The Balance Error Scoring System (BESS) test is commonly used to assess postural stability and balance in athletes with concussions. The BESS test consists of three stances (double-leg, single-leg, and tandem) performed on two different surfaces (firm and foam), for a total of six trials. The individual being tested is instructed to maintain balance in each stance for 20 seconds while keeping their hands on their hips and their eyes closed. The test is scored by the number of balance errors made during each trial, with errors including lifting hands from hips, opening eyes, step, stumble, or fall, or if the individual's hip reaches 30 degrees or more of abduction. The BESS test is a widely used, reliable, and valid tool for assessing postural stability and balance in athletes with concussions.
The Standardized Assessment of Concussion (SAC) is a brief neurological examination designed to evaluate the cognitive function of a person suspected of having a concussion. It consists of assessing orientation, immediate memory, concentration, and delayed recall, and can be completed in approximately 5-10 minutes. The SAC is one of several tests used to assess concussion, and is often used as part of a comprehensive concussion evaluation.
The Head Impact Telemetry System (HITs) is not a concussion test itself, but rather a technology used to measure the forces experienced by an athlete's head during athletic events. It uses sensors placed in a helmet to measure the frequency, magnitude, and location of impacts to the head, which can provide objective data to help evaluate the risk of concussion and inform decisions about treatment and return-to-play.
The Sway Balance Mobile Application is a mobile device-based assessment tool that uses the built-in sensors in tablets and phones to measure balance and sway as indicators of potential concussion. It includes a series of balance and reaction time tests that can be administered by medical professionals to help identify potential concussions and monitor recovery progress. The app also provides real-time data analysis and comparison to age-matched norms, which can be useful in determining whether an athlete is ready to return to play after a concussion.
The VOMS (Vestibular/Ocular Motor Screening) test is a tool used in the assessment of concussions. It is designed to evaluate the vestibular and ocular systems, which can be affected by a concussion.
The test consists of six subtests:
Smooth Pursuits: The patient follows a visual target smoothly with their eyes.
Saccades: The patient looks back and forth between two visual targets as quickly and accurately as possible.
Convergence: The patient looks at a visual target moving toward them and tries to keep it in focus as it gets closer.
Vertical/Horizontal Ocular Motor Control: The patient moves their eyes vertically and horizontally while keeping their head still.
Visual Motion Sensitivity: The patient looks at a moving visual target and reports if it makes them feel dizzy, nauseous, or uncomfortable.
Visual Motor Processing Speed: The patient identifies numbers on a chart while pointing to them as quickly and accurately as possible.
The VOMS test is not diagnostic of concussion but can be used in conjunction with other assessments to aid in diagnosis and management of concussion.
The graded symptoms checklist is a tool used to assess the severity of concussion symptoms. It is a standardized list of concussion symptoms that are rated on a scale from 0 to 6, with 0 indicating no symptoms and 6 indicating the most severe symptoms. The checklist includes symptoms such as headache, dizziness, nausea, fatigue, and difficulty concentrating. The severity of each symptom is rated by the patient or a healthcare provider, and the total score is used to determine the severity of the concussion. The graded symptom checklist is often used in combination with other tests and assessments to help diagnose and manage concussions.
The King-Devick (K-D) test is a rapid visual screening tool used to evaluate ocular motor and visual symptoms that are common in concussions. It involves reading aloud a series of single-digit numbers presented on multiple index cards as quickly as possible, and the time taken to complete the test is recorded. If the time taken to complete the test increases significantly from a pre-injury baseline, it may indicate the presence of a concussion. The K-D test is a simple, quick, and objective way to assess for concussion and has been used in various sports settings.
The Sport Concussion Assessment Tool 5 (SCAT5) is a standardized tool used for the evaluation of athletes suspected of having a concussion. The SCAT5 includes a combination of symptom evaluation, physical examination, and cognitive screening. The components of the SCAT5 are as follows:
Symptoms Checklist: The athlete is asked about a list of symptoms associated with concussion, and the presence and severity of each symptom is recorded.
Glasgow Coma Scale: A quick assessment of the athlete's level of consciousness and overall neurological function.
Maddocks Questions: A series of questions that assess the athlete's orientation to time, place, and person.
Standardized Assessment of Concussion (SAC): A brief cognitive evaluation that assesses orientation, immediate memory, concentration, and delayed recall.
Balance Examination: A series of tests that evaluate the athlete's balance and coordination.
Coordination Examination: A series of tests that evaluate the athlete's coordination.
Cervical Spine Examination: An evaluation of the athlete's neck and cervical spine to rule out any associated injuries.
The results of the SCAT5 are used to help determine whether an athlete has sustained a concussion, and to guide the management and treatment of the concussion. The Kids SCAT5 is a modified version of the SCAT5 designed specifically for children aged between 5 and 12 years old. It includes age-appropriate modifications to the tests and questions included in the SCAT5. For example, the Kids SCAT5 includes a symptom checklist designed for younger children, which includes pictograms of common concussion symptoms instead of written words. It also includes a balance assessment, where the child is asked to stand on one leg and to walk heel-to-toe in a straight line, but with modifications that are appropriate for younger children. Additionally, the Kids SCAT5 uses a modified Maddocks questions to assess orientation to time and place, and the number of digits backwards is reduced to three. These modifications help to make the SCAT5 more accessible and appropriate for children who have experienced a concussion. The return to activity or return to sport protocol after a concussion typically involves a gradual and individualized process that allows the athlete to safely return to their normal activities while monitoring for any recurring symptoms. The protocol generally includes the following steps:
Complete rest: Immediately after a concussion, the athlete should avoid all physical activity and cognitive stimulation to allow the brain to rest and recover.
Light aerobic exercise: Once the athlete is symptom-free at rest, they may begin light aerobic exercise, such as walking or stationary cycling, to gradually increase their heart rate.
Sport-specific exercise: After completing the light aerobic exercise stage, the athlete may progress to activities that are specific to their sport, such as running, jumping, or throwing, under the guidance of a medical professional.
Non-contact training: If the athlete remains symptom-free after sport-specific exercise, they may begin non-contact training drills that mimic the movements of their sport.
Full contact training: If the athlete remains symptom-free after non-contact training, they may progress to full contact training under medical supervision.
Return to play: After successfully completing full contact training, the athlete may be cleared to return to competition.
It is important to note that the return to activity protocol should be individualized and may vary based on the athlete's age, sport, and severity of their concussion. The athlete should also be monitored closely by medical professionals throughout the process. The general return to activity protocol for children after a concussion is similar to that of adults, but there may be some modifications based on the child's age and individual situation. It is important to consult with a healthcare provider experienced in concussion management to develop an appropriate return to activity plan for children. Additionally, the return to activity plan may need to be adjusted based on the child's symptoms, progress, and risk factors. The most common and widely accepted assessment for a concussion is the SCAT (Sport Concussion Assessment Tool), specifically the most recent version, SCAT5. The treatment for a concussion typically involves physical and cognitive rest until symptoms have resolved, followed by a gradual return-to-activity protocol under the supervision of a healthcare provider. However, the specific treatment plan may vary based on the severity of the concussion and the individual needs of the patient. The highest level of care and assessment for a concussion would depend on the severity of the concussion and the individual's specific symptoms and medical history. In general, the highest level of care for a concussion would be provided by a specialized concussion clinic or a team of healthcare professionals with expertise in concussion management. This may include neurologists, neuropsychologists, physical therapists, and athletic trainers. Advanced imaging techniques such as MRI or CT scans may also be used for more severe cases. The most important aspect of concussion care is a thorough assessment and individualized treatment plan tailored to the patient's needs.
studies have suggested that implementing concussion management protocols and using appropriate screening tools can lead to cost savings by reducing the number of unnecessary diagnostic tests, emergency room visits, and hospitalizations. Additionally, early detection and appropriate management of concussions can prevent long-term sequelae and reduce the economic burden associated with long-term healthcare costs and lost productivity.
There are several measures that can be implemented to better let data drive concussion management, such as:
Use of standardized and validated concussion assessment tools: Implementing the use of standardized and validated concussion assessment tools can help to ensure that data collected is accurate and reliable, which can then be used to drive concussion management decisions.
Electronic health records (EHRs): Using EHRs to document concussion assessment results, symptoms, and treatment plans can help to ensure that all data is centralized and easily accessible for clinicians involved in concussion management.
Real-time monitoring: Real-time monitoring of athletes during practices and games can provide valuable data on the frequency and severity of head impacts, which can be used to identify athletes who may be at risk for concussion.
Data sharing: Sharing concussion data between healthcare providers, coaches, and parents can help to ensure that all parties involved in concussion management have access to the same information, which can lead to better-informed decisions.
Artificial intelligence (AI): The use of AI to analyze large datasets can help to identify patterns and trends in concussion data that may not be immediately apparent to human analysts, which can lead to more effective concussion management strategies.
Overall, the key to letting data drive concussion management is to ensure that all data collected is accurate, reliable, and accessible to all stakeholders involved in concussion management. By implementing these measures, healthcare providers, coaches, and parents can work together to develop more effective concussion management strategies that prioritize the health and safety of athletes. Big data analytics in the healthcare industry. They first define big data as a large volume of complex, high-velocity, and variable data that require advanced techniques and technologies to capture, store, distribute, manage and analyze the information. They then explain how the healthcare industry generates vast amounts of data due to record-keeping, compliance & regulatory requirements, and patient care. The authors discuss the potential of big data analytics in improving clinical decision-making, disease surveillance, and population health management.
The article emphasizes the future of medicine as a personal, institutional, national, or global whole with the aid of big data in healthcare. The authors also provide several examples of how big data analytics can help healthcare organizations to better understand the patients they serve and optimize treatment plans. They also highlight the potential cost savings, with the potential for a $300 billion savings on national healthcare.
The authors also discuss the challenges of using big data in healthcare, including privacy concerns, data security, and the difficulty of integrating data from different sources. They provide a solution-based strategy to address these challenges and encourage the continued development of big data analytics in healthcare.
Overall, the article highlights the promise and potential of big data analytics in the healthcare industry and provides a framework for future research in this field.
Annotated bibliographies for each concussion test screening or exam:
SCAT5 (Sport Concussion Assessment Tool 5th Edition)
Echemendia, R. J., Meeuwisse, W., McCrory, P., Davis, G. A., Putukian, M., Leddy, J., ... & Kutcher, J. (2017). The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale. British Journal of Sports Medicine, 51(11), 848-850.
This article provides an overview of the development and rationale of the SCAT5, which is a standardized tool used to assess concussions in sports. It includes sections on the history and evolution of the SCAT, the development process of the SCAT5, and an explanation of the various components of the SCAT5.
King-Devick Test
Galetta, K. M., Barrett, J., Allen, M., & Wilson, J. A. (2011). The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology, 76(17), 1456-1462.
This study evaluated the effectiveness of the King-Devick test in identifying head trauma and concussion in boxers and MMA fighters. The results showed that the test was able to detect head trauma and concussion with high sensitivity and specificity. The authors concluded that the King-Devick test could be a useful tool for identifying head trauma and concussion in combat sports.
ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)
Lovell, M. R., & Collins, M. W. (1998). Neuropsychological assessment of the college football player. Journal of head trauma rehabilitation, 13(2), 9-26.
This study investigated the effectiveness of the ImPACT test in assessing cognitive function in college football players. The results showed that the ImPACT test was able to identify cognitive deficits in players who had experienced a concussion, and was also able to track recovery over time. The authors concluded that the ImPACT test could be a valuable tool for assessing and managing concussions in athletes.
Sway Concussion Test
Valovich McLeod, T. C., Barr, W. B., McCrea, M., & Guskiewicz, K. M. (2014). Psychometric and measurement properties of concussion assessment tools in youth sports. Journal of athletic training, 49(6), 659-672.
This article provides an overview of several concussion assessment tools, including the Sway Concussion Test. It includes a discussion of the psychometric properties of the Sway test, such as reliability and validity, as well as its potential uses in youth sports. The authors conclude that the Sway test shows promise as a tool for identifying and managing concussions in young athletes.
1. Vestibular Ocular Motor Screening (VOMS)
Mucha, A., Collins, M. W., Elbin, R. J., Furman, J. M., Troutman-Enseki, C., & DeWolf, R. M. (2014). A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. The American journal of sports medicine, 42(10), 2479-2486.
This study evaluated the validity and reliability of the Vestibular Ocular Motor Screening (VOMS) in identifying concussions in athletes. The VOMS consists of a series of tests that assess eye movements, balance, and symptoms associated with concussion. The study found that the VOMS was a valid and reliable tool for identifying athletes with concussions, and may be useful for making return-to-play decisions.
1. Balance Error Scoring System (BESS)
Valovich McLeod, T. C., Barr, W. B., McCrea, M., & Guskiewicz, K. M. (2014). Psychometric and measurement properties of concussion assessment tools in youth sports. Journal of athletic training, 49(6), 659-672.
This article reviews the psychometric and measurement properties of several concussion assessment tools, including the Balance Error Scoring System (BESS). The BESS is a widely used test that assesses balance and postural stability in individuals with concussion. The authors conclude that the BESS has good psychometric properties, including reliability and validity, and may be useful for identifying individuals with concussions.
1. Kids Sport Concussion Assessment Tool (SCAT5)
Echemendia, R. J., Bruce, J. M., Bailey, C. M., & DeMaio, C. (2018). The Sport Concussion Assessment Tool (SCAT): A Review. NeuroRehabilitation, 42(4), 507-518.
This article provides a review of the Sport Concussion Assessment Tool (SCAT), which includes the Kids Sport Concussion Assessment Tool (SCAT5). The SCAT5 is a standardized assessment tool that includes tests of balance, memory, and concentration. The article discusses the reliability and validity of the SCAT5 in identifying and managing concussions in children and adolescents. The authors conclude that the SCAT5 is a valuable tool for concussion assessment in young athletes.
1. Standardized Assessment of Concussion (SAC)
McCrea, M., Kelly, J. P., Randolph, C., Kluge, J., Bartolic, E., Finn, G., ... & Powell, J. W. (1998). Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. Journal of Head Trauma Rehabilitation, 13(2), 27-35.
This study evaluated the reliability and validity of the Standardized Assessment of Concussion (SAC) in identifying and managing concussions in athletes. The SAC is a brief bedside assessment tool that evaluates orientation, immediate memory, concentration, and delayed recall. The study found that the SAC had good reliability and validity, and was useful in identifying and managing concussions in athletes.
1. Head Impact Telemetry System (HITs) Bailes, J. E., & Petraglia, A. L. (2014). Omalu’s
legacy: the future of concussion research. Neurosurgery, 75(suppl_4), S106-S112.
This article discusses the use of the Head Impact Telemetry System (HITs) in measuring the frequency, magnitude, and location of head impacts in sports. The HITs provides objective data on head impacts, which can be used to identify athletes who may be at risk
Reference:
Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: Promise and potential. Health Information Science and Systems, 2(1), 3. https://doi.org/10.1186/2047-2501-2-3
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