Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT...
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Transcript of Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT...
ConcussionBaseline Testing
Baseline Assessments
Symptom Checklist
Standardized Cognitive and Balance Assessments
SACSCATSCAT IISCAT III
Balance Error Scoring Symptoms - BESS
NCAA Recommendations 2013-14 NCAA Sports Medicine Handbook 24th edition pg. 56-66
Athletes at high risk of concussion should undergo baseline exams prior to season
New baseline test annually for adolescents, those with recent concussion, and all athletes whenever possible
Baseline test should consist of:Clinical history – including symptomsPhysical and neurological evaluationsMeasures of motor control (balance)Neurocognitive function
NATA Position Statement 2014Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement:
Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265
Baseline and post injury examinations should be administered in similar environments
Baseline examinations should be reviewed for suboptimal performance
NATA Position Statement 2014Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement:
Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265
Multi-dimensional approach encouraged
“Concussion diagnosis must be clinical, and cannot be made by computerized testing.” 2013-14 NCAA Sports Medicine Handbook
Help with decision makingNot a stand alone tool
Over-Reliance on Computerized Testing
Possible AdvantagesBaseline test groups of athletes concurrently
Large groups discouragedWide availability via internet and other
platformsEase of administrationAccess to alternate test formsCentralized data for access by practitionersDo not require direct involvement of
neuropsychologist for administration
Computerized Neurocognitive Testing CNT
Pro’sAccount for individual neurocognitive variability for each
athleteLearning disabilities, ADD/ADHD, other cognitive or
neuropsychiatric conditions
Con’sMay lack evidence to support clinical useMay not be time or cost effectiveRandom error
Environmental distractions amount of sleepcaffeine consumption,acute psychological distresssub-optimal effort – “sandbagging”
Baseline CNT
Immediate Postconcussion and Cognitive Testing (ImPACT)
CogSport/State (Axon Sport)
Headminder Concussion Resolution Index (CRI)
Automated Neuropsychological Assessment Metrics (ANAM)
Review of Literature 2005-2013Common CNT’s
Resch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of sport-related concussion: an update. Neuropsychology Review
2013 23:335-349
39.9% athletic trainers reported CNT part of concussion management protocol
ImPACT – 93%Axon Sport -2.8%Unspecified software 2.8%Headminder CRI 1.4%
86%-95.7% report using pre-participation baseline CNT
Majority of CNT reports interpreted by AT or physician3% - 17% by licensed neuropsychologist26.4 % of AT’s interpreting CNT have formal training
CNT’sResch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of
sport-related concussion: an update. Neuropsychology Review 2013 23:335-349
ImPACT study95.5 % would not return symptomatic athlete
regardless of CNT results4.5% would return symptomatic athlete if CNT
results within normal limits86.5% would not return asymptomatic athlete
if CNT results within the norm9.8 % would return athlete based on symptom
recovery3.8% reported it depended on the importance
of competition
CNT influence on clinical decisionResch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of
sport-related concussion: an update. Neuropsychology Review 2013 23:335-349
Select tools that fit clinical settingProper training in administration and interpretationConsistent with baseline and post injury evaluationMultifaceted approach
Neurocognitive testingSymptom scoreMotor-control
Maximize performance on baseline and post injury tests
Administer test individually or in small groups to minimize distraction
Neuropsychologist or physician with concussion training to interpret post injury data
Do Your Homework
Since 2005, 29 articles addressing psyhcometric properties of commercially available CNTs in the assessment of SRC
ImPACT – 13 CogSport/State (AXON) – 7 Headminder CRI – 5 ANAM - 4
Do Your Homework
Incoming freshman with contact/collision sports/at risk sports
BESSSCAT3CNT
Formerly ImPACTCurrently Concussion Vital SignsResults of CNT interpreted by neurologist.
University A
BESS/SAC/Symptom ScoreFootball
CNTAXON Sports (Cogsport)
Contact/collision sportsDivers and Pole VaultersTeam physician interprets CNT
University B
All student athletesBESSCNT
Headminder CRITeam physicians interpretations
University C
All student athletesCNT
ImPACTTeam physician interpretations
SCAT3BESS
Video taped10 ft heel toe walk
Video tapedVisual accommodationsSmooth pursuits
University D
All student athletes CNT
ImPACTUniversity physician interprets baseline tests
BESS
University E
All student athletesCNT
ImPACTTeam Physician Interprets
University F
2013-14 NCAA Sports Medicine Handbook 24th edition pg 56-66
Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265
Resch J, McCrea M, Cullum M. Computerized neurocognitive testing in themanagement of sport-related concussion: an update. Neuropsychology Review 2013 23:335-349
References