A baseline concussion test aids sports concussion diagnosis and treatment

It’s important to know the athlete’s behavior when healthy, and a baseline test provides a touchpoint. The goal is to capture as much objective data as possible about athletes when they are functioning at 100%.

A baseline concussion test provides data to measure functional change in an athlete, making it crucial to concussion care, according to Tad D. Seifert, M.D., a neurologist and sports concussion specialist who is director of the Norton Neuroscience Institute Sports Neurology Center.

In addition to offering information about the athlete’s behavior when healthy, baseline concussion tests provide a touchpoint. The goal is to capture as much objective data as possible about athletes when they are functioning at 100%.

One assessment is a 20-minute neurocognitive test done on the computer, which looks at functional performance such as reaction time, and short-term and moderate-term memory.

“If an athlete is concussed, that’s something you can repeat easily during their recovery period,” said Dr. Seifert, an unaffiliated neurotrauma consultant with the Cleveland Browns football team in the NFL and chairman of the Kentucky Boxing and Wrestling Commission Medical Advisory Panel.

Another baseline concussion test involves having the athlete perform a brief series of basic tasks, such as balance testing.

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With a potential concussion, the mantra “when in doubt, sit them out” should be followed, according to Dr. Seifert.

“If you see someone you suspect has been concussed, you immediately remove them from play and keep them out of further contact until they have been evaluated by a medical professional,” Dr. Seifert said.

The reason to err on the side of caution is a second injury within a short period of time, from 24 to 48 hours, or possibly as long as 10 to 15 days, exponentially increases the risk of an athlete having catastrophic effects from the injury — and a much more prolonged recovery.

Dr. Seifert spoke during a recent “MedChat” podcast episode: “Identification and Management of Sports-related Concussions.”

A concise but thorough on-field sport concussion tool called SCAT5 helps standardize different elements of a neurologic exam that anyone from an athletic trainer to primary care physician to neurologist can perform accurately in a short period of time, according to Dr. Seifert.

An athlete with a concussion often presents like someone who is intoxicated. They will be dazed and confused, and short-term memory is often off. Occasionally, concussion has an element of amnesia, where the individual doesn’t remember the period of time surrounding the impact to the head.

Headache is the most common symptom of concussion. Visual changes are also common, as are lightheadedness, dizziness, nausea, light sensitivity, sound sensitivity, imbalance/gait instability and difficulty with fine motor movement.

“One that’s often overlooked but is just as important are mood changes, and that can run the spectrum,” Dr. Seifert said. “An athlete who’s usually very calm and collected often will become irritable and emotional, and then on the other end of the spectrum, an athlete who’s usually quite amped up and going 100 miles an hour when they’re out on the field of play suddenly becomes very flat and removed.”

Traits an individual takes into a concussion often are amplified afterward, according to Dr. Seifert.

“If you have a history of migraine pre-injury, if you have a history of anxiety pre-injury, if you have a history of ADHD [attention deficit hyperactivity disorder] pre-injury, those things are very likely for a time period after the concussion to be much worse,” Dr. Seifert said.

Loss of consciousness occurs only in about 10% of concussions. The data suggests that briefly losing consciousness will not prolong recovery. Only those athletes who lose consciousness for longer than four or five minutes or more are likely to have a prolonged recovery, according to Dr. Seifert.

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