Transcript BeyondClinicalEval

Beyond the Clinical
Evaluation of a Concussion:
The SAC
Mark Davis, ATC, LAT
Frye Regional Medical Center
Pieces to the Puzzle
 History
 Symptoms
 Clinical Exam
 SAC/BESS
 Knowing your kids/Academic performance
 Functional Evaluation
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
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
Pieces to the Puzzle
 Clinical Exam:
– Pupil reaction
– Coordination- are they stumbling?
– Cranial Nerves
– Blood Pressure/Pulse
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
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
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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
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
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
Pieces to the Puzzle
 Functional Evaluation
– Progression of activities to elicit symptoms
1.
2.
3.
4.
Start easy- jogging
Progress to non-contact practice
Then full contact practice
If no symptoms appear, then athlete can progress
to next phase
5. If symptoms appear, stop activity
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
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!