Korebalance Concussion Management Program

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Gregory Walsh
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2 Korebalance Concussion Management Program The comprehensive program that combines baseline assessment, proven strengthening regimen, and post injury assessment including both cerebrum (cognitive) and cerebellum (automatic) function. Document- Individual s pre-season balance and cognition Protect- Strengthen neck musculature with Nautilus Neck Protocol Assess- Post concussive event Rehabilitate- Using strength and balance training Return- Use objective test information to determine return to action 2

3 Korebalance Concussion Management Baseline and Retest Procedure SUGGESTED PLAN FOR CONCUSSION MANAGEMENT 1. Korebalance Balance Assessment: Pre-injury/pre-season computerized balance assessment to establish a balance baseline for static and moving balance for each athlete in sports that have a high risk of concussion, including but not limited to the following: a.) Baseball e.) Cheerleading i.) Soccer b.) Diving f.) Football j.) Softball c.) Gymnastics g.) Basketball k.) Pole Vaulting d.) Field Hockey h.) Wrestling l.) Lacrosse 2. Pre-Participation Assessment: Pre-season test utilizing the attached Cognitive Test (see pg. 13) to establish a baseline for each athlete participating in a high risk sport. 3. Previous Diagnosis of Concussion: If the athlete has previously been diagnosed with a concussion, he must have written confirmation of clearance to play from a physician. 4. Strengthening Program: Utilizing the proven neck and upper back strengthening routine developed by Dr. Wayne Westcott. 5. Post-Incident Assessment: Performance of the same balance and cognitive tests as pre-season, with results being shared with the clinical team. Subsequent re-tests to assist in determining return to activity. PRE CONCUSSIVE TESTS

1.) COGNITIVE: Conduct a Cognitive Test (see page 13) to establish a baseline and document score. 2.) BALANCE: Select the following settings from the software screens: a.

c.) Position of the Feet: Position the athlete s feet shoulder width apart.

4 1.) COGNITIVE: Conduct a Cognitive Test (see page 13) to establish a baseline and document score. 2.) BALANCE: Select the following settings from the software screens: a.) Bladder Pressure: Inflate the SportKAT bladder to four (4) PSI (Pounds per Square Inch). Check the PSI level on the gauge after each athlete to ensure a constant pressure for all the athletes. b.) Number of Feet: Select both feet. c.) Position of the Feet: Position the athlete s feet shoulder width apart. Use the foot positioning lines on the disc to document where the athlete achieves their optimum center of gravity by using the middle target in the pre-test screen. 3.) Conduct three 30 second SAMPLE tests. Two static tests, one with eyes open and one with eyes closed and one dynamic moving test. These SAMPLE tests are for the purpose of allowing the athlete to become familiar with the equipment and to reduce the influence of the learning curve on the scores. 4.) Encourage the athletes to do their best. 4

5.) Conduct the BASELINE tests immediately following the SAMPLE tests. There should be three tests each of the STATIC eyes open, STATIC eyes closed and DYNAMIC CLOCKWISE CIRCLE. 6.

) Select shape of clockwise moving circle(cwmc) c.) Select both feet d.) Select PSI level of four (4) e.) Select speed level medium 7.

5 5.) Conduct the BASELINE tests immediately following the SAMPLE tests. There should be three tests each of the STATIC eyes open, STATIC eyes closed and DYNAMIC CLOCKWISE CIRCLE. 6.) For the DYNAMIC CLOCKWISE CIRCLE, select the following settings from the software screens a.) Shape size should be at the default setting (Medium) b.) Select shape of clockwise moving circle(cwmc) c.) Select both feet d.) Select PSI level of four (4) e.) Select speed level medium 7.) SAVE all of the BASELINE test results under the athlete s name in the computer by clicking SAVE at the end of each Test. The COMMENTS section of the form used to establish the file for each athlete can be used to designate the sport, and likely position of the athlete. 5

Nautilus Neck Strengthening Protocol One

intensity set - Three second concentric,

burn, not orthopedic pain during the final

6 Nautilus Neck Strengthening Protocol One set each, two - three times weekly High intensity set - Three second concentric, five second eccentric movement Between 8-12 repetitions. Exercisers should experience a lactate burn, not orthopedic pain during the final few repetitions of each set. Nautilus 4-Way Neck Exercise Neck Extension Neck Flexion 6

7 Nautilus Shoulder Shrug 7

8 Nautilus Upright Row 8

9 Nautilus Mid Row Nautilus Wide Overhead Press 9

10 CONCUSSION ASSESSMENT: 10

11 1. Evaluation of the athlete should be done by a physician, physician assistant or athletic trainer. If none are available the athlete should be removed from competition and referred to a physician for evaluation no later than 24 hrs from injury. 2. The athlete should be reassessed with the Korebalance computerized balance assessment equipment for comparison with his/her pre-season, pre-injury balance baseline assessment, along with the Cognitive Test, within 24 hours of injury. Copies of these assessments should be given to the doctor and/or the medical staff to assist them in the evaluation of the athlete. 3. It is suggested to retest the athlete at regular intervals to assist the doctor in issuing a Return to Play Notice when appropriate. MANAGEMENT OF ATHLETE WITH A CONCUSSION: 1. The athlete should be immediately held from all physical activity. The medical staff should reassess the athlete with the Koreblance and the Cognitive Test until he/she is asymptomatic. A final reassessment with the Koreblance and the Cognitive Test should be done to establish that a return to pre-injury baseline levels has been achieved. Copies of the assessments should be sent to the physician and/or medical staff. Before the athlete may return to play, he/she must obtain a written report from the physician that he/she is cleared to return to play. 2. If the athlete is diagnosed with a concussion, the parent or guardian of the athlete should be notified by letter to make them aware of the injury and the related symptoms that the athlete may experience including adverse effects on his/her academic performance. (Suggested Letter to Parent or Guardian of Athlete) NOTICE OF CONCUSSION 11

12 The (Name of School or Youth Activity) would like to inform you that (Name of Athlete) sustained a concussion on (Date) during (Activity). (Name of Athlete) was evaluated by (Name of Dr.), MD, team physician. (Name of Athlete) will undergo additional concussion testing today. A concussion or mild traumatic brain injury can cause a variety of physical, cognitive and emotional symptoms. Concussions range in significance from minor to major, but they all share one common factor. They temporarily interfere with the way the brain works. With proper treatment, these symptoms will in most cases disappear over time. However, during the next several weeks (Name of Athlete) may experience one or more of these signs and symptoms and they should not be ignored. Please advise your physician if you become aware or any of the following: Dizziness Headache Difficulty Sleeping Blurred Vision Sensitivity to Light or Noise Memory Problems Nausea Loss of balance Double Vision Difficulty Concentrating Feeling Groggy We are concerned about the well being of (Name of Athlete) make you aware of this injury and the related symptoms that may occur. and we just wanted to Although (Name of Athlete) is attending class, please be aware that the side effects of the concussion may affect academic performance. Any consideration you can provide your child academically during this period would be appreciated. We will continue to monitor the progress of (Name of Athlete) and anticipate a full recovery. Should you have any questions or require further information, please do not hesitate to contact us. (Name of ATC. PT or Physician) Phone 12

13 Cognitive Test Name: Team: Examiner: Date of Exam: Time: Pre-Season Post Injury Cognitive Test Scoring Summary: Orientation /5 Immediate Memory /15 Concentration /5 Delayed Recall /5 Total Score /30 1. Orientation: Introduction: I am going to ask you some questions. Please listen carefully and give your best effort. What month is it? 0 1 What s the date today? 0 1 What s the day of the week? 0 1 What year is it? 0 1 What time is it right now? (within1 hr) 0 1 Award 1 point for each correct answer Immediate Memory: I am going to test your memory. I will read you a list of words and when I am done, repeat back as many words as you can remember, in any order. List Trial 1 Trial 2 Trial 3 Elbow Apple Carpet Saddle Bubble Total Trials 2&3: I am going to repeat that list again. Repeat back as many words as you can remember in any order, even if I said the word before. Complete all 3 trials regardless of score on trial 1&2. Score 1pt. for each correct response. Total score equals sum across all 3 trails. Do not inform the subject that delayed recall will be tested. Orientation Total Score /5 Immediate Memory Total Score /15 3. Concentration Digits Backward: I am going to read you a string of numbers and when I am done, you repeat them back to me backwards, in reverse order of how I read them to you. For example, if I say 7-1-9, you would say If correct, go to next string length, if incorrect, read trial 2. Score 1 pt. for each string length. Stop after incorrect on both trials / / / / Months in Reverse Order: Now tell me the months of the year in reverse order. Start with the last month and go backward. So you ll start with December, November Go ahead. 4. Delayed Recall: Do you remember that list of words I read a few times earlier? Tell me as many words from the list as you can remember in any order. Circle each word correctly recalled. Total score equals number of words recalled. Elbow Apple Carpet Saddle Bubble 1 pt. for entire sequence correct. Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-Apr-Mar-Feb-Jan 0 1 Concentration Total Score /5 Delayed Recall Total Score /5

14 POST EVENT TEST RECORD PAGE DATE BALANCE SCORES Eyes Open / Eyes Closed / Moving / Total COGNITIVE TEST SCORE PRE-SEASON TEST /30 Post Injury Test #1 /30 Post Injury Test #2 /30 Post Injury Test #3 /30 Post Injury Test #4 /30 Post Injury Test #5 /30 Post Injury Test #6 /30 Post Injury Test #7 /30 Post Injury Test #8 /30 Post Injury Test #9 /30 Post Injury Test #10 /30 14

15 Notes: 15

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COS SPORTS MEDICINE CONCUSSION ASSESSMENT FORM BASELINE TEST Adapted from SCAT3

COS SPORTS MEDICINE CONCUSSION ASSESSMENT FORM BASELINE TEST Adapted from SCAT3 Name Sport Examiner Name: Date of BASELINE TEST: Age Gender M / F COGNITIVE ASSESSMENT Orientation (1 pt each) What month