Sports Concussion – New Testing Methods are Imperative




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The long-term, serious consequences of concussion have come to the attention of the general public with issues like Chronic Traumatic Encephalopathy (CTE), found in the brains of deceased NFL players; and with its dramatization in the Will Smith-starring movie Concussion.

Sports concussion is, of course, a condition prevalent not only in the NFL, but in other contact sports both professional and amateur – as well as daily life; for example, in motor vehicle accidents.

The term “punch drunk” was an early acknowledgment of the persistent and lasting effects of repeated concussion in the sport of boxing, with clinical recognition of the condition dating at least as far back as the 1920s. Addressing sports concussion – developing and employing tools and procedures designed to keep athletes safe – is essential in ensuring the long-term health and maximizing recovery of people suffering a brain injury.

Existing screening tools

ImPACT is one of the most widely used neurocognitive screening tools. The ImPACT test is computerized; and, according to the ImPACT website, measures “verbal and visual memory, processing speed, and reaction time.” According to ImPACT, clinicians can make return-to-play decisions based on the test scores.

Another test, the King-Devick system of reading test cards, originated in 1976 and has been used for decades in schools to help detect learning disabilities such as dyslexia. In 2011, the applicability of the King-Devick test as a rapid sideline screening test in helping to detect concussion emerged from a study of boxers and mixed martial artists.

The SCAT-3 and balance testing, such as the BESS (Balance Error Scoring System) are also widely used tools in concussion assessment and return-to-play decision-making.

The need for new testing methods

With these screening tools for concussion available, why are new testing methods so imperative? The answer is simple: because these tests are not adequate in helping to form a complete assessment of athletes’ brain and nervous system health.

Tests like ImPACT, King-Devick and BESS measure athletes’ responses; they don’t directly measure the brains of the athletes themselves. Because of this, they are prone to error and even cheating. Pro athletes who want to ensure they won’t be taken out of games can ‘sandbag’ concussion tests by intentionally performing poorly during baseline testing. NFL quarterback Peyton Manning has openly admitted to this.

Beyond scenarios of error and cheating, neither can these tests determine if an injury has completely healed, because they measure performance and symptoms, not the actual brain neuron health. These are not accurate, comprehensive, or objective indicators of whether the specific brain regions that were injured have healed post-concussion. The more that is understood about concussion – how symptoms manifest, how long they last, and the serious consequences of returning to competition too early on – the more apparent becomes the need for screening tools that provide objective brain measurements beyond the tests commonly used today.

The long-term impact of concussion

One peer-reviewed study after another concludes that concussions can last months, a year, or more. Research also shows that returning to activity too soon, before the injury is completely healed, and sustaining another brain injury can cause permanent damage, lifelong cognitive impairment, and – in many instances – death.

The only way to assess the effects of a concussion on an athlete’s brain – to see the extent of injury, or to know when the injury has been resolved – is to look at the brain itself. Evoke Neuroscience’s eVox® System is a medical device that combines proven, non-controversial modalities (EEG, ECG, and ERP) so that doctors can see brain activity clearly and objectively; helping them to assess whether a traumatic brain injury has occurred and track recovery by measuring electrophysiological biomarkers in both the central and autonomic nervous system (brain and heart respectively).

eVox is small and readily portable, so testing can be done in a doctor’s office or even ringside at a gym – as is the case with Dr. Sheryl Wulkan, a ringside physician for the New Jersey State Athletic Control Board, and her Mixed Martial Arts patients.

All better?

Symptom resolution does not necessary indicate injury resolution. As a result of many known neurophysiological phenomena (plasticity, unmasking of neural connections, and neural network redundancies – to name a few), it is possible for the symptoms an athlete suffers to resolve themselves, and a return to baseline behavior – both cognitive and physical – to occur while the brain injury still exists.  

By making it possible to visualize the actual brain injury and activity in the brain itself post-concussion using the eVox system – and also track when activity returns to normal – doctors can work with their athlete patients in determining when it is safer to reenter competition; i.e., when the actual brain injury is healed – not when there is simply a “false recovery” of returning to baseline behavior and cognitive scores.

Additionally, the use of functional neuroimaging in the form of EEG recordings and the digital analysis of the EEG provides information on the specific location of the brain injury. This injury localization allows for targeted active rehabilitation in the form of brain EEG-biofeedback for athletes who do not have spontaneous recovery of concussive injury. EEG-biofeedback has demonstrated clinical and research validity in remediating unresolved concussion symptoms, as well as normalizing brain-imaging findings by rehabilitating abnormal neuron function.

As objective concussion screening tools like eVox become more widely used, athletes and their doctors will be better prepared to assess and manage the negative effects of concussion at all levels and improve athlete safety.

Image via Aspen Photo / Shutterstock.

James Thompson, PhD

James Thompson, PhD, holds a doctorate degree in kinesiology and psychophysiology from Pennsylvania State University. He is the Chief Strategy Officer, Chief Technical Officer, and Founder of Evoke Neuroscience, which develops medical grade devices for cognitive measurement and management. Thompson has worked with many high-level athletic programs to improve neuro-safety and cognitive performance. These programs include Penn State ‘Nittany Lions football, hockey and rugby programs; the Bermuda National Junior Sailing Team; the Japanese Youth Curling Team; Canadian Junior Alpine skiers; and the Canadian Provincial Sailing teams. He has also published articles and book chapters in the areas of EEG, traumatic brain injury, sports-related concussions, and peak performance and biofeedback.
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