Assessment Tools

Sports Concussion Assessment Tool

Standardize Assessment of Concussion• measures the domains of

immediate memory delayed memory, orientation, and concentration

• Scores range 0-30; higher scores mean better functioning.

• Has 3 alternate forms to minimize practice effects.

Balance Error Scoring System• Preparation

– Athlete stands with eyes closed and hands at hips – Two surfaces

• Firm, flat ground • Block of foam large enough to stand on

– Three positions • Both feet on the ground • Tandem stance (toes of one foot to heel of the other) • Balance on one leg

• Technique – Test balance in 6 trials of 20 seconds each

• Firm ground: Both feet, tandem and one leg • Foam block: Both feet, tandem and one leg

– Observe for balance errors (1 point for each error) • Stepping • Stumbling • Opening eyes • Hands lifted above the iliac crests • Forefoot or heel lifted • Hip moved >30 degrees flexion or abduction • Out of test position >5 seconds

• Interpretation – Average of 12 errors following concussion

BESS

• Tested against trials on force plates and determined to have significant correlations with single leg stances

• Has been shown to have a practice effect if administered repeatedly

Acute Concussion Evaluation

ACE continued…

• specific characteristics of the injury including details of the direct or indirect blow to the head, retrograde and anterograde amnesia and loss of consciousness

• a full array of 22 symptoms and 5 signs associated with mTBI,27 referred to as the ACE symptom checklist

• risk factors that might predict a prolonged recovery such as a history of previous mTBI, headaches, learning disabilities, or attention-deficit/hyperactivity disorder, and anxiety or depression

• Monitors symptoms over time through repeated assessments to document the progress of recovery

Glascow Coma Scale• Not developed to asses

mild TBI• More appropriate to

assess the depth of a coma following a severe TBI.

• If administered in the ED, not unusual to show up normal.

• No follow up appointments to determine improvement or changes

GCS-E

• Developed with the support of the World Health Organization Advisory Group on the Prevention and Treatment of Neurotrauma

• Comprised of GCS and an Amnesia score• Recorded as GSC:PTA.• PTA scores are taken immediately upon arrival to

the ED, no sooner then 24 hours after initial assessment, no sooner than 1 week after the second assessment and then some time in the outpatient department.

New Tests• Steeler’s Battery

– Used to evaluate athletes at the professional level

– Had a grant as of Feb. 2000 to start testing on college athletes

– Wants a computerized model for testing on younger athletes

• ImPACT– Developed by the Henry Ford

Health System in Detroit in conjunction with The University of Pittsburg Medical School

– Immediate Post-concussion Assessment and Cognitive test

Both computerized

Promote a pre-test at the beginning of the season to establish baseline measures, and continued measures after concussion to help determine injured areas of brain and when it is appropriate for return to activity.

References• Guskiewicz, KM. Postural stability assessment following concussion: one piece of the puzzle.

Clinical J of Sports Medicine 2001;11 (3): 182-189.• Naunheim, R.S., Matero, D., Fucetola, R. Assessment of Patients With Mild Concussion in the

Emergency Department. The J of Head Trauma Rehab. 2008;23(2): 116–122.• Concussion: tests and diagnosis-MayoClinic.com.

http//www.mayoclinic.com/health/concussion/DS00320/DSECTION=tests-and-diagnosis.• Laura Purcell and James Carson. Sport-related concussion in pediatric athletes. Clinical Pediatrics

2008;47 (2): 106-113.• Drake, A., McDonald, E., Magnus, N., Gray, N., and Gottshall, K. Utility of Glasgow Coma Scale-

Extended in symptom prediction following mild traumatic brain injury. Brain Injury 2006; 20(5): 469-475.

• Nell, V., Phil, D., Yates, D.W., Kruger, J. An extended Glasgow Coma Scale (GCS-E) with enhanced sensitivity to mild brain injury. Arch Phys Med Rehabil. 2000;81: 614-617.

• Program Improves Concussion Care for High School Athletes. http://www.henryfordhealth.org/body.cfm?xyzpdqabc=0&id=46335&action=detail&ref=266

• Gioia, G.A., Collins, M., Isquith, P.K. Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the Acute Concussion Evaluation. J of Head Trauma Rehab. 2008;23(4): 230-242.

• Riemann, B.L., Guskiewicz, K.M., Shields, E.W., Relationship between clinical and forceplate measures of postural stability. J of Sports Rehabilitation 1999;8: 71-82.

• Valovich, T.C., Perrin, D.H., Gansneder, B.M. Repeat administration elicits a practice effect with the Balance Error Scoring System but not with the Standardized Assessment of Concussion in high school athletes. Journal of Athletic Training 2003;38(1):51–56.