Children with TBIDr. Robert Cantu talks about the importance of athletes having a comprehensive baseline test and neurologic assessment at the start of the season, and how those tests should ideally be administered.
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[Dr. Robert Cantu] Well if we were starting a program for high school in terms of concussion management, most importantly would be a baseline assessment. The baseline assessment as the neurologic would include a symptom checklist, what symptoms the individual has or doesn't have at baseline; would involve a neurologic assessment in which vision, eye-tracking should be a part of it; balance testing using the balance error scoring system or some other balance testing should be a part of it; as well as a cursory neurologic exam. If you wanted to have neuro-psychological testing be done, I have no problem at all with that. That's perfectly fine. That's great. But understand that it's the cognitive part of the neurologic exam that that's replacing. It's not replacing the eye-tracking or it's not replacing the balance part of the neurologic exam. And then when an individual is suspected of possibly having a concussion, they need to be withheld from play until medical personnel has examined him and compared their current exam with their baseline exam. It's very uncommon. Roughly only half the high schools—public high schools have certified athletic trainers. And most of high schools do not yet still have comprehensive baseline testing. Unfortunately some of them are using ImPACT testing and thinking that that's the whole test, that's all you need to do. And although the people from ImPACT will tell you, "Use it as a cognitive exam. Don't use it as all the tools in your toolbox," unfortunately it's being used that way at a number of high schools still. The negative of using it as a comprehensive red light-green light is that you can pass the cognitive part in some instances and still have balance symptoms or signs, still have visual deficits, and not have recovered from your concussion based on that. And yet if you only use the neuro-cognitive assessment part, you can falsely think you've recovered, and you can be allowed to go back in while still symptomatic from other parts of the brain. I'm aware, without question, that not just Peyton Manning but athletes at all levels sandbag their baseline testing. And you have to do the best you can to be sure you're getting the most maximal response from the athlete. Sometimes it's not the athlete's fault. Sometimes the baseline testing is given in a not-quiet environment or an environment with too many people or doors opening or closing for distraction or sometimes given after the athlete, for one reason or another, whether it be an emotional problem or whether it had been an up-late-all-night, that kind of thing, is just really in no condition to take a baseline assessment.
Posted on BrainLine August 30, 2013.
About the author: Robert Cantu, MD
Robert Cantu, MD is chief of Neurosurgery Service, chairman Department of Surgery, and director of Sports Medicine, Emerson Hospital; clinical professor, Department of Neurosurgery, and co-director, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine.
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