Athletes' optimal brain care at risk: Should vestibular-ocular motor screening replace established neurocognitive protocols?

Recent recommendations in South Africa propose replacing validated neurocognitive baseline and post-injury assessment with NeuroFlex, a vestibular-ocular motor test, as part of a proposed new paradigm in concussion management. This commentary examines the clinical, regulatory, and ethical implications of excluding neurocognitive testing and removing neuropsychologist oversight from concussion protocols. Available evidence indicates that NeuroFlex does not currently hold FDA clearance and lacks validation for concussion identification. In contrast, established platforms such as ImPACT and Sway Medical possess FDA clearance and robust peer-reviewed support for concussion assessment. Neuropsychologists play a critical role in interpreting cognitive data, guiding academic and return-to-play decisions, and monitoring longitudinal cognitive health through annual baseline testing, functions not replaced by vestibular-ocular motor measures. Our evidence-based recommendations advocate routine inclusion of post-injury neurocognitive assessment with neuropsychologist application, preferably including baseline evaluation; optional research-based use of Neuroflex in conjunction with cognitive testing; and transparent, scientifically informed consent for all protocol changes.