Beyond the Clinical Evaluation of a Concussion: The SAC Mark Davis, ATC, LAT Frye Regional Medical Center

Pieces to the Puzzle  History  Symptoms  Clinical Exam  SAC/BESS  Knowing your kids/Academic performance  Functional Evaluation

Pieces to the Puzzle  History: –Severity? –How many have they had? –How close together were they? –Were they “knocked out” or were they alert and responsive? –Each athlete is different

Pieces to the Puzzle  Symptoms: –Graded symptom checklist monitors variety, severity, duration: no one returns to play while symptomatic, symptom free for 1 week. –Graded symptom checklist is another objective measurement tool

Pieces to the Puzzle  Clinical Exam: –Pupil reaction –Coordination- are they stumbling? –Cranial Nerves –Blood Pressure/Pulse

SAC  SAC- Standardized Assessment of Concussion –Developed by Michael McCrea and colleagues at Northwestern University Medical School –Uses objective/measurable criteria to assess mental status –Very simple to administer, minimal material/cost –Follow up tests done at time of injury, post game, 1 day, 3 days, 5 days, 7 days later, and so on until scores return to normal

SAC  SAC –Uses 6 tests to determine neurologic function, but the key is to have a baseline/normal score of that mental function as a comparison Orientation- time, date, etc Immediate memory- recall word list Exertional maneuvers- trying to recreate symptoms Neurologic screening- LOC, Amnesia, Sensation Concentration- repeat strings of numbers in reverse, months of year in reverse Delayed Recall- recall word list

BESS  BESS- Balance Error Scoring System –Tests postural stability- can athlete maintain appropriate posture? –Developed by Kevin Guskiewicz at UNC –Another piece to the puzzle

BESS  BESS –Just like the SAC, key is the baseline/normal score to have for comparison –Uses 6 20-second trials: 3 stances on 2 different surfaces –Count errors made during each trial

Pieces to the Puzzle  Functional Evaluation –Progression of activities to elicit symptoms 1.Start easy- jogging 2.Progress to non-contact practice 3.Then full contact practice 4.If no symptoms appear, then athlete can progress to next phase 5.If symptoms appear, stop activity

Why Use SAC/BESS  Gives us another piece to the puzzle to help us understand what is going on  Objective/measurable evidence of injury/mental deficits  To prevent 2 nd Impact Syndrome, decrease the amount of long term neurologic deficit  A teenager’s brain is still developing- very susceptible to injury

Things to remember  The scores are only a piece to the puzzle –Communication with team physician, or child’s physician on “big picture” of scores, symptoms, clinical exam, school performance, etc. Do pieces fit together? –Results from one test should not override results from another, all tests/scores/symptoms need to return to baseline status, and have a physician clearance before return-to-play –ALL THE PUZZLE PIECES MUST FIT!