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Stockton's Concussion Management
Management of concussions in athletics remains one of the most difficult aspects of sports medicine. The effects of a concussion are easily overlooked and underestimated by athletes, coaches and parents. There is no treatment or rehab to aid in the recovery of a concussion. The best management remains early recognition and prevention of additional concussion injury. We have adapted an approach that focuses on objective tests for a concussion. The use of these tests minimizes an athlete's ability to false report about their symptoms and, therefore, safely to return to play. Following is an overview of the concussion management tools we use.
ImPACT Concussion Software:
ImPACT is a research-based program that assists in the evaluation of recovery after a concussion. The program evaluates multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time and post concussive symptoms. Once an athlete sustains a possible concussion they are tested on ImPACT and their scores are compared to their baseline test (before they had a concussion) or to normative scores if a baseline test was not done. At Stockton every intercollegiate athlete is baseline tested with the exception of indoor/outdoor track and crew. Post injury use of the ImPACT software begins at least 24 hours after the injury.
Balance Error Scoring System (BESS Test) and Biosway Balance Test:
The
BESS test and the
BioSway Balance system are research-based tools used for the evaluation of an athlete’s balance after a possible concussion. They provide objective measurements of an important concussive symptom. The BESS measures an athlete’s balance through a clinical-assessment battery and is scored by counting the errors the athlete commits during the tests. The BESS takes approximately 4 minutes to administrate. We started phasing in the BioSway Balance Test in 2011 and have had much success with it. The Biosway tests balance through a computerized forceplate that measures sway. There are four components for testing. Two with eyes open and two with eyes closed using both a firm and a foam surface. Each test lasts twenty seconds. The BESS and BioSway Balance tests are used to compare baseline scores with scores after a concussion. At Stockton, every intercollegiate athlete is baseline tested with the exception of non contact sports. Our post injury use of the BESS and BioSway tests begins at least 24 hours after the injury.
Standardized Assessment of Concussion (SAC Test)
The SAC is another objective research-based evaluation tool that we use for the immediate assessment of a possible concussion. It tests the domains of neuropsychological function most commonly affected by concussion. It includes measures of orientation, immediate memory, concentration and delayed recall. If an athlete sustains a possible concussion they are given a SAC test on the sideline. The results are then compared to their baseline score or to normative scores if a baseline test was not done. Every athlete at Stockton with a history of a previous concussion is given a baseline SAC test. The test takes approximately 5 minutes to administrate.
Concussion Symptom Questionnaire
This symptom questionnaire is a self-report tool that the athlete completes after a possible concussion. The questionnaire allows athletes to quantify 21 different symptoms related to a concussion. The post-concussion score is then compared to each athletes baseline score. Every intercollegiate athlete at Stockton completes a baseline Concussion Symptom Questionnaire. This is important because some athletes may experience concussive-like symptoms on a regular basis (i.e., headache). The athlete completes additional questionnaires on a daily basis until all their concussion tests return to normal levels.
Formal Concussion Evaluation
This is the traditional concussion evaluation where the athletic training staff will question and test the athlete on injury details, signs and symptoms. This includes a history, observation and testing eye function, cranial nerves, memory and balance and coordination. This evaluation is given on the sideline after a possible concussion and repeated daily during re-evaluations.
The NATA Position Statement on concussions can be found
here and their press release on this topic
here.
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