For many years now, athletes who suffer concussions have been cleared for a return to sport once their clinical symptoms have subsided. However, the International Consensus Statement on Concussion in Sport (2017) refers to recent literature suggesting physiological deficits in the brain may outlast the period of clinical symptoms. This is of great importance, as there is evidence that suggests that this physiological deficit in the brain represents a window of vulnerability. During this window of vulnerability, a mild second concussive event can worsen this physiological deficit and potentially result in severe brain injury (Vagnozzi, et al. 2007).
Baseline testing is a very useful tool for the safe management of concussion injuries, and is most effective in helping determine when an athlete can return to a high-risk sport safely. Baseline testing involves a variety of tests that measure balance, visual tracking and processing speed, strength and physical performance measures, auditory memory, concentration and neurocognitive parameters. After an athlete experiences a concussion, some or all of these parameters can be affected, which means that baseline testing can be re-measured to help determine if an athlete is still impaired in these parameters. Evidence suggests that baseline testing can be between 80-100% specific and sensitive in determining the recovery of a concussed athlete (Naunheim, et al., 2008), (Molloy, et al., 2017), (McCrea et al., 2003), (Resch, et al., 2016), (McCrea, 2001).
It has been well established by the research that the physiological deficits that affect the brain can outlast the duration of symptoms following a concussion. The use of baseline testing helps provide an objective measure, which is effective in helping determine whether an athlete can safely return to a high-risk sport. Capital Clinic offers rigorous baseline testing, as well as return to play management, physical exertion tests, and re-testing of injured individuals using the Complete Concussion Management (CCMI) database. This information can be given to the treating practitioner or physician, offering further information to support more informed return to sport decisions.
References
1. Vagnozzi, R., Tavazzi, B., Signoretti, S., Amorini, A. M., Belli, A., Cimatti, M. & Lazzarino, G. (2007). Temporal window of metabolic brain vulnerability to concussions: mitochondrial-related impairment—part I. Neurosurgery, 61(2), 379-389.
2. Naunheim, R. S., Matero, D., & Fucetola, R. (2008). Assessment of patients with mild concussion in the emergency department. The Journal of head trauma rehabilitation, 23(2), 116-122.
3. Molloy JH, Murphy I, Gissane C. ARTICLE IN PRESS. Journal of Science and Medicine in Sport. Sports Medicine Australia; 2017 Feb 28;1–4.
4. McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19; 290(19):2556–63.
5. Resch, J. E., Brown, C. N., Schmidt, J., Macciocchi, S. N., Blueitt, D., Cullum, C. M., & Ferrara, M. S. (2016). The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ open sport & exercise medicine, 2(1), e000012.
6. McCrea, M. (2001). Standardized mental status testing on the sideline after sport-related concussion. Journal of athletic training, 36(3), 274.