by Tom Billups, C.S.C.S.

In this piece, we will present and discuss concussion management tests and how they are used to ensure player welfare. During a recent audit in England jointly conducted by the Rugby Football Union, Premiership Rugby, and the Rugby Players Association found that one of the most common injuries last season were concussions. For ease of discussion, we will narrow our focus to two core parts of a concussion management plan: establishing a pre-injury baseline score and calculating a post-head injury score. When a player suffers a head injury, the athlete can perform a concussion test to obtain a score, which can be compared to the pre-injury score. This testing and re-testing process helps determine the presence of a concussion and when a player is allowed to return to training and competition. It is important to understand that concussions, like rugby players, can vary greatly.

In dealing with concussions, teams should have or work towards establishing a concussion management plan. A comprehensive concussion management plan in includes pre-injury assessment, acute injury/sideline management, post-acute injury and return to play management. At the center of building a concussion management plan is selecting a concussion assessment test that can be administered to your athletes on a seasonal basis. Today, we will briefly discuss three different concussion tests and their testing protocols. There are many different and effective concussion tests available today; these three are simply a sample of what you have to choose from. It is ultimately up to each individual team to determine what concussion test to employ. Choose a concussion test based on the protocols involved and what is the best fit for your team.

ImPACT: Immediate Post-Concussion Assessment and Cognitive Testing

This is a 20-minute test widely used by sophisticated high school, college and professional collision/contact sport programs. A desirable element of the ImPACT test is that many high school football players who play rugby in the Spring will be familiar with the test and may already have established baseline data. This computerized test is highly objective, diminishing human bias. This testing program can be purchased online or rugby coaches can inquire with their school’s sports medicine staff to determine whether this test is accessible through their school.

MBESS: Modified Balance Error Scoring System

The National Football League recently announced this test as part of its new sideline concussion testing assessment. It is based on assessing orientation, recall, concentration, and balance on two different surfaces. Similar to the ImPACT test, post-injury scores are compared to pre-season baseline scores to determine the presence of a legitimate concussion. This ten minute test is portable and requires minimal testing equipment, but does call for an administrator to “score” the athlete’s physical performance.

SCAT 2: Sport Concussion Assessment Tool 2

The SCAT2 test is endorsed by FIFA, soccer’s governing body, and the International Rugby Board (IRB). SCAT2 is an extensive standardized questionnaire administered to the athlete post head injury. The SCAT 2 includes multiple areas of assessment and is widely accessible as it can be found online and downloaded.

Rugby coaches can minimize player exposure to concussions by teaching proper contact skills. Whether coaching a tackler to keep their “head up, head behind” when tackling, or controlling their body position in contact, proper technique must be promoted. It is a coach’s responsibility to establish a standard of safe and effective technique. The days of celebrating a big hit made with unsafe technique have got to end.

As we await the International Rugby Board’s announcement regarding concussion protocols to address suspected head injuries, teams should perform online research to make informed decisions as to which test to employ as part of their concussion management plan. Below are links to the three tests discussed:

ImPACT: http://www.impacttest.com

MBESS: www.sportsconcussion.com/pdf/management/BESSProtocolNATA09.pdf

SCAT2: www.athletictherapy.org/en/pdf/SCAT2.pdf

Tom Billups began his rugby career in 1984 and has spent time as a player in New Zealand (Bay of Plenty), the U.S. (The Old Blues), England (London Harlequins), and Wales (Pontypridd) for domestic teams as well as representing the U.S.A. at international tournaments with the Eagles. After hanging up his boots, Billups got into coaching leading the Eagles and now with University of California – Berkeley. Read the entire bio of Tom Billups as well as Billups first column My Rugby Path and then check out what Billups is saying about the game of rugby in The Billups Column on Rugby Rugby.