Baseline Assessments Symptom Checklist Standardized Cognitive and Balance Assessments SAC SCAT SCAT II SCAT III Balance Error Scoring Symptoms - BESS

Athletes at high risk of concussion should undergo baseline exams prior to season New baseline test annually for adolescents, those with recent concussion, and all athletes whenever possible Baseline test should consist of: Clinical history – including symptoms Physical and neurological evaluations Measures of motor control (balance) Neurocognitive function

Baseline and post injury examinations should be administered in similar environments Baseline examinations should be reviewed for suboptimal performance

Multi-dimensional approach encouraged “Concussion diagnosis must be clinical, and cannot be made by computerized testing.” NCAA Sports Medicine Handbook Help with decision making Not a stand alone tool

Possible Advantages Baseline test groups of athletes concurrently Large groups discouraged Wide availability via internet and other platforms Ease of administration Access to alternate test forms Centralized data for access by practitioners Do not require direct involvement of neuropsychologist for administration

Pro’s Account for individual neurocognitive variability for each athlete Learning disabilities, ADD/ADHD, other cognitive or neuropsychiatric conditions Con’s May lack evidence to support clinical use May not be time or cost effective Random error Environmental distractions amount of sleep caffeine consumption, acute psychological distress sub-optimal effort – “sandbagging”

Immediate Postconcussion and Cognitive Testing (ImPACT) CogSport/State (Axon Sport) Headminder Concussion Resolution Index (CRI) Automated Neuropsychological Assessment Metrics (ANAM)

39.9% athletic trainers reported CNT part of concussion management protocol ImPACT – 93% Axon Sport -2.8% Unspecified software 2.8% Headminder CRI 1.4% 86%-95.7% report using pre-participation baseline CNT Majority of CNT reports interpreted by AT or physician 3% - 17% by licensed neuropsychologist 26.4 % of AT’s interpreting CNT have formal training

ImPACT study 95.5 % would not return symptomatic athlete regardless of CNT results 4.5% would return symptomatic athlete if CNT results within normal limits 86.5% would not return asymptomatic athlete if CNT results within the norm 9.8 % would return athlete based on symptom recovery 3.8% reported it depended on the importance of competition

Select tools that fit clinical setting Proper training in administration and interpretation Consistent with baseline and post injury evaluation Multifaceted approach Neurocognitive testing Symptom score Motor-control Maximize performance on baseline and post injury tests Administer test individually or in small groups to minimize distraction Neuropsychologist or physician with concussion training to interpret post injury data

Since 2005, 29 articles addressing psyhcometric properties of commercially available CNTs in the assessment of SRC ImPACT – 13 CogSport/State (AXON) – 7 Headminder CRI – 5 ANAM - 4

Incoming freshman with contact/collision sports/at risk sports BESS SCAT3 CNT Formerly ImPACT Currently Concussion Vital Signs Results of CNT interpreted by neurologist.

BESS/SAC/Symptom Score Football CNT AXON Sports (Cogsport) Contact/collision sports Divers and Pole Vaulters Team physician interprets CNT

All student athletes BESS CNT Headminder CRI Team physicians interpretations

All student athletes CNT ImPACT Team physician interpretations SCAT3 BESS Video taped 10 ft heel toe walk Video taped Visual accommodations Smooth pursuits

All student athletes CNT ImPACT University physician interprets baseline tests BESS

All student athletes CNT ImPACT Team Physician Interprets

NCAA Sports Medicine Handbook 24 th edition pg Broglio S, Cantu R, Gerard G, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training (2): Resch J, McCrea M, Cullum M. Computerized neurocognitive testing in themanagement of sport- related concussion: an update. Neuropsychology Review :