Complex concussion protocol necessity
A professional athlete who takes a hit to the head must do a lot more than insist they’re OK to get back in the game.
Players suspected of suffering a concussion should be sidelined for at least a week, experts say, during which time they must undergo testing to determine the extent of their injuries.
“Appropriate early management can limit how severe a concussion becomes,” said Charles Tator, a neurosurgeon at Toronto Western Hospital.
Toronto Raptors shooting guard Landry Fields has missed four games after a fall during a Dec. 19 game against the Detroit Pistons left him with eight stitches to the head. He passed an initial exam, but he has since failed concussion testing before each game. The NBA, along with the NHL, MLB and CFL, follow different concussion protocols — a series of tests that a player must clear before returning to play. It starts immediately after the injury.
“If he’s knocked on the head and he has a headache, he’s coming out of the game,” said Paul Comper, a neuropsychologist at the Toronto Rehabilitation Institute and consultant with NHL Players’ Association.
The Sport Concussion Assessment Tool 3, a standardized test for evaluating athletes, can help determine early signs of cognitive impairment as well, by asking questions like “Which half is it now?” and “Who scored last in this game?”
“Over the years, people have thought, ‘well, we want to see if that player is oriented,’ ” said Comper.
Questions differ from team to team and sport to sport. One of the questions Fields reportedly had to answer in his testing is to list all the months of a year in reverse chronological order.
If a player does indeed have a concussion, diagnosed by a medical exam, there are more cognitive and physical tests to come.
“There’s a six-step return-to-play protocol,” set out by the International Conference on Concussion in Sport, according to Tator. Complete rest Light exercise, like walking More vigorous activity, like skating or running Non-contact training Full contact training Game play “There should be at least 24 hours between each step,” said Tator, and “you can only go from one step to another if you accomplish the first step without any symptoms.”
Tator said another medical exam should be completed between steps four and five. To assess cognitive function, Comper said teams have baseline tests that they compare against after an injury occurs.
The NHL, for example, uses ImPACT, a 20-minute computer test that examines things like reaction time and thinking speed. Verbal tests can also be helpful for things like measuring memory, said Comper.
Comper cautioned that tests are just one part of assessing whether a player is fit to play; another major factor is the athlete’s self-reported symptoms.
“There is no real magic bullet to get all the information that you need,” he said.