Another youth concussion case came in our office this week: a player with a headache, looking more than a little “drunk” standing the reception area. After a collision on the field, the athlete was identified as having possible issues but was allowed to go back into play where he got hit again, and then hit a third time. A pediatrician finally diagnosed the concussion and he and his parents received the standard sheet of paper that outlines the “Return-to-Play Guidelines”. The parents of the athlete are desperate for answers. Their response: “There has got to be something we can do!” In the meantime, the athlete is depressed and frustrated, and the coach is at the mercy of a diagnosis without a plan of action and recovery for the athlete.
The fact remains that the way we deal with concussion in America is asinine. The process is passive and symptom-based, with no way to allow for a systematic, graduated protocol for a healthy recovery. It continues to be a dangerous head-in-the-sand approach that is leaving us with at-risk kids to the tune of billions of dollars a year as only <50% of concussions are correctly diagnosed .
There are seven steps given to return-to-play guidelines and each is based on increasing physical and cognitive demands based only on an absence of symptoms, particularly focused on headache, and a nebulous “return to baseline” determination. With the agreement of the “physical team” and “academic team” the player can then return to play. However, there are huge problems with this process!
Strike one: Baseless Baselines
When most medical professionals evaluate an athlete for concussion, they have no baseline study to compare against the athlete’s current condition. For those who have actually done a baseline analysis, almost all of the processes, including IMPACT and King-Devick, usually have their analyses conducted when the athlete is in an environment completely dissimilar to the environment he or she is in at the time of the potential concussion. It should be obvious that the variable of the testing environment is a major factor, yet this is generally ignored.
A baseline is only a baseline when all factors are taken into account and the student-athlete’s performance can be quantified as consistent with their “normal” performance within a similar environment. There is a popular approach where a baseline is determined immediately after a potential concussion. A baseline taken after the fact is only a comparison to “normal” statistics and says nothing about the student himself or herself. A quality baseline is one that measures the student’s true abilities and can result in identifying performances, deficits, and risk factors prior to injury. Instead, with the current processes, no one knows when the student returns to normal, including the medical professional conducting the analysis, and especially the athlete who needs the best care for protection and healing.
Score: Real Holistic Baselines
There are four qualities/factors of baselines MUST be taken into account for an athletic individual;
Beaumont, L., Theoret, H., Mongeon, D., Messier, J., Leclerc, S., Tremblay, S., Ellemberg, D., & Lassonde, M. (2009). Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain, a Journal of Neurology, Vol. 132, pp. 695-708.