Balance Assessment: key in detection and rehabilitation

So last night in the 1st quarter of the junior varsity game our team was fielding a punt, the returner bobbled the ball and started to lean forward to recover it.  He was then drilled in the chest/head by two oncoming defenders.  He laid there for a second, and about a second later I was standing over him.

He attempted to sit up but could not muster the energy, nor wherewithal to complete this easy task.  After the routine checking of neck and gross neurological issues it was time to stand him up.  With the aid of me and another coach he was brought to his feet and it was time for his first and most important concussion test, balance assessment.

One nanosecond after the coach and I released stabilization he grabbed me like I was the rock in his world.  FAIL.  As we turned to the sideline he started walking not in the direction we were pointed. FAIL.  I didn’t need sophisticated tests to tell that this player was “possibly” suffering from a concussion.

Gross and fine balance are easily disrupted with any head trauma.  Not only are your bearings in your head messed up, the inner ear is affected, along with vision.  That is why, in my professional opinion, the balance assessment of an athlete is the most important factor in determining if the player is concussed.  You see, it is physiologically impossible to fake/sandbag your balance (at least in my experience); where as you can answer any question untruthfully.  Don’t get me wrong, the who, what, when, where and why we ask during assessments is important for the whole picture but the balance of the player can tell you pretty much all you need to know in regards to playing.

Simple sideline tests like Rhomberg’s or BESS can accomplish this determination quickly and should be number one in your arsenal for quick screening.  Those tests are also key to weeding out the players that have enough brain power to evade the neuro and cognitive exam.  When it is near the time for the player to return these tests will once again prove to be the benchmark for proper and safe return to play.

Recently I have seen multiple articles about the Neurocom machine being used (pictured above); obviously this is not practical for the sideline.  What it is good for is the rehab setting and determining how the individual is recovering or if they have recovered.  Not everyone can afford this piece of machinery, there are other options as well.  Wii and its game Wii Fit can provide similar feedback to the clinician and provide training for the concussed.

There was no need to run this player through the SCAT2 or other tests on the sideline, it was much more effective to talk to mom, hand out the proper paperwork on concussions, give immediate instruction, as well as 72 hour instruction (get to a doctor and stay out of school).  Once that was done it was time to get the player to the locker room and home with mom and dad to begin the recovery from this injury.

It should also be noted that the other reason for not doing the standard cognitive testing on the sideline is that I have known this kid for three years and his “personality” was dramatically changed.  Being the school athletic trainer I knew the subtle changes in his “workings” that instinctively told me he was not right.

I guess the point of this post was to let everyone know that as good as the neuro and cognitive tests are on the sideline, as well as the training the coaches get, the obvious signs should NEVER be overlooked.  Those should trump anything else you hear from them in regards to concussions.

Be safe out there.

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