We began our work with TBI clients in 2010.
At first, these were all victims of single-event catastrophes: car crashes, falls, or being struck by a hard object. Some of these clients are now back to work, and most still do CrossFit. Dozens of others have been through our workouts since, with funding from social service agencies or auto insurance.
But concussions cause the same long-term effects. Usually, the depression, anxiety, memory loss and cognitive problems take awhile to become obvious, but they’re no less severe. Though the effect is the same as a tree falling on your head, no one gets too worked up about concussions in sport because the results aren’t immediately obvious.
Only years later are the effects of concussion traumatic. Severe brain damage caused by repeated smaller blows has been the cause of abuse, suicides, drug use, social withdrawal…all the things you’d expect from someone hit over the head with a bat. And kids in YOUR town are suffering concussions every day.
“Concussion-proof” helmets don’t work, and professional leagues are at a loss to calm parents’ fears of hurting their kids’ brains. The NFL’s “Heads Up Football” stresses helmet use at age six; John Madden believes kids should learn to play without helmets first. Doctors aren’t instructed on concussion diagnosis: consider the Canadian concussion diagnosis guidelines here. If a kid isn’t brought into the ER unconscious or with visible bleeding, there’s a good chance they won’t be diagnosed with a concussion. Even an athlete with a severe concussion might never lose consciousness, and returning to play too early will greatly compound the injury. This is scary.
In 2012, we launched ConcussionPro in our city. The goal was threefold:
1. Help coaches determine when a concussion has occurred;
2. Help doctors determine the severity of concussions, and give educated return-to-play orders;
3. Bring new athletes into our gym to talk about vestibular training and prehabilitation.
Though we were only using the SCAT3 test to take baseline measurements, prominent researchers told us this method was more relevant than any advanced diagnostic test, because it provided a cognitive comparison: how smart was the athlete yesterday? Is he back to “normal” yet?
Since then, the ConcussionPro program has rapidly evolved to provide a better service. At the request of overworked doctors (most of whom readily admit they aren’t comfortable providing return-to-play guidelines) and parents, our new service guides the athlete through the recovery stages. Here’s how it works:
1. Baseline testing, including both physical tests (like the O’Neill and Stroop tests) before the season.
2. If a concussion is suspected during a game, athletes are tested using the SCAT test (developed by the IOC and freely available to everyone here.) If they show any sign of concussion, they’re pulled from the game and told to book a follow-up assessment with us.
3. Stage 1 assessment. Athletes complete a simple rowing, balance and memory test. If they score within 10% of their baseline level, they book their Stage 2 assessment. If not, they wait 48 hours before trying again. They’re also given a tracking log (available here) to record daily symptoms.
4. Stage 2 assessment. Athletes complete a more challenging physical agility test, another balance test, and a tougher cognitive test. If they score within 10% of their baseline, they book their Stage 3 assessment. If not, they rest 48 hours before trying again.
5. Stage 3 assessment. A higher-level physical skills test, followed by more challenging cognitive tests. If they score within 10% of their baseline, they book their Stage 4 assessment. If not, they rest 48 hours before trying again.
6. Stage 4 assessment. This is challenging, but a ‘pass’ (score within 10% of baseline) will indicate the athlete is ready to return to non-contact practice. A ‘pass’ means the athlete can book an appointment with their doctor; we fax all results to the doctor’s office.
Our fee for the baseline test is currently $70; retesting is free (each level takes about 10 minutes with a coach.) ANY GYM can be taught to do these tests; there’s no requirement for a registered healthcare professional (AT, OT, or Physio.) A local college has already taken the template and begun teaching our baseline process as part of their OTA/PTA curriculum. Local doctors are referring parents; parents are referring coaches. As one parent recently posted on facebook:
The real benefit comes by removing subjectivity from the process. Parents see progress and don’t press anyone to speed up return-to-play time. Coaches aren’t required to balance athlete safety against athlete eagerness (or wins and losses.) And doctors don’t have to guess.
Gyms can create their own testing criteria; we’ll make ours available as an online learning module soon. In the meantime, gyms can host seminars for local coaches to teach the SCAT3 test. Invite a healthcare expert and link parents and coaches with your gym as the host. Read everything you can, and put information in the hands of your young athletes.