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Computer based screening in concussion management: use versus abuse
  1. A B Shuttleworth-Edwards,
  2. M A Border
  1. National Sports Concussion Initiative (NSCI), Rhodes University, Grahamstown, South Africa; A.Edwards{at}ru.ac.za

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    As reviewed by Schnirring,1 a number of user friendly, computer based systems for concussion management have been developed, including CogSport in Australia and HeadMinder and ImPACT in America. Important cautionary comments have been made about the appropriate use of such programmes (versus potential for their misuse),1,2 which from a neuropsychological perspective warrant further elaboration. The computer based technology in question falls within the specialist field of the clinical neuropsychologist, whose area of expertise encompasses the development and use of psychometric tests for screening for brain damage. The problem to emphasise here is that there is the potential for malpractice when such computer based tests become separated from their professional—that is, neuropsychological—source.

    There is a growing consensus that computerised test platforms such as referred to above have substantial practical advantages over conventional neuropsychological tests for use in the sports arena.1–4 They offer automated assessment which can be conducted on groups of individuals, and they can be administered by a trained team doctor or school coach, or be web based, without the presence of a neuropsychologist. However, it is precisely herein—that is, the apparent ease with which these computer based systems can be applied—that the potential for misuse lies.

    As Schnirring1 points out, non-psychologists are not in a position to evaluate the various programmes being marketed. Developing this point further, there is a real danger that non-psychologists may fall into the trap of construing that the scores derived from such programmes can be used, in and of themselves, as a type of “litmus paper” for making decisions about the presence or absence of cerebral dysfunction in the individual case. This type of misconception occurred in the early days of neuropsychological test development, and has been a chronic source of inadequate practice in the discipline.5,6 Accordingly, in modern neuropsychology the attribution of this type of diagnostic power in respect of a single neuropsychological test, or any set of tests in isolation—that is, in the absence of clinical and collateral data—goes against fundamental practice principles and is vehemently opposed.5,6 In keeping with this, it is encouraging that top medical professionals involved in concussion management (as cited in Schnirring’s article) have emphasised the following: computer based test results should be viewed as only one aspect of an assessment, together with the individual neurological examination, careful analysis of symptom presentation, possible imaging tests, and/or a more detailed neuropsychological examination.

    From a neuropsychological perspective, such cautionary comments on computer based screening batteries cannot be too strongly endorsed. In practical terms this amounts to the following: return to play decisions should not be made on the basis of computer based test outcome alone in the absence of access to a clinical assessment of the individual, and importantly, nor should test results be interpreted by a practitioner without neuropsychological expertise. In the event of a medicolegal claim, such non-specialist use of computer based programmes is unlikely to be upheld as ethical practice. Due respect for the complexities involved in neurological interpretations of psychometric test results—that is, the professional terrain of the neuropsychologist—will ensure that the apparent ease of computer based testing does not result in its misuse.

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