Concussion -Evaluation SCAT5
There are several tools used on the field when a player sustains a blow to the head or starts acting differently, including the most widely used sideline tool, the Sports Concussion Assessment Tool - 5th Edition (SCAT5).
The SCAT5 sideline tool was updated in 2017 by the Concussion in Sport Group (CISG) during the 5th International Consensus Conference on Concussion in Sport in Berlin.
It is intended for use by medical practitioners and gives guidance on how to approach and monitor suspected concussions. However, it does have its limitations, notably that a player may have a concussion despite having a normal SCAT5 score, and, therefore, clinical judgement should take precedence.
The adult SCAT5 has on-field and off-field assessments to categorize severity and follow-up evaluation. It is broken down into sub-scales, or categories of observable signs and examinations, some of which can be scored individually. The composite scoring system was removed during the update of SCAT2 to SCAT3 in 2012 based on limited evidence supporting its use.
Step 1 includes easily identifiable red flags: loss of consciousness, severe and increasing headache, seizures, tonic posturing, vomiting, deteriorating alertness, severe neck pain, or weakness. These players should be removed from play and immediately transported to an emergency room.
Step 2 is to recognize other observable signs including motionlessness, facial injuries, blank stares, disorientation or confusion, and balance or gait difficulties. Most items on this list seem obvious. However, the balance or gait issues occur on a spectrum, and many highly coordinated athletes will have a better ability to compensate for balance loss than other less seasoned athletes. There are several other behaviors that are subtler and may not be recognized without retrospective video analysis, if at all. Research is underway to develop better recognition skills for medical providers, trainers, and other non-medical providers.
Step 3 is a memory test to evaluate the mental status of an athlete. The Child SCAT5 skips this step, presumably because children may not be able to answer these types of questions in a normal state. Questionnaires, in general, are fraught with subjectivity and inaccuracies that make interpretation difficult. However, these are relatively straight-forward and give an idea of whether amnesia is a component of the head injury. Amnesia alone is a less sensitive than specific associated symptom of concussions.
Step 4 is a basic Glascow Coma Scale (GCS) examination, which evaluates the visual, verbal, and motor responses on a scale of 0-15. This is a crucial component of any trauma assessment, especially in the acute emergency setting, and is intended to be performed serially when monitoring a suspected concussed athlete. This is the only scored section of the on-field assessment process of the SCAT5.
Step 5 Lastly, a cervical spine exam is required for all on-field concussion subjects. This exam focuses on neck pain at rest, which is an important distinction from pain with activity for vertebral injuries. Once determining a pain-free state at rest (again, a subjective finding athletes could lie about), range of motion, limb strength, and sensation is evaluated. This is a one-time assessment and a trained medical professional can rule out significant cervical dangers.
Off-site or in-office assessment should be performed on all athletes in the concussion protocol. This secondary assessment should be done in a distraction-free environment because it is long and requires full attention to get an accurate score. This assessment is especially important in distinguishing non-concussed from mild- or moderately-concussed athletes. Ideally, each player would complete this entire assessment in a non-concussed state before play to know their baseline. This would be helpful for higher level athletes that may display better balance or for those with lower cognitive baseline during the Standardized Assessment of Concussion (SAC) (step 3 of the SCAT5)
Accelerated Return to Play - Principles
An accelerated concussion 'Return to Play' can be implemented to reduce the time away from training and play. This is based on a scientific '5 step' return to play' protocol.
Using the 'NOISE' process.
Neural Growth and Repair.
Oxygenation and Circulation.
Inflammation down regulation.
Scar and Protein modulaton.
Elevated Cell Signalling.
Shortening the return to play and improving the cognitive function upon return to play.
NeuroGenic Nutrition & Supplementation,
Cognitive Exercise and Modulated Stimulation,
Graduated and Pulsed Physical Activity,
Vision & Vestibular Program of Neuro-Optometry,
The ultimate goal is not only regain pre- concussion baselines but to surpass previous levels of cognitive function, proprioception, visual spatial awareness, dynamic vision, improve focus and attaining greater control of the alpha brian that is associated with performance and sporting 'focus' .
Step 1. (at time of TBI
Clinically validated tool for diagnosis including objective & subjective tests.
Using world leading technologies of testing and treating the athlete.
Step 2. (at time of TBI)
Initial TBI 'First Aid Kit' that includes Neuro-genic Supplements to reduce Oxydative Stress and the formation of Reactive Free Oxygen Species that are the damaging components of the inflammatory cascades associated with TBI.
Step 3. (day 1)
(monitoring dependent on severity)
Severity and referral along the appropriate pathway.
Multi-disciplinary team approach based on needs.
Step 4. (week 1)
Athlete centered approach to rest, with a planned Neurosensitivity
with an emphasis of accelerated return to play at the earliest and safe resumption of training and play.
Controlled re-introduction of the following based on a individual and targeted program of neuro-stimulation.
Pulsed exercise (sub to super threshold)
Neurological Stress Management
Vestibular and Visual Rehabilitation
Step 5. (week 2 onwards)
Prescribe a mid to long term strategy
to reduce any residual symptoms and improved cognitive state.
Further information can be obtained on the Professionals Enquiry page and is based on your location and regulatory processes that exist within the area of treatment.