Although the emergence of computerised neuropsychological testing has revolutionized our approach to the assessment of the concussed athlete, clinical evaluation remains essential if we are to truly individualise concussion management and return-to-play decisions.
The sports physicians associated with Sports Concussion South Africa countrywide have experience in treating athletes from school to international level. In addition, each Sports Concussion Centre has an established network of consultant neurologists, neurosurgeons, radiologists and neuropsychologists. This multi-disciplinary approach, co-ordinated by the sports physician, will allow for the most appropriate decision to be made for that individual.
The clinical assessment begins fieldside and is followed up with several serial medical consultations that may or may not include a computer test.
Important criteria used in the assessment of the concussed player include:
• A thorough history from the player and witnesses (family, team mates, coaches & referees) trying to elicit mechanism of injury, signs of concussion & immediate management:
- Previous concussion history.
o Number of episodes
o Management of each
- Co-existing medical conditions e.g. attention deficit disorder, depression.
- 22 symptom analysis and scoring.
o at time of injury
o at time of consultation
• Cognitive assessment – immediate & delayed recall.
• Balance assessment – static & dynamic.
• General medical examination.
• Assessment of any co-existing neck injury.
• Visual field assessment.
• Neurological examination – sensory, motor, co-ordination.
Decisions are then made regarding the need for:
• Brain imaging (CT/MRI scans).
• Neurosurgical opinion.
• Hospital admission or home discharge.
• In depth clinical neuropsychological assessment.
• Follow-up consultations.
Ongoing education of the injured player is essential and, particularly in the acute stages following injury, it is preferable to have a family member present to explain the nature of the condition, the assessment protocols and the return-to-play process.
The final consultation will clear the player based on the combined clinical findings and computer analysis. The player is then presented with a return-to-play programme.
No player should be cleared for play without seeing a medical doctor & following the recommended step-wise management protocol.
Related Topics : Our Experience | Our Protocols