Baseline Concussion Testing and Post Concussion Assessment and Treatment
What is baseline testing?? A baseline concussion test is an assessment of various elements of brain function that are commonly impaired following concussion injury. The reason these tests are referred to as “baseline” is because they are an assessment of an individual BEFORE the injury occurs. The tests record an athletes normal (baseline) brain function, visual function and balance.
Recent research from the Consensus Statement on Concussion in Sport Berlin has suggested that baseline testing is not mandatory in every assessment, however may be helpful or add useful information to the overall interpretation of the tests it seen as an opportunity to educate athletes, coaches and parents about concussions and proper management.
Baseline testing should not be done in children under the age of 12 due to the neurological development of the brain being very rapid up to this age.
Concussions affect the energy levels in the brain and can impede cognitive ability, vision and balance. However at times the deficits can be subtle and because every individual person is so uniquely different, it is virtually impossible to know how much impairment is present if we don’t know how you were when you were healthy.
There is no X-ray or brain scan that can determine when you have received a concussion or when your brain has recovered to the point where you are safe to return to sport. This is where baseline tests play a role because resolution of the symptoms DOES NOT reflect the actual recovery of the brain! So even after someone feels 100% better and believes that they are no longer concussed, they are still not fully recovered from a brain energy standpoint…and this is where the danger lies. Return to play before the brain heals can lead to more significant injury and a prolonged recovery. Following a concussion the athlete will redo their baseline tests and this follow up testing when compared to the baseline test will reveal if the athlete is functioning differently than their normal state.
The knowledge about the effects of concussion on our brains has grown considerably and the long term consequences of repeated concussions is now recognized. Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly. Proper recognition and response to concussion symptoms can prevent further injury and can help with recovery.
Baseline Test Components
The tests consist of the Post Concussion Symptom Scale – an initial high symptom load following concussion can be an indicator of prolonged recovery, comparing that to the pre-injury level can assist in assessing level of recovery.
The BESS balance test – balance and postural stability are often affected after concussion and athletes baseline balance can be varied, knowing how their balance was pre injury can assist with assessing recovery.
The King Devick Reading Test – the visual system is often affected following concussion with difficulty in the eyes working together in a coordinated fashion. Assessing how the eyes move across a page before the injury cana assist with determining recovery (note ithis is not an optometric eye exam)
The Impact Neurocognitive computer test is a computer based test that looks at verbal and visual memory and reaction time.
Not one test in isolation will determine if an athlete has a concussion but the combination of the tests can indicate that an athlete is not the same as his baseline tests.
NOTE all athletes should see their physician for an assessment if a concussion is suspected.
Post Concussion Assessment and Treatment
Most concussions heal in 7-14 days however children/adolescents are known to have longer recovery periods up to 30 days.
There are those that persist past this point with ongoing symptoms. This can be for various reasons, a concussion injury not only affects the brain but can also injure the joints in the neck, the muscles of the neck, the inner ear and the brainstem affecting the control of eye movements and balance. These areas can cause dizziness, headache, difficulties with focusing on objects and motion sickness.
Because of this, it is important following a concussion to get a thorough assessment to determine what areas are affected.
At Vista Place Physiotherapy and Sports Injury Centre we are trained in orthopaedic assessment and vestibular assessment in order to assess all of the possible areas that can cause persistent symptoms. Based on the findings and in conjunction with the athlete’s physician, school &/or workplace we will make a treatment plan that promotes a resolution of symptoms and a full return to function.
Return to play decisions will be made by the athlete’s physician.