Concussion 1, 2, 3

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     In the realm of sports the term “concussion” is used frequently for players that experience a serious head injury.  To many players—however—concussions are seen less as a serious and potentially life altering injury and more as a roadblock to their team or career.  Our society has often glorified players who refuse to quit or walk off the field—despite injuries. Unintentionally, our awe of player who can ignore extreme pain as created a culture of seriously detrimental health habits.

To circumvent this notion of “too tough to quit”, we need to have an overhaul in thinking and head trauma response spearheaded by both organizational leaders and social leaders. Coaches and athletic trainers must be cautious when deciding whether or not to have a player return in the game.  Health must come before wealth—and the team. But how can you assess on-field the health of a play after a fall, hit or accident?

The BESS Test, King-Devick Test, and SCAT Test are your one-two-three standbys—commonly used on the side lines to assess if a player has a concussion

1.       BESS Test

The Balance Error Scoring System (BESS) assess the effects of mild head injury on stationary postural stability.  It can be performed in any environment and takes approximately 10 minutes to conduct.  All that is need is a foam pad, a stop watch, and a BESS Score card. 

The player will first stand on the ground surface for the test and stand in three different positions for twenty seconds. Any positioning deviation during this time is considered an “error”.  The three positions include a double leg stance, single leg stance on non-dominant leg, and tandem stance.  Positions also require players to place their hands on their hips and keep their eyes closed.  While administering the test, a qualified staff member should count and record the number or errors.  Typical errors include: moving hands off hips, lifting forefoot or heel off testing surface, and remaining out of the proper testing position for longer than five seconds. 

Repeat these stances on a foam pad.  The purpose of the foam pad is to create an unstable surface and a more challenging balance task. Unstable surfaces increase the tactile sense for support. This increase in stimuli will serve as a better scale to measure cognitive function and the presence or severity of a concussion.

If the error count surpasses 10, the player should be deemed unfit to continue play. 

This link will provide you with the formal BESS Test: http://www.sportsconcussion.com/pdf/management/BESSProtocolNATA09.pdf

The BESS Test is good for short-term, quick result assessment. The physical component is great for balance testing and will spot any dizziness or physical symptoms of a concussion, though it may miss the mark on the cognitive aspect of impairment. Using this test does require some pre-planning and equipment from organizational leaders. If you plan on using this test to assess the health of a player—be sure you have everything you need (foam mat, semi-private location and a qualified professional)

 2.       King-Devick Test

The objective of the King-Devick Test is to evaluate visual tracking and saccadic eye movements.  To administer and use this assessment, all players must first perform this test under normal conditions—as a baseline for results.

This two minute timed test bases results on the player’s ability to read and recite single digit numbers on test cards.

The player must read the cards aloud from left to right as fast as possible without making any errors.  The sum of the three test card time scores is the summary score for the entire test.  Results are compared to the player’s baseline score, if it the second test differs from the baseline, the player should be removed from the game and seek medical attention.

This link will provide you with a video demonstrating the King-Devick Test: http://kingdevicktest.com/for-concussions/

King-Devick Tests are great for on-the-spot testing, as it can be completed and analyzed in under five minutes. However, baseline testing must be planned and completed before an injury occurs. Also, since players control their own baseline testing, the results may be biased or intentionally slowed in an attempt to assure playing time.

3.       SCAT Test

Sport Concussion Assessment Tools (SCAT) is a standardized method of evaluating concussions from the sideline using a pre-determined of Maddocks questions.  Some examples of Maddocks questions are: what venue are we at today, which half is it now, who scored last, and did you win the last game? It is designed for the use of medical and health professionals and can also be used for base-line testing.

This is a link to formal SCAT 2 Test: http://www.atsnj.org/documents/pdf/ATSNJ_SCAT2.pdf

SCAT Tests are frequently used to assess the cognition of players after head trauma. Tests are quick, simple and produce fairly accurate preliminary results. However, many question the validity of this test, as the questions are pre-determined in baseline testing and fairly simple. If you choose to administer a SCAT Test, always have more than 1 party present and try to use your best evaluation of answers based on speech patterns, vocal inflection and physical symptoms.

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