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Required concussion testing 'right thing to do'

October 24, 2013, David Caraviello,

The preseason baseline test is for doctors to have a snapshot of the brain in a healthy state

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At the beginning of this season, NASCAR met with drivers from its three national series and encouraged them to take a baseline concussion test. It was very likely, the drivers were told, that such a test would one day become mandatory.

That day was Thursday, when NASCAR again met with its national series drivers, and this time told them that baseline neurocognitive testing -- one of the fundamental tools in concussion diagnosis -- would be obligatory for next year. As a result, every driver in the Sprint Cup, Nationwide and Camping World Truck tours will be required to take the ImPACT test prior to the start of the season beginning in 2014.

"I think we had some drivers who took the initiative, but I think it was a good process to take the time and talk to them about what we were doing and where we wanted to go," said Steve O'Donnell, NASCAR's senior vice president for racing operations. "You're seeing it more and more in all professional sports, college, even down to the high school level."

Indeed, the ImPACT test -- which stands for Immediate Post-Concussion Assessment and Cognitive Testing -- is also used by a number of NFL, NHL and Major League Baseball teams, as well more than 1,000 colleges and 7,400 high schools, according to the Pittsburgh-based company. When Dale Earnhardt Jr. was forced to sit out two races last year due to the effects of a pair of concussions suffered behind the wheel, one of the specialists he visited was ImPACT co-founder Dr. Michael Collins.

O'Donnell said Earnhardt's case did not specifically lead NASCAR to make baseline testing mandatory. The sanctioning body was already headed down that road, he added, when Earnhardt announced late last year that the symptoms from two concussions -- one suffered in a testing crash at Kansas, the other in a wreck at Talladega -- had forced him to see a doctor, which led to him being pulled him from the race car.

"One of the things with concussions that’s a challenge for any sport right now is, a lot of it is up to the athlete to let the doctors know how they're feeling," O'Donnell said. "I think if anything, Dale Jr. coming out and talking about it and seeking the help certainly put the spotlight more on concussions. I think helped us be able to introduce it, I'd say. But I think we were already headed down this path."

Why the season-long gap between recommending the test to drivers, and then mandating it? O'Donnell said NASCAR officials faced many questions from drivers, who wanted to know how much weight the test carried in the evaluation process, and what it might mean for them in terms of getting back into the car. NASCAR took this season, he added, to put minds at ease before telling drivers the test would be required beginning with 2014.

"One thing we felt we needed to do was educate our drivers," O'Donnell said. "There were a lot of questions about concussions … so we wanted to take the time to educate them this year. We told them at the beginning of the year we were strongly looking at this, first and foremost for their safety. We took that time to educate them. We think it's the right thing to do to implement ImPACT testing. It's not the be-all, end-all of how we'll evaluate a driver, but we think it’s an additional tool to help us, and believe it's the best direction to go in for their safety."

The 25-minute, Web-based ImPACT test evaluates an athlete's verbal and visual memory, processing speed, and reaction time. By taking the test before the season, doctors have a snapshot of the brain in a healthy state, and can use that baseline to compare to post-concussion to evaluate the extent of an injury and judge recovery time.

Drivers were told of the move Thursday in a meeting at the NASCAR Research and Development Center in Concord, N.C. Dr. Vinay Deshmukh, a neurosurgeon and member of NASCAR's medical advisory group who consulted on the Earnhardt case, presented drivers with an overview of what concussions are, as well as causes, treatments, and the role baseline testing plays in evaluation and diagnosis.

"There were some questions, for sure," O'Donnell said. "Just on, 'If I have a concussion, is it a go-no-go?' I think there was some further education through Dr. Deshmukh that this is just one tool used to evaluate a driver before he can get back into the car. And actually, in educating the drivers, what we're able to tell them is … by not having (a baseline test), there's almost more of a risk of not allowing a driver to get back in the car, because you have nothing to compare it to. By having that baseline test and looking at symptoms and saying, 'OK, we think this driver's ready to go,' it makes that call a lot easier."


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