Validity of Neurological Tests Questioned : Boxing: Nevada report concludes that California exam does not accurately detect cerebral injuries related to the sport.

A Nevada Athletic Commission medical panel recently concluded that California’s neurological testing program for professional boxers is “not valid” for detecting boxing-related cerebral injuries.

That conclusion follows a two-year study of the California exams.

At an Aug. 11 meeting of the Nevada Athletic Commission, a seven-page report was submitted by the study’s coordinators, Dr. Flip Homansky and Dr. Robert Clift of Las Vegas.

Dr. Joseph LaMancusa Jr., chief neurology resident at the Ohio State University School of Medicine, also participated in the study.

The California exam is a written and oral test administered by a state-designated neurologist. It does not include computerized axial tomography (CAT) scans or magnetic resonance imaging (MRI) exams, which are far more expensive than the current test.

“It was concluded that the (California) test is invalid in detecting cerebral injury secondary to pugilistic activity,” said Homansky, in reading the report to the Nevada commission.

The commission tested nine boxers who failed the California exam. Homansky said those nine were given “standard” neurological exams in Nevada and all passed. Further, the California exam was administered by LaMancusa to 15 non-boxers and 10 failed the exam.

Summarizing, the Nevada report declared: “Therefore, the basic premise of the test--that it will detect sub-cortical cerebral injury secondary to boxing--is invalid.”

The report did indicate, however, that the California exam administered to a boxer over a period of years that resulted in steadily declining scores would demonstrate a high probability of boxing-related neurological impairment.

“But as a spot test, the California exam has no validity whatsoever,” Homansky said.

Ken Gray, executive officer for the California Athletic Commission, said he still supports the four-year-old testing program. The tests were mandated by the legislature in 1986.

“I haven’t seen the Nevada report, so I can’t comment on its content, but I firmly believe our tests will stand up to outside scrutiny by any national panel of experts,” Gray said.

Dr. Richard Drew, a neuropsychologist in Sacramento and one of the designers of the boxing exam, also backed the California test. He also said he hadn’t seen the Nevada report.

“I back it 100%,” he said, “and the results we’re getting from the test are consistent with the sports medicine literature we see as to what areas of the brain are affected by boxing, and what symptoms show up first.”

Drew said he is heading a team of neurologists administering the boxing exam to dozens of non-boxers of equivalent language and education backgrounds, looking for test result differences.

The neurological exams, required yearly of all professional boxers in California, have been criticized in recent years by boxers, managers and promoters. A major criticism is that the tests are biased in favor of English-speaking applicants.

From September, 1987, through August, 1989, the exam was administered 1,356 times to California boxers, and 107 flunked.

The cost of the test is $175.

Managers of Hispanic boxers have complained often that non-English speaking boxers are at a disadvantage, and the Nevada report tended to support that charge.

“One of the questions in the California exam is, ‘Name five animals found in a zoo,’ ” Homansky said. “Well, maybe you’re dealing with some kid from a Venezuelan ghetto who’s not only never been to a zoo but doesn’t know what a zoo is.”

In 1987, three Southern California neurologists who were administering the tests for the California Athletic Commission criticized the exams in a Times story and all three were fired by Gray shortly afterward.

“What it comes down to is that a boxer could pass our test and still walk out of our office with a subdural hematoma or some other type of boxing-related brain injury that we couldn’t detect,” said one, Dr. Laurence Carnay.

Another, Dr. Clark Espy, also was a harsh critic.

“I think the exam is fairly worthless,” he said. “But it’s a start . . . the start of a consciousness that we need some kind of early warning system to spot the kind of brain damage boxers get if they box too long.”

All the neurologists interviewed agreed that superior testing would involve CAT scans or MRI exams.

In defending the exams, Drew said Nevada test administrators probably did not administer, score and interpret the exams as neurologists in California do.

“Our tests are given, scored and interpreted inside a rigid set of parameters, and if they’re administered outside those parameters, then the results are not valid,” he said.

The Nevada commission does not require a neurological exam of boxers, but fearing liability problems associated with permitting boxers who flunked the California exam to box in Nevada, Nevada’s commission appointed a medical team to evaluate the California exam.