Concussion Baseline Testing


Overview of the CCMI baseline test protocol

CCMI offers a service to physicians by conducting the most comprehensive, preseason testing available, as well as return-to-play management, multistage physical exertion tests, and re-testing of injured individuals. All of this information can be provided to the overseeing physician in a detailed report; providing you with more information to make your decisions.

CCMI baseline testing takes roughly 30 minutes per individual and is covered under secondary health insurance benefits for either physiotherapy or chiropractic (depending on who administers the test). Full team testing can be completed within 1 to 2 hours and can be done either in the certified clinic location or off site at a team training/practice facility. All patient data is stored on an electronic health records system that is accessible by all 130+ clinic locations across Canada.

The CCMI baseline test protocol consists of the following test areas:
Concussion history, medical history, learning disabilities, psychiatric history
Symptom score
Orientation
Auditory Memory
Concentration
Visual tracking and processing speed
Balance (sideline measure)
Balance – using force-plates to measure postural sway
Reaction Time
Strength
Delayed Recall
ImPACT neurocognitive testing
Visual word & shape memory
Go/No-go tests
Reaction Time (with cognitive processing component)
Effort tests

**Note: Re-testing prior to return to play also involves physical exertion testing immediately prior to conducting the baseline re-assessment. This method (testing in a physically exerted state), has been shown to be a more sensitive way of testing, revealing up to 28% more neurocognitive impairment than neurocognitive testing at rest (11,12).

Symptom Score

The Post-Concussion Symptom Score (PCSS) is the most widely used concussion symptom inventory worldwide. Adapted by the Concussion In Sport Group as part of the Sideline Concussion Assessment Tool (SCAT), the PCSS is a 22-item measure with each symptom scored on a 7-point likert scale (13). A study by McCrea et al., found that the PCSS demonstrated the most sensitive and specific measure for concussion at the time of injury (when compared to balance and a neurocognitive examination), however fewer than 5% of athletes reported higher symptom scores than baseline at 7 days post injury(14). These findings have also been replicated in other studies(5). This indicates that the symptom score, while potentially the most useful parameter for making the initial diagnosis of concussion, does not coincide with the recovery of the brain following concussion (22 to 30 days in previous metabolic studies). Therefore, more objective testing parameters are required to inform safer return-to-play decision-making.

Standard Assessment of Concussion (SAC)

Also a component of the SCAT, the SAC is a verbal/auditory neurocognitive test, which consists of Orientation, Immediate Memory, Concentration, and Delayed Memory Recall Tests. The SAC has been validated in several studies for use in the assessment of sport-related concussion(15-17). Because the SAC does not yet have established normative data, this test must be administered at baseline to establish individualized scores(18). Barr & McCrea found that immediate SAC scores decrease in concussion patients by an average of 4 points from baseline. Using multiple regression the authors found that a 1-point decrease from baseline SAC carried a 94% sensitivity and 76% specificity for the diagnosis of concussion (19). Marindes et al., found that the SAC alone was only able to accurately diagnose concussion 52% of the time, however adding in balance assessments and the King-Devick test improved the diagnostic accuracy to 100% (20). This demonstrates that the strength of concussion assessment rests in having numerous testing parameters versus relying on one single test. This test has also been found to demonstrate objective impairment in individuals reporting a complete resolution of symptoms (14).


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