Baseline recordings: Prior to the start of the season (usually during training camp) a baseline assessment is performed. This is the standard protocol regarding assessment for these injuries and is used by amateur and professional sports teams. If at any time a concussion has been sustained as determined by the trainer, coach, or attending physician, a member of the concussion management program will be contacted and post-injury assessment schedule will be determined.
Post-injury follow-up: Re-assessment of the athlete using the same procedures employed during baseline will provide an assessment of injury severity, specifically, how much change has occurred compared to baseline. Post-injury follow-ups will be scheduled within 48 hours of injury when possible (if not possible due to hospitalization or travel, the first recording will occur as soon as possible following the injury) and at the completion of the management phase of the program. Feedback will be given for each follow-up regarding the athlete’s injury and treatment plan.
Methods of Assessment:
Sport and concussion history: One of the most beneficial forms of information when first treating an athlete is to have knowledge of their sport history and specifically the number and types of injuries they may have sustained. Of primary importance is the number of prior concussions sustained, however, other injuries to the head, face, and neck may also be relevant. It also provides an opportunity to document any other limitations or impediments to recovery. This information will be gathered during baseline recordings and used as reference as the athlete is monitored over time.
ImPACT software: ImPACT software evaluates and documents multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time and post-concussive symptoms. It also provides an injury documentation system that facilitates the tracking of the injury from the field through the recovery process.
Neurophysiologic assessment battery: These procedures use computerized electroencephalogram (EEG) technology to measure neural responses related to complex cognitive processes. They test brain function related to auditory and visual information processing associated with context and memory updating, anticipation, preparation of a motor response, and impulsivity –- all of which can be effected by concussion. Electrophysiologic measures have the advantage of providing information about a concussion by looking at “the source”.
Balance and postural stability: Basic clinical tests of balance and postural stability, similar to those used during sideline evaluations, are performed.
Exercise testing: Testing using a cycle ergometer will be performed, using a heart rate monitor to assess autonomic nervous system function. EEG is recorded prior to and following the test. In the case of post-injury follow-up, the second stage of rehabilitation is “Light aerobic exercise such as walking or stationary cycling, no resistance training” (McCrory et al., 2005). By performing these tests in the presence of trained exercise physiologists, this stage of rehabilitation can be carried out in a safe and effective manner. Most importantly, if symptoms re-occur during exercise, the athlete can be cared for on site and symptoms accurately documented.