By Dev K. Mishra, M.D., President, Sideline Sports Doc
In today’s post I’d like to outline some current and future techniques that medical professionals use to detect concussion. A very important point is that these are techniques used by physicians and certified athletic trainers on the sidelines and should not be used by coaches who are not physicians or trainers.
I want to very briefly outline 5 topics: the SCAT2 assessment, Head Impact Telemetry System (HITS), the Ahead System, the King-Devick test, and blood markers for concussion. Some are in use today, others are under development, and all have various benefits.
The Sideline Concussion Assessment Tool Version 2 (SCAT2)
The SCAT2 offers a standardized method of evaluating athletes aged 10 years and older for concussion. It is a part of the 2008 Zurich Consensus Statement on Sport Concussion.
The SCAT2 is a paper-based test designed to evaluate various brain systems that can be effected in a concussion such as balance, memory, and general orientation to the game situation facts. I use this test for all of the high school athletes on the sideline and most professional sports leagues now require some form of the SCAT2 test in their on-field concussion evaluations. It’s impossible for an athlete to fake the balance and memory portions. This is the best available simple test. There are some drawbacks, as some recent studies have shown that high school athletes can have baseline normal test values that are lower than one might expect, so the clinician needs to combine this test with good judgment. Because it’s paper based it is very low cost and completely portable. I believe high school athletic trainers should be using this test if other tests are not available.
Head Impact Telemetry System (HITS)
This system uses helmet-mounted sensors and computer software to measure potentially harmful, concussion-causing head acceleration after an impact. Several colleges and high schools use HITS. I’m a very technical person and I like objective data. The HITS system provides exactly that. We need much more information about the ability of HITS to actually predict whether an athlete is approaching the threshold for concussion, and we need information about differences in younger age groups. Studies in these areas are ongoing, and perhaps we will someday have the ability to remove an athlete from play before the concussion happens.
This is a portable brain wave detector under development byBrainScope, Inc.It is intended to quickly identify concussions by sensing whether the electrical activity in a patient’s brain is normal or abnormal. Medical devices such as this often take many years to reach marketed use but I’ll be keeping a close watch on this very promising technology.
The King-Devick test was originally designed for individuals with dyslexia and requires the athlete to use rapid eye movements (called saccades) displayed on index cards, a computer, or through an iPad app. A sideline version takes about two minutes to perform. This test needs to be compared to the athlete’s preseason baseline but also shows great promise as a very rapid sideline assessment tool for the medical professional.
Blood Protein Markers
Blood tests are commonly used in medicine to detect various conditions. Certain blood proteins are released into the blood stream after brain trauma, and some research indicates that specific proteins might be detectable in the blood stream after concussion. Research in this area is in the early stages. My feeling is that these tests will ultimately be used by physicians in determining when it is safe to return to play but the invasiveness of a blood test and the time needed to get a result could make it impractical for the sideline.
This is all exciting stuff, sure to make the sideline concussion diagnosis more objective, accurate and reliable