Reaction Time (Drop Stick replaced by App-Based Testing)

Last year, we implemented the DANA Neurocognitive Test into the Concussion Tracker smartphone application.  The DANA Neurocognitive Test was selected because it’s been shown to be the most sensitive test available for concussion detection.  The DANA test is a battery of 8 separate tests (4 tests for 12 and under) which all measure reaction time and cognitive efficiency for different functions, including:
Simple Reaction Time, Choice Reaction time, Accuracy, Impulsivity, Attention, Visuospatial Analytic Ability, Immediate Recall, and Working Memory.

In head-to-head studies, the DANA test has beaten out ImPACT, ANAM, and CogSport/Cogstate (commonly used concussion tests) in terms of its sensitivity and ability to detect changes due to concussion.  Learn more about the DANA Test here.

Because each of the 8 tests included in the DANA test include reaction time metrics, we have moved our traditional in-clinic “Drop Stick” reaction time test to be an “optional test” for those clinics who wish to continue including it.    Most have opted to discard it.

Grip Strength

Grip Strength used to be a portion of the baseline testing battery at Complete Concussions however we noticed that the research world has been drifting away from this test as a concussion biomarker.  Also, we have had years of difficulties in attempting to keep the hand-grip dynamometers calibrated.  As such, we have removed grip strength from our battery.

Balance – BESS (Balance Error Scoring System) & Force Plate replaced by App-Based)

The Balance Error Scoring System (BESS) Test is a simple sideline screening test which is done as part of the SCAT6.  This test has instructors monitor a subject while they stand in a series of 3 different stance positions with their eyes closed.  What the instructor is looking for is whether the subject commits any “errors”, such as: taking their hands off their hips, putting their non-stance foot on the ground, opening their eyes etc.  The BESS test is a poor measure of balance and its only real utility is as a basic sideline screening tool.  The issue with the BESS test is that it tends to normalize within 48 hours after injury – so it cannot assist us in making safer return to sport decisions.  We included the BESS in our battery so that the results could be used on the sidelines and then we added in Force-Plate testing for return to play decision making.

Although BESS testing normalizes within 48 hours after injury, Force Plate metrics tend to show deficits that can persist for a number of weeks after injury.

App-based postural sway testing has given us the best of both worlds!  It allows us to have a test which can be administered immediately on the sidelines (where force plate can’t) and the results are almost identical to those of a Force Plate balance test.  This change not only saves clinics from having to purchase expensive Force Plate units, but it allows for way more accurate sideline balance assessment and gives us the sensitivity of a Force Plate for safer return to sport decision making.

Timed Tandem Gait (optional)

This test requires the subject to walk in a heel-to-toe fashion along a 3-meter-long line and back as fast as they can without stepping off the line.  This test measures simple balance in a dynamic environment.  This test was added to the updated SCAT6 document, and we have incorporated it as well.  One difference however is that we have chosen to make this an “optional” test because the next test is the exact same test, except it involves a cognitive element to it.

Dual-Task Tandem Gait

Dual-Task is the concept of doing 2 things at once.  This has been studied for years in the concussion space and the results show that adding in a cognitive task while someone is trying to do a physical task increases the difficulty, and thus, the sensitivity of the test to detect concussion injuries.

This test requires the subject to walk heel-to-toe along a 3 meter long line as fast as they can without stepping off the line.  At the same time (i.e., while they are walking) they are also required to complete a cognitive task which, in this case, is counting backwards by either 7’s (or 3’s for younger subjects) by a randomly selected number greater than 85.

The test is scored in a few ways.  We look at the number of correct responses vs. the number of responses attempted on the cognitive task and we also analyze the time it took to walk the line.

Because this test includes the dynamic balance elements from the Timed Tandem Gait test, we have decided to make the Timed Tandem Gait test optional and the Dual-Task Tandem Gait test mandatory; due to its increased sensitivity and utility for detecting abnormalities in concussed patients.