Head Injury Management

Typically, those who sustain a single concussion have a complete resolution of symptoms rapidly after injury.

Persistent symptoms at three months have been known to occur in 20% of those who do not recover from their initial injury. Approximately 2-4% will develop permanent symptoms. There is suggestion that repeated concussion prolongs recovery times after each incident.

Patients who suffer a concussion can display a wide variety of signs and symptoms after injury. It is difficult to encompass this with a single test. The current Gold Standard of test is called the SCAT 3. This has to be performed by a medical professional (either a doctor or physiotherapist). Our study involves looking at four non-invasive tests which cover all the symptoms set out in the 2012 Zurich Consensus meeting on concussion.

These tests are:
a) The King-Devick test
b) IMPACT memory recall test
c) Balance test
d) 9 hole peg test.

These cover oculomotor (eye movement), memory recall, Balance and coordination. None of these tests need to be performed by a medical professional. Therefore the aim is to compare the results of these tests with the current gold standard. If they show a similar sensitivity and specificity to concussion, then this would be able to be used in the semi-professional and amateur game as well to provide safety for concussed players in places where there are less medical resources. We have performed a pilot study which suggests that our results are promising.

The trial is mandated in the whole of professional cricket within the UK (both male and female) this year, and within both Rugby Union and Rugby League.

To individualise the rehabilitation of a player from concussion we take baseline scores of these tests in preseason, and when an individual suffers a concussion, the tests are repeated. The testing process takes around an hour per player, and we can perform this on around 8 players per hour. Therefore we can manage to cover a squad in one day easily. As well as validating the test results, it also would help shape the rehabilitation of the player as they gradually return to their baseline scores.

As well as the concussion aspect we take a holistic approach to the baseline tests. As such we do a medical, mental health screening, mental toughness test and concussion knowledge questionnaire.

We have two current PhD students. One student is dealing with cricket and concussion, the other dealing with Video Surveillance and Injury correlation. We have a paediatric project starting in the summer of 2017 and another PhD student starting at the same time to deal with Rugby Union. In 2018 we hope to start a rehabilitation trial.