The Incorporation of Objective Baseline Testing as a Necessary Component of the Safe-Return-to-Play Decision Making Process
I share in the commitment to provide the safest environment for children participating in sport, and to reduce, where possible, the risk of injury. In the case of concussion. There has been great advancement in awareness and the immediate removal of injured parties from their activity. However, I feel there is now an absolute necessity to address the safe-return-to-play process.
The question is: when is an injured athlete, whether they sustained a head-injury/concussion/ or orthopaedic injury, actually ready to safely return to their respective sport? In a perfect world, we would have a snapshot of their performance capabilities prior to their injury that we could reference, and as they recover, we could monitor their progress or regression. When their performance had improved to the level of their pre-injury performance, we could then begin to consider their return to play.
Baseline testing is the standard in many industries worldwide and the concept is fundamentally sound. Hence, all the initial excitement to try to incorporate it into the concussion model. However, the technology was not available at that time and innovators were trying to retrofit tests that were designed for other purposes and apply them to variables of a concussion with little effectiveness or reliability. Therefore in 2012, it was the correct decision not to put too much emphasis on the baseline testing as it was proposed, constructed and being applied.
Over the past seven years, with the aid of technological advancements, that has changed.
Trazer, a sport performance testing company for the last 20 years, addressed the problem as their researchers devised a well thought out, structured program using the latest technology currently available in 2019. Their research has provided us with meaningful measurements that give us insight into one’s performance. Following injury, they have identified specific data trends and patterns that can be used to evaluate one’s status and fitness to return.
Mainly, the reaction time to random stimuli; the ability to stop on a dime; and the lateral shuffle test that can provide us with some of an athlete’s relevant and objective measurement metrics. These metrics can further provide valuable insights for the decision makers as to the athlete’s ability to perform. The data is acquired in an environment that simulates the demands of their performance requirements in the real world.
No definitive decision should be made in a doctor’s office as to an athlete’s fitness to return to play without any objective performance data under duress to support it. Consider the heart-stress test that incorporates a treadmill to create physical exertion to uncover underlying irregularities/pathologies that would otherwise go unnoticed at rest. Similarly, in our application, taxing the brain or orthopaedic injury under demand/duress could uncover cognitive or orthopaedic insufficiencies that are only elicited under stress. These relevant marker’s, tendencies and insights could help gauge one’s fitness to return. For example, my car overheats when I drive it on the highway for 15 minutes at 60 miles per hour, but when I take it to my mechanic, he starts it up and it runs fine while at rest in his garage. That’s a dangerous paradigm to promote.
Furthermore, when we consider more recent definitions of concussion referring to an energy crisis at the cellular level of the mitochondria and an ATP insufficiency, it becomes essential to incorporate active testing into the evaluation process.
If we’re going to put the athlete in the safest position to return, we must provide the decision makers with more information to ensure a better and more accurate decision-making processes. As in any research project, self-reporting of a subject who gets a reward for choosing one answer over another is considered a biased test. Bias tests are not associated with a lot of validity in the research world. We cannot allow the injured athlete to dictate verbally or proclaim their readiness to return without substantiating their claim based on supportive objective performance data. This is especially significant when you consider that there can be a 25-30 percent performance response time deficit still present after the self reported symptoms have subsided.
The Trazer can act as a standardized test to aid in the decision-making process and has 6-stage rehabilitation protocols which were designed by the Cleveland Clinic. The athlete’s performance capabilities are recorded on each subsequent test, and the software automatically provides comparative data evaluations, which are provided via printout, cloud-based website or PDF, to the decision makers, and they can then clearly see via relevant data, the individuals performance improvements or degradations. They then have a target to aim for as they know what the athlete’s capabilities are when healthy.
This, minimally, can provide an additional information to aid in a better more accurate decision- making process and in conjunction with how the Doctor or other decision makers perform their own individual assessment on criteria they deem relevant.
The TRAZER is the first credible technological advancement that can be incorporated into the decision- making process of head-injury/concussion, and orthopaedic injuries, and safely screen for those who would otherwise prematurely be put in harms way.
If we truly want to be the leaders in protecting our athlete’s, we must equip our decision makers with relevant objective data where possible and get onboard with other divisions of health and safety which lean heavily on technology that contribute valuable data to help solve our problems. What disturbs me terribly is the regression of going back to protocols with subjective reporting that I employed some 28 years ago as a trainer in the G.T.H.L. and witnessed first- hand its ineffectiveness and unreliability.
The technology devised by TRAZER’s engineers (or some derivative of that technology) will become an integral component of how concussions are evaluated and shape the safe return to play process.
I would like to share a quote I read along the way that I feel relevant:
“If you are not measuring your guessing” and with the magnitude of the potential devastation that can accompany a concussion. Guessing is clearly not an option.
Please find enclosed some research articles. more are available on request. For more information on Trazer please contact me at 905- 882- 4476, 416 – 704 – 1437, or spanpt.com
Dr. Stuart Greenspan D.C.