Rehab Insights is a weekly blog written by Burke Rehabilitation professionals to offer practical information for patients, families and the community. Its goal is to educate the reader on relevant topics in rehabilitation, general health and wellness.

Back to School; Back to Sports: Get Ahead of Concussions with Baseline Testing

September 14, 2018

For parents of kids who play contact sports like soccer or football, the threat of their young athletes sustaining a concussion looms large. Sometimes, despite our best efforts, a concussion may occur. One way you can help your child—even before he or she starts playing: Baseline testing.

“Baseline assessments are useful in making return to play decisions if an athlete sustains a concussion,” says Katelyn Walter, PT, DPT, NCS, a physical therapist and one of the lead clinicians in Burke’s Outpatient Concussion Management Program. “Every person’s balance and neurocognitive status are all different. Though there are normative values for balance tests or neurocognitive tests, the best comparison to whether a person has returned to baseline, is themselves.”

We spoke with Walter and Lauren DiChiara, PT, DPT, NCS, also a physical therapist and lead clinician in the Concussion Program, about what parents should know about baseline testing.  

Different tests are offered. Though baseline testing is recommended for all kids who play a sport, there is no standardized assessment tool that all schools and physicians utilize. However, a combination of tests should provide the necessary—and vital—information. An ideal combination: a symptoms questionnaire, balance assessment, a neurocognitive assessment and a vestibular/visual baseline.

“The ImPACT test is the most commonly used,” says DiChiara. “This test is a computer-based program developed out of the University of Pittsburgh Medical Center that assesses reaction time, short and long-term memory, processing and executive function.” This test, however, doesn’t take balance or any other prior conditions into consideration. “Ideally, a child would also have balance testing, such as the BESS test, performed prior to playing a sport,” says DiChiara. “It would also be advantageous to have a vestibular and visual baseline as well (i.e. has the child ever been dizzy, has a history of a lazy eye, etc.).”

Testing might be offered at your child’s school—or you may have to find another option. While some school districts require (and provide) baseline testing before a child is allowed to play a sport, others don’t. In that case, there are physicians or certified practitioners that can do assessments. “The most important thing is to do your research: Look for a hospital or outpatient-based facility that has a concussion program. Look for a physician or nurse practitioner who is ImPACT-certified, or has experience treating this patient population,” advises DiChiara.

If your child is doing his assessment at school: “Make sure [the practitioner] is ImPACT-certified and that the testing environment is conducive to accurate reporting,” says DiChiara. “Oftentimes, students take the exam in a noisy room with several of their peers, which can lead to distraction.”

The assessments are beneficial no matter the sport. “In general, a baseline assessment should capture similar elements and assess the same systems across all sports,” says Walter. “That being said, some school systems or sports teams may assess baseline function for sport-specific tasks—for example, a cheerleader may have their balance assessed while in a specific stunt.”

Test annually. Have a baseline assessment done at the start of every year or season, recommends Walter. “As a child grows, their balance and coordination changes and becomes more sophisticated,” she says. “Additionally, skill sets assessed on neurocognitive tests, such as visual processing and reaction time, also develop throughout childhood and adolescence.”

Don’t rush to return to play. If your child does sustain a concussion, the most important thing you can do is take him or her out of the game or practice. Make sure to then have your child examined by a professional who has had concussion training. In kids, most concussions resolve within four weeks, says Walter.

“Once an athlete is symptom free at rest, completes an exertion assessment with no symptom provocation, and has balance testing within normal limits (and neurocognitive testing if requested by the physician), a return to play protocol can begin,” she says. “This may be different at individual schools, but generally follows the Zurich Return to Play Guidelines, which gradually increases an athlete’s exposure to physical activity, from light cardio activity, to sport drills, to non-contact practice, then contact practice and then return to full sport.” 

Says Walter: “Overall, the best advice is to follow your doctor or therapist’s recommendation, to be patient and to be honest. Everyone’s brain is unique and recovers differently, and because of this, trajectories after a concussion are different not only for every person but for every concussion.”

If your child does suffer a concussion, Burke offers a concussion management program specially geared toward getting you or your child back on the field safely. These services are offered at Burke's Mamaroneck, Purchase and White Plains Outpatient Clinics. Click here to learn more.

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Burke's Rehab Insights blog is intended to provide general information about rehabilitation and other health care topics. It should not take the place of medical care. Burke staff cannot comment on individual medical cases or give medical advice.

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