Monday, December 22, 2014

Vick's concussion: The sideline assessment

As soon as Eagles quarterback Michael Vick staggered to the sidelines after two tough hits in Sunday's game, the medical team went to work assessing the situation.

Vick's concussion: The sideline assessment

Eagles´ Michael Vick gets taken down during the first half against the Cowboys. (Yong Kim/Staff Photographer)
Eagles' Michael Vick gets taken down during the first half against the Cowboys. (Yong Kim/Staff Photographer)

by Robert Senior

By now, you’ve probably seen the hit that forced Eagles quarterback Michael Vick from Sunday’s game with a concussion—his second in as many seasons.

This afternoon, typically reticent coach Andy Reid revealed that Vick’s was a “pretty significant” concussion, so in hindsight the decision to hold him out of the contest was likely an easy one. But the quarterback was evaluated on the sideline before the leaving for the locker room. What can doctors determine during that brief period?

We asked Robert Franks, D.O., who specializes in concussion management at the Rothman Institute and contributes regularly to this blog. Dr. Franks says the first assessment happens literally on the field. ‘You have to determine whether they’re stable enough to come off the field,” he says. “Is there an associated neck injury, or do you suspect something catastrophic that needs to be transported immediately?”

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Once the doctor clears that hurdle, sideline assessment can begin. A cranial nerve exam, muscle strength and reflexes are all tested before beginning the SCAT2 (Standardized Concussion Assessment Tool) test.

“That’s what most athletes are put through,” Dr. Franks says. “The NFL has its own sideline examination that uses the SCAT2 as a template, but it’s a little more in depth.”

The SCAT2 looks at some basic parameters typically assessed in an office. For example:

  • Balance. A BESS (Balance Error Scoring System) test walks the athlete through a few different stances—standing on one leg, one foot in front of the other, then both feet together. It’s about a 20-second test conducted on a 30-point scale, with points deducted for each deficit in balance.
  • Symptom Checklist. “What symptoms do they have, and how bad are they?” asks Dr. Franks. Based on a series of simple questions—do you have a headache? Do you feel foggy or drowsy?—as well as assessing irritability and emotion, the doctor can assess the level of involvement.
  • Maddocks Score. This part of the test focuses on questions that should be answered rather easily. Where are we today? Who did you play last week? Who scored the last touchdown?
  • Standardized Assessment of Concussion (SAC) Test. This consists of general orientation questions—what time is it, what month is it?—followed by evaluating immediate memory. “I’ll give them a list of words, like ‘elbow, apple, carpet, saddle, bubble’ and they’ll have to repeat the words back to me,” says Dr. Franks. “Then I give the player a string of digits, and have him repeat them to me backwards. So if I give them ‘4-9-3’ they need to give me ‘3-9-4’.”  

The coordination examination—the widely-known ‘follow my finger’ test—is followed by a return to the SAC test. “I have them give me those five words again—elbow, apple, carpet, saddle, bubble,” he says.

Through that assessment—which Dr. Franks says can be performed in 10-15 minutes—you can gain a feeling of the functionality of the athlete. “We’ll give them a cumulative score, based on everything they just did on the sideline,” he says. “You’re scoring them on a basis of 0-100.”

While experts are hard at work to establish one, right now there’s no magic number for what constitutes a ‘good’ or ‘bad’ score. “The closer to 100 you score, the better off you are,” says Dr. Franks. “Ideally, you want to see them get 30 out of 30 on the balance scale, 5 out of 5 for delayed recall on the SAC questions and so on.”

Later this week: How will the Eagle's team doctors know when it is OK for Vick to return. 

About this blog
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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