Beyond the Clinical Evaluation of a Concussion: The SAC

1. Beyond the Clinical Evaluation of a Concussion: The SAC Mark Davis, ATC, LAT Frye Regional Medical Center

2. Pieces to the Puzzle • History • Symptoms • Clinical Exam • SAC/BESS • Knowing your kids/Academic performance • Functional Evaluation

3. Pieces to the Puzzle • History: • Severity? • How many have they had? • How close together were they? • Were they “knocked out” or were they alert and responsive? • Each athlete is different

4. Pieces to the Puzzle • Symptoms: • Graded symptom checklist monitors variety, severity, duration: no one returns to play while symptomatic, symptom free for 1 week. • Graded symptom checklist is another objective measurement tool

5. Pieces to the Puzzle • Clinical Exam: • Pupil reaction • Coordination- are they stumbling? • Cranial Nerves • Blood Pressure/Pulse

6. SAC • SAC- Standardized Assessment of Concussion • Developed by Michael McCrea and colleagues at Northwestern University Medical School • Uses objective/measurable criteria to assess mental status • Very simple to administer, minimal material/cost • Follow up tests done at time of injury, post game, 1 day, 3 days, 5 days, 7 days later, and so on until scores return to normal

7. SAC • SAC • Uses 6 tests to determine neurologic function, but the key is to have a baseline/normal score of that mental function as a comparison • Orientation- time, date, etc • Immediate memory- recall word list • Exertional maneuvers- trying to recreate symptoms • Neurologic screening- LOC, Amnesia , Sensation • Concentration- repeat strings of numbers in reverse, months of year in reverse • Delayed Recall- recall word list

8. BESS • BESS- Balance Error Scoring System • Tests postural stability- can athlete maintain appropriate posture? • Developed by Kevin Guskiewicz at UNC • Another piece to the puzzle

9. BESS • BESS • Just like the SAC, key is the baseline/normal score to have for comparison • Uses 6 20-second trials: 3 stances on 2 different surfaces • Count errors made during each trial

10. Pieces to the Puzzle • Functional Evaluation • Progression of activities to elicit symptoms • Start easy- jogging • Progress to non-contact practice • Then full contact practice • If no symptoms appear, then athlete can progress to next phase • If symptoms appear, stop activity

11. Why Use SAC/BESS • Gives us another piece to the puzzle to help us understand what is going on • Objective/measurable evidence of injury/mental deficits • To prevent 2nd Impact Syndrome, decrease the amount of long term neurologic deficit • A teenager’s brain is still developing- very susceptible to injury

12. Things to remember • The scores are only a piece to the puzzle • Communication with team physician, or child’s physician on “big picture” of scores, symptoms, clinical exam, school performance, etc. Do pieces fit together? • Results from one test should not override results from another, all tests/scores/symptoms need to return to baseline status, and have a physician clearance before return-to-play • ALL THE PUZZLE PIECES MUST FIT!