The Benefits of Incorporating Baseline Neurocognitive Screenings into Your Concussion Management Program

By: Jennifer Heiligman, PT, MPT

Concussion. Don’t be fooled by the seemingly innocuous name.  A concussion is a brain injury that occurs when the brain is violently shaken. These are serious injuries that can occur from a motor vehicle accident, a fall, a work accident, an assault, including domestic violence, and from participation in a contact sport.

A concussion can impact physical, cognitive and emotional well-being.  Physical symptoms include headaches and dizziness, balance and vestibular difficulties and vision deficits including blurred vision and double vision.  Cognitively the patient may experience difficulty concentrating, difficulty with short and long term memory, and confusion.  Irritability, aggression and depression may be some of the emotional results of suffering a concussion.

Post concussion management is a specialty offered by many outpatient rehabilitation practices. The symptoms of a concussion may resolve in a matter of days or weeks, but some may last for months.  Since this is an injury to the brain, treatment for post concussion syndrome is very important.  The training and knowledge of a physical therapist perfectly aligns with the needs of a post concussion patient to aid in their recovery and return to their activities including work, school and sports.

Diagnosing a concussion is not always an easy task.  High tech screens such as MRIs or CT scans do not often show brain abnormalities, even if the patient has suffered a concussion.  A physical therapist will generally rely on multiple tests to evaluate the physical deficits, cognitive deficits and emotional symptoms being experienced by the patient. These tests will then be repeated throughout the course of care to gauge the patient’s progress.

As the school year and sports are starting back up again, the volume of patients suffering from concussions will likely increase within your practice.  However, in relation to athletes, there is something that could make diagnosing a concussion a bit easier for a physical therapist.  This is the administration of pre-participation neurocognitive screenings.  This adds an additional objective, reliable tool to the physical therapist’s toolbox to help in diagnosing and treating patients with concussions.

Pre-injury baseline neurocognitive screenings usually include a computer administered test.  The test will measure the individuals processing speed, reaction time and verbal and visual memory.  The benefit of having athletes complete these screenings is that should a head injury occur, the test can be re-administered post injury and the results can then be compared to the individuals pre-injury results.  The differences in scores can help the physical therapist determine where the athlete may be experiencing deficits.  This allows the therapist to create a more personalized treatment plan to help that patient return to their “normal”.  It is recommended that baseline concussion testing be administered annually.  Often schools will provide these tests to their students.  If that is the case, the physical therapist should request access to the results of the pre-screening testing and request a post injury test be administered for their patient.  

However, many schools may not be able to afford the cost of purchasing the rights to the computerized testing software.  This is where an opportunity for community involvement and a potential revenue boost to your rehab practice may present itself.   If the schools in your area do not offer these types of screenings you may want to consider purchasing the rights to one of the computer software programs designed to complete concussion baseline testing.  You can then market this testing service to your local schools, township sports teams and club teams in your area.  In addition to providing the screenings, should an injury occur, you will most likely gain that athlete as a patient for their post concussion therapy.  You may also want to look into certifications that are available for your therapists to be recognized as an expert in concussion therapy to add to your practice’s expertise.

There are many people who will benefit from your practice establishing a baseline neurocognitive testing program. The organizations that participate are looking out for the best interests of their athletes, it can create an additional revenue source for your practice and most of all, the athletes benefit since these tests can help the physical therapist establish a more personalized treatment program.  This may allow the athlete to return to sports and their daily activities more quickly.  Pre-concussion screening can allow for the best chance of successful recovery from these brain injuries.