The introduction of mandatory testing to help reduce the damage of head injuries in young hockey players has done nothing to snuff out the controversy over concussions in sport.
Medical experts remain skeptical, if not dismissive, of decisions by some hockey associations to implement baseline testing for players, and not all parents have expressed whole-hearted support. The tests are meant to prevent injured players from returning to the ice before they have fully recovered, but the worry is parents, players and coaches may rely on them too heavily.
Head injuries have become a weighty issue as professional athletes are sidelined due to concussions. NHL star Sidney Crosby's ongoing struggle is the most prominent in Canada, and CFL and NFL players have criticized the way their sports address the subject.
In Canada, some hockey parents want baseline tests implemented, if only to gather more data to determine whether they are reliable. And parents stressed that the tests should not be used to decide if it is safe for youngsters to return to the ice but to indicate whether further medical examinations – and patience – are needed.
Baseline tests, some of which are done online and take about 25 minutes, examine such things as memory and attention span. Proponents say that the results can be compared to tests done after an injury to see if the player has recovered. Some tests cost $25.
Blair Dimock, who has volunteered as a minor hockey coach in Toronto for nine years, wants to experiment with the tests to see if they are reliable and valid. If so, he said, they should be used in conjunction with other tools to determine whether an injured player is fit to get back in the game. Parents, coaches and trainers would need to rely on more than online tests gauging memory and attention spans.
"If there's anything that can give us an even better sense of what we need to do and how quickly we need to act, I would be all for it, recognizing that at the end of the day, these are complicated medical issues that we would need to get proper medical advice," said Mr. Dimock, the father of 13-year-old twin boys.
"Anything we can do to make our understanding and our decisions about head injuries more evidence-based, with good reliable kinds of tests and data, would be a huge step forward," he said. "[But]we have got to be honest about what the limits are on these kinds of tools at the moment."
Christopher Randolph, a clinical professor of neurology at the Loyola University Medical Center, called the tests unreliable and said they could put kids in danger if false results are trusted and players return to the game prematurely.
Concussions, he said, should be treated like any other injury, with physicians calling the shots.
"You should manage a concussion in a kid the same way you would manage a sprained ankle – you have appropriate medical personnel evaluate the kid, and consult with the team about how he is doing and when he or she is ready to play," he said.
"We don't baseline test people in terms of their ankle flexibility before the season to determine that their ankles are just as flexible after they've been sprained [before]returning to skating. And we probably shouldn't be doing it for a concussion either."
Even if the tests were trustworthy, a number of problems remain, Dr. Randolph said. If the online tests are administered in a group setting, for example, kids could goof around, skewing the results. Further, teens may sandbag their baseline test so that if they get hurt and have to take another before being cleared to play, the odds of passing will be higher.
"It is nothing more than a scam," Dr. Randolph said.
Despite skepticism, the Greater Toronto Hockey League at its annual meeting in June had a motion to make baseline testing mandatory for its competitive players, but the motion was tabled until 2012.
"Some of our members had different pieces of information as to the validity of it, the proper age that baseline testing can be used," said Scott Oakman, executive director of the GTHL. "There were some concerns around the cost of it. But I think we're working at addressing those issues. … Quite frankly, our board has been a huge proponent for the need for baseline testing. And we have a number of our organizations that have implemented it anyways."
But some of Canada's leading neurological experts have pointed out that little independent peer-reviewed research exists.
A study published during the summer indicated that baseline data collected from the SCAT2 test – a standardized oral test designed by concussion specialists – can have a beneficial effect in diagnosing and treating subsequent concussions.
But previous studies, including one by Canadian researchers published in a British medical journal last year, indicated it's harder to establish the benefits of baseline testing among youths, partly because of continuing neurological and cognitive development during childhood and early adolescence.
Leslie Kennon, a hockey parent in Saskatchewan, is cautious about baseline testing because of the changes children go through as they mature. Her 11-year-old son had a concussion last December, and was further hurt when he returned to playing shortly after. He still gets symptoms such as headaches, but that may be attributable to puberty, she said. Her son has an appointment with a neurologist this month.
Ms. Kennon supports computerized baseline testing, but said she would not exclusively rely on its results.
"At the end of the day, I would still want a professional's opinion."