a proper scientific method. Validation by science is a good jumping off point, a good start to addressing an issue as inherently complex as the human brain. Based on science is meaningless.
This is where ImPACT, or what I like to call BIG CONCUSSION steals a page from BIG PHARMA. Most of the studies touting the reliability of these tests have been conducted by people with financial interests in the testing. The same way the vast and influential pharmaceutical industries research regarding drugs are always more helpful and less harmful than independent investigations have proven.
Check out the review published in the Journal of Head Trauma and Rehabilitation back in August where the authors looked at all the ImPACT studies and concluded that the testing showed “poor to moderate reliability”, and that “clinicians should be cautious” when using ImPACT as a criterion for medical clearance.
See a problem here? ImPACT is closing in on some 10,000 institutions from high school up to pro sports using a tool that has not been validated by science. What’s even worse is that ImPACT testing often leads parents, coaches and the athletes themselves into a false sense of security and objectivity. I gave a recent talk at a high school where every kid in a sports program had taken the ImPACT test. Every single one of them, 100% of them, believed that the test alone could identify if they were concussed and when they would be allowed to return to play.
This is the hard part. Concussion education and care is like the Wild West right now. You must search for experienced professionals with more than a couple days of concussion training. With approximately 85billion neurons in your brain, that’s a lot to cover in two days! If your concussion provider puts you on a computer in the middle of a busy clinic while he fits an old lady for another pair of useless orthotics that is not the guy for you.
Someone well versed in concussion care will help you to understand the complexity in human brain function. They will have an understanding of the neurophysiological consequences of concussion, even though we may not know the best way to treat it right now. They will consider a multidisciplinary approach in treating an injury that is often too multifaceted for any one person. And finally, you need to find someone who will honestly describe to you the limitations and flaws in the evolving world of concussions, because there are many.
Over the next few weeks a group of folks much smarter than myself, and myself are launching a charitable organization empowering individuals and their families on this ever winding road of concussion recovery. The education and information available to the public has been terrible for too long and that is going to change. It has to.