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Page 1: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS
Page 2: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

ConcussionBaseline Testing

Page 3: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Baseline Assessments

Symptom Checklist

Standardized Cognitive and Balance Assessments

SACSCATSCAT IISCAT III

Balance Error Scoring Symptoms - BESS

NCAA Recommendations 2013-14 NCAA Sports Medicine Handbook 24th edition pg. 56-66

Page 4: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Athletes at high risk of concussion should undergo baseline exams prior to season

New baseline test annually for adolescents, those with recent concussion, and all athletes whenever possible

Baseline test should consist of:Clinical history – including symptomsPhysical and neurological evaluationsMeasures of motor control (balance)Neurocognitive function

NATA Position Statement 2014Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement:

Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265

Page 5: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Baseline and post injury examinations should be administered in similar environments

Baseline examinations should be reviewed for suboptimal performance

NATA Position Statement 2014Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement:

Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265

Page 6: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Multi-dimensional approach encouraged

“Concussion diagnosis must be clinical, and cannot be made by computerized testing.” 2013-14 NCAA Sports Medicine Handbook

Help with decision makingNot a stand alone tool

Over-Reliance on Computerized Testing

Page 7: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Possible AdvantagesBaseline test groups of athletes concurrently

Large groups discouragedWide availability via internet and other

platformsEase of administrationAccess to alternate test formsCentralized data for access by practitionersDo not require direct involvement of

neuropsychologist for administration

Computerized Neurocognitive Testing CNT

Page 8: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Pro’sAccount for individual neurocognitive variability for each

athleteLearning disabilities, ADD/ADHD, other cognitive or

neuropsychiatric conditions

Con’sMay lack evidence to support clinical useMay not be time or cost effectiveRandom error

Environmental distractions amount of sleepcaffeine consumption,acute psychological distresssub-optimal effort – “sandbagging”

Baseline CNT

Page 9: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Immediate Postconcussion and Cognitive Testing (ImPACT)

CogSport/State (Axon Sport)

Headminder Concussion Resolution Index (CRI)

Automated Neuropsychological Assessment Metrics (ANAM)

Review of Literature 2005-2013Common CNT’s

Resch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of sport-related concussion: an update. Neuropsychology Review

2013 23:335-349

Page 10: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

39.9% athletic trainers reported CNT part of concussion management protocol

ImPACT – 93%Axon Sport -2.8%Unspecified software 2.8%Headminder CRI 1.4%

86%-95.7% report using pre-participation baseline CNT

Majority of CNT reports interpreted by AT or physician3% - 17% by licensed neuropsychologist26.4 % of AT’s interpreting CNT have formal training

CNT’sResch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of

sport-related concussion: an update. Neuropsychology Review 2013 23:335-349

Page 11: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

ImPACT study95.5 % would not return symptomatic athlete

regardless of CNT results4.5% would return symptomatic athlete if CNT

results within normal limits86.5% would not return asymptomatic athlete

if CNT results within the norm9.8 % would return athlete based on symptom

recovery3.8% reported it depended on the importance

of competition

CNT influence on clinical decisionResch J, McCrea M, Cullum M. Computerized neurocognitive testing in the management of

sport-related concussion: an update. Neuropsychology Review 2013 23:335-349

Page 12: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Select tools that fit clinical settingProper training in administration and interpretationConsistent with baseline and post injury evaluationMultifaceted approach

Neurocognitive testingSymptom scoreMotor-control

Maximize performance on baseline and post injury tests

Administer test individually or in small groups to minimize distraction

Neuropsychologist or physician with concussion training to interpret post injury data

Do Your Homework

Page 13: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Since 2005, 29 articles addressing psyhcometric properties of commercially available CNTs in the assessment of SRC

ImPACT – 13 CogSport/State (AXON) – 7 Headminder CRI – 5 ANAM - 4

Do Your Homework

Page 14: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Incoming freshman with contact/collision sports/at risk sports

BESSSCAT3CNT

Formerly ImPACTCurrently Concussion Vital SignsResults of CNT interpreted by neurologist.

University A

Page 15: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

BESS/SAC/Symptom ScoreFootball

CNTAXON Sports (Cogsport)

Contact/collision sportsDivers and Pole VaultersTeam physician interprets CNT

University B

Page 16: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

All student athletesBESSCNT

Headminder CRITeam physicians interpretations

University C

Page 17: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

All student athletesCNT

ImPACTTeam physician interpretations

SCAT3BESS

Video taped10 ft heel toe walk

Video tapedVisual accommodationsSmooth pursuits

University D

Page 18: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

All student athletes CNT

ImPACTUniversity physician interprets baseline tests

BESS

University E

Page 19: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

All student athletesCNT

ImPACTTeam Physician Interprets

University F

Page 20: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS
Page 21: Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

2013-14 NCAA Sports Medicine Handbook 24th edition pg 56-66

Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training 2014 49(2):245-265

Resch J, McCrea M, Cullum M. Computerized neurocognitive testing in themanagement of sport-related concussion: an update. Neuropsychology Review 2013 23:335-349

References