Concussion: Baseline & Post-Injury Assessment
Concussion, sometimes referred to as mild traumatic brain injury (mTBI), is a temporary disturbance of brain function that involves a complex pathophysiological process (1). A concussion may be caused by a direct blow to the head or face, but may also occur as a result of an injury to the neck (e.g. whiplash) or elsewhere on the body with the impulsive force transmitted to the head (2). You do not need to lose consciousness ("get knocked out") to have a concussion, with only approximately 10% of concussions involving a loss of consciousness.
Symptoms people may experience with concussion include headaches, mood and/or behavioural changes (e.g. depression, irritability), ‘fogginess’, memory loss, dizziness, visual changes, slowed reaction times, gait unsteadiness, fatigue and neck pain (1,2). The symptoms of concussion typically resolve spontaneously, with the majority of adults recovering in 2 weeks, whilst children/adolescents may take longer (symptom resolution can take up to 4 weeks). However, in some cases, symptoms can linger beyond the expected time frames (i.e. >2 weeks in adults and >4 weeks in children/adolescents) (2).
Importantly, recent research suggests that the time for complete recovery may actually take longer than the clinical recovery (i.e. the physiological time for the nervous system to recover may take longer than the resolution of symptoms) (1,2). With no two concussions being exactly the same, it has been stated that there is a need for objective and clinically useful tools for the diagnosis of concussion (1), as well as individualised targeted treatments, directed to the findings identified in the concussion assessment (1,2).
At Optimize Sports Chiropractic, we utilise objective technology to record and quantify an individual's baseline level of symptoms, eye movements, balance, reaction time and cognitive function.
"Initial baseline evaluation including a symptom checklist, cognitive evaluation and balance assessment
has been considered ‘best practice’ for all athletes by the National Collegiate Athletic Association." (1).
Technology we use for baseline assessment includes:
Cambridge Brain Sciences (CBS Health) cognitive assessment platform
EQ Active Brain Tracking
RightEye computerised eye-tracking technology
Vestibular First Insight Infrared Video Goggles (VOG)
Balance Tracking System (BTrackS) force-plate technology
Once a baseline evaluation has been performed, an individual can decide if they would like to improve areas of deficiencies identified within the assessment, or simply record the progression - or regression - of the different domains. The baseline evaluation then serves as a good reference for individuals in the situation should a concussion occur, as it can help assist with return-to-play decisions (i.e. the health professional involved will be able to better determine an individual's recovery beyond their symptom resolution).
Following a suspected - or diagnosed - concussion, at Optimize Sports Chiropractic we will conduct a comprehensive history and perform an extensive, detailed neurological examination including: symptom trajectory; neurocognitive function; reaction time; oculomotor function (eye movements); vestibular function; balance; autonomic function (including exercise tolerance); gait and coordination; as well as a musculoskeletal assessment, with a specific focus on the cervical spine.
As part of the post-concussion injury assessment, we utilise computerised technology to record and quantify symptoms, neurocognitive function, reaction time, and balance (EQ Active Brain Tracking); neurocognitive function (CBS Health); oculomotor and vestibular function (Insight Infrared Video Goggles); oculomotor function, vestibular function, and reaction time (RightEye); balance and cervical spine assessment (BTrackS).
If a baseline assessment has previously been conducted, we can provide an individual with a more objective benchmark on which they can compare their complete recovery, assisting in better return-to-play decisions.
If you have any specific questions, or want to know if we can help, feel free to contact Brett, or call our friendly reception staff to schedule a baseline or post-injury consultation.
Harmon KG, Clugston JR, Dec K, et al. Amercian Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019;53:213-25.
McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 Apr 26;0:1–10.