Mandatory baseline testing not recommended
Baseline testing is the practice of having an athlete complete certain concussion assessment tools before sport participation – usually before the start of a season – in order to get baseline or “pre-injury” measurements. In the event of a suspected concussion, assessment is done again, and these post-injury measurements are compared to the baseline measurements. The goal of this testing is to identify cognitive differences in the athlete before and after the injury. Baseline testing does not refer to one specific tool or test, but can refer to many forms of assessment, such as computerized, pencil-and-paper and sport-specific skill testing.
Baseline testing is not required or recommended for post-injury care of youth athletes with suspected or diagnosed concussion. Rather than using resources for baseline testing, we encourage sport organizations and schools to develop processes within their organizations to recognize and remove anyone with a possible concussion, ensure they get medically assessed and support them to return to school and sport safely.
What is a concussion?
A concussion is a funcitonal brain injury that can’t be seen on x-rays, CT or MRI scans. It can affect the way a person thinks and can cause a variety of symptoms.
What causes a concussion?
Any blow to the head, face or neck, or somewhere else on the body that causes a sudden jarring of the head may cause a concussion. Concussions can happen during sports like hockey or soccer or during motor vehicle collisions or accidents at work.
When should a concussion be suspected?
Concussion should be suspected in any adult who takes a blow to the head, face, neck, or body and shows ANY of the signs or symptoms of a concussion.
What are the symptoms of a concussion?
Symptoms of concussion describe how a person feels after they are injured. It is not necessary to be knocked out (black out) to have a concussion. Some symptoms may not appear until the next day. Common symptoms are:
- Headaches or head pressure
- Nausea and vomiting
- Blurred or fuzzy vision
- Sensitivity to light or sound
- Balance problems
- Feeling tired or having no energy
- Not thinking clearly
- Feeling slowed down
- Easily upset or angered
- Nervous or anxious
- Feeling more emotional
- Sleeping more or less
- Having a hard time falling asleep
- Difficulty working on a computer
- Difficulty reading
- Unable to learn new information
It’s important to note that concussion symptoms are non-specific and are frequently experienced by adults during normal everyday life and stressful situations and among those with other pre-existing medical conditions such as depression, anxiety, chronic pain and migraine. Concussion-like symptoms can also occur in adults with more serious injuries to the brain or spine or other neurological disorders.
You should assess for a concussion when the following signs are observed?
Signs of concussion describe how an adult looks or acts when they are injured. Common signs of a concussion are:
- Lying still on the ground or ice
- Slow to get up
- Confusion or can’t answer questions
- Blank stare
- Difficulty standing or walking
- Injury to the face or holding their head
What should I do if a concussion is suspected?
It is important that ALL adults with a suspected concussion undergo medical assessment by a medical doctor or nurse practitioner as soon as possible. It is also important that ALL adults with a suspected concussion receive written medical clearance from a medical doctor or nurse practitioner before returning to sport and work activities. In northern communities medical assessment and clearance can be completed by a nurse with access to a medical doctor or nurse practitioner.
How is a concussion diagnosed?
In order to diagnose a concussion your medical doctor or nurse practitioner must perform a comprehensive medical assessment. This will usually include a clinical history (gathering information about how your injury occurred, your past medical history and the symptoms you felt at the time of injury and are feeling now), a physical examination (performing tests of your nervous system, neck and inner ear functioning) and determining whether you need any additional tests (e.g CT scans, x-rays, blood work) to rule out more serious injuries or medical conditions.
If you require any additional tests, your healthcare provider should explain to you the risks and benefits of the tests they are ordering and what could happen if the test is or is not completed. Based on all this information, your medical doctor or nurse practitioner should provide you with a medical diagnosis as well as information on how to manage your symptoms, what activities you are safe to return to, and where you should go for specific treatment or medical follow-up.
When should I go back to seek medical attention?
You may seek medical attention if you have persistent symptoms or if your sport/activity requires medical clearance to return. Adults who have been diagnosed with a concussion should seek medical attention at the nearest emergency department immediately if symptoms get worse. These symptoms may include:
- Increased confusion
- Worsening headache
- Vomiting more than once
- Not waking up
- Trouble walking
- Slurred speech
- Strange behavior
What can I do to help recover from a concussion?
It is important that all adults with a diagnosed concussion take appropriate steps to promote recovery. Below is a list of suggestions to help return to a pre-concussion status.
- Engage in physical activity and exercise only at a level that does not increase symptoms
- Engage in mental activity and schoolwork at a level that does not increase symptoms
- Remember to take breaks if your symptoms increase
- Make sure to drink adequate amounts of water and eat regular and balanced meals
- Make sure to get adequate amounts of sleep
- Avoid using any drugs, alcohol as well activities with a risk of head injury
- Work with your employer to make a gradual return to work
- Limit the use of over-the-counter pain medications (i.e Tylenol) to less 15 days per month and only use as directed.
- Avoid activities with a risk of another head injury.
When can I return to school, work or sports?
It is important that all adults diagnosed with a concussion follow a step-wise return to school, work and sports-related activities. Return to school and sports should be guided by the Return-to-School and Return-to-Sport Strategies. It is important that student-athletes return to full-time school activities before progressing to stage 5 and 6 of the Return-to-Sport Strategy. In general, each step should take one day to complete. If symptoms recur, stop immediately and go back to the previous stage.
Return to School Strategy
|Stage||Aim||Activity||Goal of each step|
|1||Daily activities at home that do not give the student-athlete symptoms||Typical activities during the day as long as they do not increase symptoms (e.g. reading, texting, screen time) Start at 5-15 minutes at a time and gradually build up||Gradual return to typical activities|
|2||School activities||Homework, reading or other cognitive activities outside of the classroom||Increase tolerance to cognitive work|
|3||Return to school |
|Gradual introduction of schoolwork. May need to start with a partial school day or with increased breaks during the day||Increase academic activities|
|4||Return to school |
|Gradually progress||Return to full academic activities and catch up on missed school work|
Return to Sport Strategy
|Stage||Aim||Activity||Goal of each step|
|1||Symptom-limiting activity||Daily activities that do not provoke symptoms||Gradual re-introduction of work/school activities|
|2||Light aerobic activity||Walking or stationary cycling at slow to medium pace. No resistance training||Increase heart rate|
|3||Sport-specific exercise||Running or skating drills. No head impact activities||Add movement|
|4||Non-contact training drills||Harder training drills, e.g. passing drills. May start progressive resistance training||Exercise, coordination and increased thinking|
|5||Full contact practice||Following medical clearance and complete return to school||Restore confidence and assess functional skills by coaching staff|
|6||Return to sport||Normal game play|
When can I return to work?
It is important that all adults work with their primary care provider and employer to develop an individualized Return-to-Work plan that allows the patient to make a gradual return to work. It is important that a Return-to-Work plan assesses the patient’s risk, capacity and tolerance to return to certain work-related activities and tasks.
How long will it take to recover?
The majority of adults who sustain a concussion will make a complete recovery and return to full-time work within 2 weeks. However, some patients experience persistent symptoms that may require additional medical care to help return to a pre-concussion status.
What should I do if I develop persistent symptoms?
Adults who develop persistent symptoms (lasting more than 1-3 months) should see their medical doctor or nurse practitioner for medical re-assessment. Based on the results of this assessment, your primary care provider should consider referring you to other healthcare providers that are licensed and trained to address the individual conditions that are responsible for your symptoms. If you require any treatment, your healthcare provider should explain to you the risks and benefits of the treatment as well as provide you with a summary of the scientific evidence supporting the treatment. Healthcare providers should also outline whether you are required to pay any fees to receive treatment and what regulatory bodies govern the costs of this treatment. Please be aware that terms such as “concussion specialist” or “certified” concussion provider/expert are unregulated designations and are not endorsed by any national healthcare professional colleges or regulatory bodies. Seeing multiple therapists at once is not usually recommended.
Sometimes healthcare professionals may offer concussion patients tests or treatment that are not based on science, are not necessary and come at great financial cost to the patient. If a healthcare provider recommends tests or treatment that you don’t feel comfortable receiving or cost too much (>$200 for a single assessment or test), always feel free to talk to your medical doctor, nurse practitioner, physician assistant or nurse before agreeing to start the treatment.
Below is a list of regulated healthcare providers and the symptoms/conditions they are optimally qualified to evaluate and treat.
|Migraine, tension, cluster and post-traumatic headaches||Primary care physician, sports medicine physician, neurologist|
|Dizziness and postural imbalance||Physiotherapist with competency-based training in vestibular rehabilitation, ear nose and throat
|Neck pain and cervicogenic headaches||Physiotherapist with competency-based training in manipulative therapy, chiropractor, athletic
|Blurred or double vision, difficulty focusing, |
Headaches with prolonged visual stimulation
|Neuro-ophtalmologist, optometrist, physiotherapist
with competency-based training in vestibular rehabilitation
|Problems with memory, concentration and paying attention||Psychologist, neuropsychologist|
|Depression, anxiety, suicidal thoughts, or difficulty sleeping||Psychiatrist, Psychologist,
Primary care physician, neuropsychologist
|Difficulty returning to exercise||Athletic therapist, physiotherapist|
|Structural brain or spine injuries (e.g intracranial |
bleeding or spine fractures)
|Difficulty returning to school, work or |
activities of daily living
|Occupational therapist, primary care physician|
|Difficulty with speech or swallowing||Speech language pathologist, Ear nose and throat
Questions about treatment that you may want to ask your healthcare provider:
- Are my problems related to concussion, or something else?
- How will the results of the test(s) you are recommending alter my care?
- Are there treatments for my problem that will alter its natural course?
- Is there good evidence for the treatment, or is it considered innovative, or experimental?
- If my problem may get better on its own with time, why is the treatment necessary?
- What is the cost of the treatment?
- How do I know if the treatment is working?
- Is there controversy among concussion treatment programs for the treatment you are recommending?
- Who is optimally trained and licensed to carry out the treatment or test(s) you are recommending?
- Are you willing to work and communicate with other members of my health care team (physician, athletic therapist etc.)?
What could happen if I return to sports too early?
Adults who return to sports or activities with a risk of head injury without medical clearance may be at risk of having another injury that can lead to more severe symptoms or persistent symptoms. Adults who return to sports or activities with a risk of head injury too soon after their injury can also be at risk of second impact syndrome, a rare condition that results in serious brain swelling and can lead to death or life-long disability.
What are some of the long-term effects of multiple concussions or repetitive head injury?
The long-term consequences of multiple concussions and repetitive head injuries remain an active area of research. Presently, there is preliminary evidence that adults who suffer multiple concussions and repetitive head injuries may be at an increased risk of developing persistent post-concussion symptoms, mental health disorders such as depression, and neurodegenerative diseases (e.g. Alzheimer’s disease). Chronic traumatic encephalopathy (CTE) is a neurodegenerative condition that has been linked to repeated head trauma and currently can only be diagnosed by autopsy. For more information on CTE please see the following link:
How can I learn more about concussions?
To learn more about concussions please visit the following:
A PRINTED HAND-OUT OUTLINING POST-CONCUSSION INFORMATION IS AVAILABLE HERE.