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Baseline Concussion Testing

Good Afternoon Everyone!
New to the site and am feeling hopeful you all can provide with your tricks to the trade! I've just completed my first full year as an ATC in the high school setting. Since completion I've been reflecting on things that I'd like to do differently in the fall. I've been doing some research on what kind of tests ATCs use for baseline concussion testing. Just curious on what everyone here uses if you do any kind of baseline testing.

Thanks for the advice in advance!

Comments

  • Hi Julie, I've been using ImPact baseline testing for 20+ years. I think it has limited value and is just a tool, but I haven't seen anything better. We group test our freshman and junior contact sports. You must ensure that you have a quiet testing area with no distractions, or your baselines will be of little value. Athlete motivation is sometimes an issue. I tell them if you don't score in the expected range for their age group, then you have to come back and take it again during a practice. We often find their freshman baseline is significantly better than their freshman one, so we compare to both.

    We then test kids under two circumstances. One, if we think a kid has symptoms and is not honest with us, and two, after they have reported all symptoms have resolved to confirm they are back to normal. The only other time would be if requested by the treating physician. I don't see much value in early testing while symptomatic.

    Hope this helps.
  • Julie, I'll be entering my 11th season as an AT and I've had experiences with multiple baseline concussion testing programs. Although our NATA position statement recommends we should baseline test, the evidence is lacking. Kinda funny, since we are supposed to be evidence based now. After the 5th and most recent International Conference on Concussion In Sport, the consensus is: The recognition of suspected concussion is best approached using multidimensional testing. The SCAT5 currently represents the most well-established and rigorously developed instrument available for sideline assessment. There is published support for using the SCAT and Child SCAT in the evaluation of concussion. The SCAT is useful immediately after injury in differentiating concussed from non-concussed athletes, but its utility appears to decrease significantly 3–5 days after injury. The symptom checklist, however, does demonstrate clinical utility in tracking recovery. Baseline testing may be useful, but is not necessary for interpreting post-injury scores. If used, clinicians must strive to replicate baseline testing conditions. Additional domains that may add to the clinical utility of the SCAT tool include clinical reaction time, gait/balance assessment, video-observable signs and oculomotor screening. Baseline or pre-season testing was considered by the panel and was not felt to be required as a mandatory aspect of every assessment; however, it may be helpful or add useful information to the overall interpretation of these tests.

    With that said, I don't think it's worth the time or effort. Kids do not take it seriously. Coaches often don't appreciate the time it takes. There are a lot of "invalid" test results due to not understanding, not caring or distractions. There are simply way too many variables to consider in order to get a valid baseline and even if you do, it's simply a snap shot of the day. Sure it could be helpful...sometimes, but I would suggest you master/memorize a thorough neurocognitive concussion screening.

    What happens when we refer our athletes for medical clearance? They undergo a neruocognitive test with their primary or neurologist. No computer testing of any kinda. The physicians rely completely on their clinical skills. I think we should and are completely capable of doing the same. After all, we are the first line of defense and supposed to be an expert in the field of concussion management.

    For sideline evaluation during competition, I use the SACTool Beta (Android), mBESS, PEARRL & VOMS. Concussion Assessment & Response app (Android) is an injury assessment tool & has the BESS, SAC, GSC & RTP guide all built into one. I think it cost $5. It takes longer to get through, but is thorough. I use that on the sideline during a practice situation. The SCAT5 was just released and extremely thorough. The SCAT5 will take longer than 10 minutes and is a great tool for sideline assessment, but off the field assessment/office/indoor sports seems more appropriate in my opinion since it's paper & pen. I use the SCAT for everyone as another tool and record keeping. It's often used in doctor's offices, etc. I find these tools far more useful than any baseline test I've ever done.

    If you're still dead set on using a baseline testing program, I would highly recommend King-Devick. It's much quicker than any other program on the market. It's been around since the 80s, but more recently has been used for concussion assessment/baseline testing. It has decent evidence to be used as a concussion assessment tool, but is very dependent on effort, so it's still not perfect. But if you're going to take the time, at least it won't take up a ton of your time :smile:
  • King-Devik in conjunction with most SCAT tests has been shown to be close to 100% correct testing for concision. When performing baseline testing I'll also do a couple balance tests also because inevitably the subject being tested on the sideline will say, " I couldn't do that when I'm not concussed".
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