Recent advancements in concussion management have resulted in the widespread use of computer-based cognitive testing protocols, and evidence now shows that concussed athletes demonstrate subtle cognitive deficits that may persist beyond symptom resolution – emphasising the fact that return-to-participation once “symptom-free” is no longer an accurate measure of readiness.
At the Athlete’s Zone, we use a combination of computer-based cognitive testing protocols, computerised visual testing, balance testing using force plates and physical examination of the nervous system and vestibular system. Our testing includes the following:
ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most widely used, and most scientifically validated computerised concussion evaluation system. It is part of baseline testing and concussion management with every single major sport within North America. It is a standard within MLB and MLB umpires are not allowed to step onto a field without an ImPACT baseline.
Developed in the early 1990’s by Drs. Mark Lovell and Joseph Maroon, ImPACT is a 20- minute test that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages. ImPACT Applications, Inc. was co-founded by Mark Lovell, PhD, Joseph Maroon, MD, and Michael Collins, PhD.
The ImPACT test is done in a clinical supervised setting using a computer. The test includes a demographic and concussion history questionnaire which is factored into the final report. The questionnaire is followed by a symptom evaluation/scale. The primary body of the test measures 8 neuro-cognitive functions including; verbal memory, visual memory, reaction time and processing speed. The test has built in baseline validity checks to minimize false scores. There are currently over 125 peer reviewed studies on the ImPACT test since 2000.
NeuroTracker was developed by CogniSens Athletics, a neuroscience-based company that has developed cutting-edge technologies to assess and condition perceptual-cognitive ability for athletes. NeuroTracker isolates, trains and tests the high-level mental resources that are necessary for the perception of complex movement in a dynamic sports environment. It is these same cognitive resources that most commonly impact concussion rehabilitation and return to play. For this reason combined with the reality that NeuroTracker is a direct objective measurement of brain function and processing speed, NeuroTracker is an ideal baseline measurement in any concussion program.
NeuroTracker has substantial scientific research in its history and development. Initial research was based on managing dementia and the aging brain, and rehabilitation of severe brain trauma. Due to its impact on brain function it has also shown significant benefit for the treatment of attention deficit disorders and more recently it use in elite athletic performance. Due to its effectiveness in this regard, both the Canadian and US Military Special Forces Units use NeuroTracker with all of their personnel.
A NeuroTracker baseline testing involves 3 trials, each trial consisting of 20 repetitions of the skill of multiple object tracking lasting 8 seconds each. Each trial takes approximately 6 minutes to complete. Between each trial the athlete is given a 5-6 minute rest. The testing is done using proprietary software and 3D virtual technology. A baseline session lasts approximately 30-40 minutes.
Additional Testing:
Binocular Vision Screen
It is estimated that 25%of the population has an undiagnosed binocular vision problem that can either affect athletic performance, academics or both. Current concussion research has also demonstrated that those with binocular vision problems are also more vulnerable to complications from head shots and/or concussions. For this reason we include a functional binocular vision screen in our baseline and post concussion management testing. The screen is done through a combination of a written questionnaire and computerized testing of the eyes. If problems are found in our screen, clients will be referred out to an eye specialist who can better evaluate the root cause of the problem and render treatment to eliminate the dysfunction.
Oculomotor Evaluation
Oculomotormeans eye movement. An oculomotor evaluation tests and measures how and when an individual’s eyes move in response to images, light, moving objects and head motion.
Not only does this serve as an important aspect of baseline information but problems with this aspect of function pre-dispose individuals to problematic recovery from a concussion.
If problems are found during the evaluation, appropriate referral and/or treatment can be given.
Vestibular Evaluation
Vestibular testing helps to determine if there is something wrong with the vestibular (balance) portion of the inner ear. These tests especially in combination with Occulomotor testing provide important baseline information in pre-concussion testing. In addition problems with vestibular function can predispose individuals to more severe concussions. If problems are found, appropriate referral and/or treatment can be given.
Musculoskeletal Testing
Whiplash and cervical spine dysfunction can also mimic and/or complicate concussion.
A spinal and postural evaluation is done both as a protocol of baseline testing and post concussion examination. Integrated into the post concussion testing we include vestibular and vestibular-ocular testing.
