Concussion Recognition & Evaluation

One of the signs usually but not always present with concussion is poor balance. An athlete's balance and equilibrium can be tested using low-technology, intermediate technology, and high-technology methods, but the most widely used and validated is the Balance Error Scoring System (BESS).

The emerging model of sport concussion assessment now involves the use of brief screening tools to evaluate post-concussion signs and symptoms on the sideline immediately after a concussion and neuropsychological testing to track recovery further out from the time of injury. One of the tools of value for sideline evaluation is called the Standardized Assessment of Concussion.

An athlete can experience two types of amnesia after a concussion: anterograde (reduced ability to form new memories) and/or retrograde (partial or total loss of the ability to recall events before injury). Whether anterograde amnesia is an indicator of more serious injury and slower recovery remains unclear.

Game officials are often in the best position to detect the subtle signs of concussions in athletes during a game but are not often given the power to order a sideline evaluation and assessment of concussion and few have received concussion education.

MomsTEAM has been advocating for years that every U.S. high school should have an athletic trainer on staff, given their key role in assessing and treating sports injuries, including concussions, and in making return to play decisions. While only 60-65% of schools have an AT, recent statistics suggest that fully 85-90% of high school athletes are now working with ATs on a daily basis.

Because one of the keys to keeping athletes safe when it comes to concussion is education, a concussion education and safety meeting should be held for parents and athletes should be held before every season. Ideally, the meeting should include presentations by medical doctors, former athletes, and parents of concussed current or former athletes.

Study shows LOC of greater than one minute duration may be associated with delayed return to play.  As a result, prolonged LOC is considered a factor that may influence management of such concussions.

Until 2004, the three most commonly used concussion grading systems were the Cantu, Colorado Medical Society (CMS), and American Academy of Neurology (AAN) guidelines. They have since been abandoned in favor of a symptom-based approach to individually guide management and return to play decisions.

The "simple" versus "complex" concussion classification was abandoned under the 3rd international consensus statement on concussion in sport, replaced by list of "modifying" factors, which have carried through to the 4th consensus statement issued in March 2013.

The AT is an invaluable member of the sports medicine team, particularly when an athlete suffers a concussion, because they have specialized training, and see athletes on a daily basis.  Because they are trusted by athletes, they can encourage the honest self-reporting that is key to avoiding delayed recovery or catastrophic injury.