In February 2018, the Canadian Olympic and Paralympic Sports Institute Network released their sports related concussion guidelines for Canadian national and national development high performance athletes.
In these guidelines they suggest that all of their athletes in high risk sports undergo:
- Concussion history evaluation
- SCAT5 testing
- Vestibular/ oculomotor assessment
- Web based neurocognitive assessment
They also recommend that a medical team member ( athletic therapist, physiotherapist, chiropractor or physician )Â trained and experienced in assessment and management of acute sports-related concussion be on site during practice training and competition.
These recommendations for Canadian national athletes are interesting departure from the 2017 Canadian Guidelines on Concussion in Sport released by Parachute Canada’s expert advisory concussion subcommittee. In these guidelines, one of their key recommendations was that baseline concussion testing of youth or adult recreational athletes using any tools or combination tools was not required to provide post-injury care of those who sustained a concussion or suspected concussion. Furthermore baseline testing was not recommended in youth athletes regardless of sport or level of play.
As a parent with children who play high risk sports, as a minor hockey league trainer, and as an experienced physiotherapist working with concussion injuries, these new Canadian national athlete concussion guidelines strike me as both confusing and maybe even a bit hypocritical.
One way to read these guidelines is that even though trained concussion medical personnel must be at all practice or competitions for National level athletes, baseline testing and concussion process are strongly suggested for high-performance Canadian athletes. These athletes would have immediate access to medical personnel should an injury occur, and effective management would be initiated immediately.
But what if you are recreational athlete (the majority of Canadian athletes) who takes part in the same high-risk sports? Are you at a greater risk of poor concussion management or long-term post concussion issues? In many recreational sports the presence of trained medical professionals are limited (or non-existent), access to experienced concussion healthcare providers may be slow, and athletes may be left on their own to manage return to learn and return to sport.
Does it not make more sense to have better concussion policies and processes in place for sports association and athletes who do not have immediate access to experienced concussion healthcare providers, or who do not have the same trained personnel onsite at their sporting events? Making preseason evaluation and baseline testing procedures mandatory for lower-level athletes would provide a higher degree of safety and efficient post-concussion management.
Exactly what this should look like and what baseline testing procedure is best is the topic for another day!
Efan Gonsalves PT 