Comprehensive Concussion Management
I Don't Have a Concussion, I Just Had My Bell Rung! |
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| Bachelor of Science in Athletic Training 
Concussions: Education, Testing, & Management
Education:
As we outline last week, education of coaches as well as student-athletes is a key component in our ability to identify and treat concussions. It is essential for all coaches to know and be able to recognize the most common signs and symptoms of concussion, so that they may be able to promptly refer their athletes to the athletic training staff for examination. We take the opportunity to educate coaches in meetings that allow for questions to be asked concerning the testing and management of student-athletes. It is important that the educational information is communicated to coaches in the off-season so that when a concussion is sustained by one of their athletes, there is no question on the protocol. It is equally important for all student-athletes to be able to recognize the signs and symptoms in themselves AND their teammates. All Iowa State athletes acknowledge in writing during the first preseason team meeting that they will immediately report any signs or symptoms of concussion in themselves or a teammate to a member of the athletic training staff or team physician.
Testing:
Student-athletes participating in NCAA defined high risk sports undergo a series of baseline tests when they arrive on campus. Our comprehensive baseline testing includes the following:
• ImPACT Test – Computer based neuropsychological test that gives us great detail when used in comparison post- injury. Tests memory, reaction time, ability to avoid distractors, etc…
• SAC Test – Standardized Assessment of Concussion (SAC) is used during practice or competition to determine the possibility that a student-athlete may have a concussion. This is a verbal test that can be administered anywhere; although we look for a location or environment with as few distractions as possible. The SAC test focuses on orientation, memory, and cognitive function.
• BESS Test – Balance Error Scoring System (BESS) is a balancing activity that will provide information on the athlete’s equilibrium and ability to balance. This is easily reproduced on the sideline post-injury and can quickly be compared to their baseline test.
Management:
Immediate evaluation of an injured athlete with a possible head injury requires us to perform a primary assessment to make sure there is not a life threatening injury present. We must take time to rule out a neck injury, spinal cord injury, or even a skull fracture. Once it is determined that it is safe to move them, the athlete is moved to the sideline where a complete assessment will be performed by a certified athletic trainer or the team physician as follows:
1. Allow the athlete time to catch their breath and calm down
2. If able, move the athlete to an area that is quieter and less distracting
3. Perform thorough evaluation of head and neck.
4. Perform post-injury version of the SAC Test, BESS Test, as well as a coordination (finger to nose) test. All of this information is compared to the baseline numbers that we keep in our possession on the field and during travel.
5. If any of the tests reveal abnormalities; all testing is repeated again in 15 - 20 minutes. If at that time the test results return to the baseline norms without any other reported symptoms, the athlete will not be considered to have suffered a concussion and be allowed to return to play. However, if after 20 minutes the testing results are still abnormal, the athlete will be assessed as having a concussion and withheld from athletic activity for the remainder of that day.
Once diagnosed with a concussion, the athlete will be monitored for deterioration of symptoms for the remainder of the day. Home care instructions will be given to the athlete’s roommate so that they may have a basic idea of what to look for overnight as the athlete rests and recovers from the concussion. Generally, the athlete will return to the Jacobson Athletic Training Room the day following injury to retake the ImPACT Test. This test will be compared to their baseline and give us a very good idea if they are having functional problems related to the concussion. If the testing results continue to show functional deficits, the test will be administered again at 72 hours and 1-week post-injury. If these functional deficits continue past one week; the team physician may refer the athlete for further testing and examination by a Neurologist. Symptom scores will be collected daily until they report no further symptoms and balance testing will be done daily until it returns to a normal baseline as well. Once the athlete is asymptomatic at rest, scores within normal limits on the ImPACT test, has no balance deficits, and has a normal neurological evaluation; they will be cleared to begin the graduated return to play program. This comprehensive management plan eliminates much of the stress on the athlete as the burden for them to return to sport participation lies in the objective testing results and not solely on them stating whether or not they have a headache that day.
Each stage in this return to play program generally represents one day. It can be assumed that an athlete should be able to return to full sport participation in five days after all of the testing has returned to normal and they have no further symptoms. However, it is very important to remember that each concussion must be examined and managed on an individual basis. Some athletes may have a return of symptoms when they begin sport specific exercises or more intense training drills. Any setback or return of symptoms results in the athlete returning to the previous “symptom free” stage in the return to play program. The athlete is then progressed as their symptoms and the program dictates.
Concussions have become a large part of sports media and it is important to note that we had to make very few changes to our long standing concussion management protocol at Iowa State. Many of the new NCAA guidelines and suggestions are strategies that we have been studying and employing for years. If you have any further questions or would just like more information related to our comprehensive yet aggressive protocol to manage sport related concussion; please stop in to visit with one of the Iowa State athletic training staff members.
Go Cyclones!
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