Brain Insurance

By: Dylan Harten

Experiencing headache, dizziness, nausea and blurred vision? You may have a concussion. Researchers and clinicians across the globe are trying to find the best way to diagnose concussions and other forms of traumatic brain injuries (TBIs). There have been many advances in concussion testing starting with standardized testing, field-side batteries and neuro-cognitive testing [1,2]. The main focus in all of these is to try and assess the different functional aspects of the individual that will be affected by the damage to the brain [3,4]. It sounds pretty well thought out, but unfortunately there is a significant lack of accuracy with these methods. One reason is that by only testing an individual after they have a concussion, there is no way of telling what their previous mental status was before the injury. The other factor that makes the testing procedure inaccurate is who they use as the comparison. These measurements create a normalized value from a random sample, or effectively an average, in order to make a generalizable set of test scores in which to compare all individuals [5]. Just like in school when you receive your marks, there will be people above and below the average. In the case of your scores for a neuro-cognitive test, however, the result that you receive is highly individual as it relates to how your brain processes information. It is because of these gaps that the concept of baseline or advanced testing was started. By using your own test score prior to a TBI and comparing these results to a neuro-cognitive test after the injury, the accuracy of diagnosing a concussion is greatly increased [6,7].

This advancement holds a lot of promise. An increase in diagnostic accuracy will lead to a cascade of positive benefits. The beginning of this cascade starts with the notion that we can better identify when someone has a concussion, which by that logic will increase the accuracy of any further testing they may have. As a consequence, anything that relies on the results of these tests, such as the rehabilitation of the individual, will also be improved. This is because there will not only be better tracking of the individuals’ recovery, but a critical assessment of which treatment methods are ultimately the most effective. These will all lead to an improved understanding of how concussions affect individuals and the mechanisms underlying such injuries. In the long-term, this understanding will provide a better framework for rehabilitation and testing for TBIs that are considered sub-concussive in nature.

Individuals that are highly susceptible to concussions, as a result of their choice in occupation or recreational activities, should consider standardizing baseline testing as a requirement for participation. In fact, many organizations have begun taking these measures for at risk populations such as soldiers and athletes. The more we support improved testing methods, the more information we can gather to improve the health and safety of individuals that are likely to sustain concussions. Clinicians have started to offer free baseline testing in an effort to prevent life-long deficits associated with concussions. Free insurance on your brain sounds like a worthy investment.

[1] Iverson, G. L., & Schatz, P. (2015). Advanced topics in neuropsychological assessment following sports-related concussion. Brain Injury, 29(2), 263-275. DOI: 10.3109/02699052.2014.965214

[2] McElhiney, D., Kang, M., Starkey, C., & Ragan, B. (2014). Improving the memory sections of the standardized assessment of concussion using item analysis. Measurement in Physical Education and Exercise Science, 18(2), 123-134. DOI: 10.1080/1091367X.2013.866558

[3] Putukian, M., Echemendia, R., Dettwiler-Danspeckgruber, A., Duliba, T., Bruce, J., Furtado, J., & Murugravel, M. (2015). Prospective clinical assessment using sideline concussion assessment tool-2 testing in the evaluation of sport-related concussion in college athletes. Clinical Journal of Sport Medicine, 25(1), 36-42. DOI: 10.1097/JSM.0000000000000102

[4] Oldham, J. R., Munkasy, B. A., Evans, K. M., Wikstrom, E. A., & Buckley, T. A. (2016). Altered dynamic postural control during gait termination following concussion. Gait & Posture, 49, 437-442.

[5] Hänninen, T., Tuominen, M., Parkkari, J., Vartiainen, M., Öhman, J., Iverson, G. L., & Luoto, T. M. (2016). Sport concussion assessment tool – 3rd edition – normative reference values for professional ice hockey players. Journal of Science and Medicine in Sport, 19(8), 636-641.

[6] MacDonald, J., & Duerson, D. (2015). Reliability of a computerized neurocognitive test in baseline concussion testing in high school athletes. Clinical Journal of Sport Medicine, 25(4), 367-372. DOI: 10.1097/JSM.0000000000000139

[7] Kontos, A. P., Sufrinko, A., Elbin, R. J., Puskar, A., & Collins, M. W. (2016). Reliability and associated risk factors for performance on the vestibular/ocular motor screening (VOMS) tool in healthy collegiate athletes. The American Journal of Sports Medicine, 44(6), 1400-1406 DOI: 10.1177/0363546516632754

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