Concussion Baseline Testing

“How do you know what level you’re trying to get to, if you dont know where you started?”

Over the past few years, a hotly debated topic in the concussion realm has been the use of “Baseline Testing”. In so many words, baseline testing is utilized to determine preinjury scores of an otherwise ‘healthy’ athlete in regard to cognitive and physical performance. These scores would then be used to determine if an athlete (after a concussion) has returned back to ‘normal’ functioning and can return to full play/school/work.

If you look towards the research, it provides conflicting results as to whether they are useful or not. However, the one major flaw in a lot of the research surrounding baseline testing for concussion is that it only tests the validity and reliability of a single test at a time. There is no doubt that a single test for determining any results in medicine is unreliable. The body is too complex and adaptable to be able to utilize only one single test to determine any meaningful information.

With that in mind, you can see why some research will conclude that only utilizing the ‘King-Devick’ or ‘SCAT-5’ test is unreliable. Instead, if you look to evaluate the research that is more consistent with utilizing a battery (multiple) tests the reliability and validity of returning a patient back to work/school/play successfully is incredibly accurate. Due to the high level of individual variability, we know many different learning behaviours and alternative variables can impact the level of scoring on any or all of these tests. However, utilizing these tests pre-season in a controlled environment when the athlete is otherwise ‘healthy’ can provide clinicians with objective measures and a measure of ‘normal’ functioning. After being completed pre-season, should the patient suffer a concussion and begin treatment, the clinician then has an objective measure of what ‘healthy’ levels of cognitive and physical performance look like. This helps guide a more precise and successful return to work/play/school with less barriers to recovery.

Current organizations and governing bodies who are in full support of baseline concussion testing:

·      International Consensus Statement on Concussion (Berlin 2017)
*New consensus statement due out this year pending COVID restrictions*

·      Canadian Olympic and Paralympic Guidelines

·      NCAA Diagnosis & Management of Sport-Related Concussion

·      Ontario Neurotrauma Foundation

·      International Ice Hockey Summit (2019)

·      Concussion in Sport- Australia

·      Centre for Disease Control and Prevention (CDC)

Season starting soon? Get your concussion baseline test booked today!

 
Research Notes

·      The proceeding from the Ice Hockey Summit III: Action on Concussion (2019) put forward 5 main recommendations after appraising the most available and pertinent literature pertaing to concussion. In their recommendations, explicitly stated “Mandate baseline testing to improve concussion diagnosis for all age groups”.

·      Neurocognitive Performance of Concussed Athletes When Symptom Free (Steven P. Broglio et al). “The exclusive use of symptom reports in making a return-to-play decision is not advised. A multifaceted approach to concussion assessment that includes evaluation of a myriad of functions is warranted”.

·      “The King-Devick test administered alone found 79% of concussive injuries. The SCAT-5 alone found 52%. Combining the two captured 89% of concussive injuries. Adding in the BESS identified 100% of concussive injuries” Marindes et al, 2014.

·      King-Devick identified 53% of concussions. Pitch Side Concussion Assessment identified 74%. CogSport identified 57%. Together they identified 100%. Molloy et al, 2017.