Play It S.A.F.E.® starts with baseline testing using objective neuro-physical balance testing to compliment the neuro-cognitive testing tool of your choice. A simple clinical guideline for a sideline assessment and follow-up evaluation provides insight to the question, “Can this athlete
return to play?”
What is the Play It S.A.F.E.®
Biodex Medical Systems, a leader in sports
medicine and rehabilitation, has teamed up with Bridgette Wallace, a Certified Vestibular Therapist and President of 360° Balance,
to develop the Play It S.A.F.E.® Concussion
Management Program - a “turn-key” solution to the assessment and management
of concussion.
The Play It S.A.F.E.® program brings together cognitive and functional assessment using accepted tools and methods to afford you a “single source” concussion management program.
Even for those facilities that have a concussion program in-place, Play It S.A.F.E.® adds the vital vestibular and objective balance assessment recently found so important in concussion assessment.
The program can be an important addition to an existing program when used in conjunction with accepted neuro-cognitive testing programs.
Objective balance testing is critical
Research shows that athletes demonstrate decreased stability up to three to five days post injury. This can be the result of ineffective use of one or more of their sensory systems.(1) Signs and symptoms will vary following head trauma. With some individuals, signs and symptoms may resolve immediately after a mild head injury (MHI) while others have persistent symptoms. In either case, the recovery period related to MHI appears to coincide with recovery of postural stability as well as normalization of eye-head coordination and return of cognitive function. (1)
Preseason Baseline Testing
The ability to quantify balance and cognitive function in athletes before an injury occurs is an important consideration in a comprehensive athletic program. The objective data provided by computerized assessments provides a performance baseline against which post-injury performance can be compared.
Post-Injury Assessment
Traditionally, balance control has not been assigned a high priority in evaluating athletic injuries. Recently, there is strong evidence demonstrating the impact of balance deficits on functional performance and increased risk of re-injury. (2,3,4)
Following head trauma, the Play It S.A.F.E.® program provides a simple “guideline” that the medical provider can follow, step-by-step to evaluate the athlete and form fact-based conclusions.
References: 1.Guskiewicz, KM, et al (1997). Alternative approaches to the assessment of mild head injury in athletes. Med Sci Sports Exerc, Vol 29, No 7 Supplement, pp S213-221. 2.Allison, et al. Contemporary management of balance deficits. NeuroCom Intl., Clackamas, OR, 1994 3.Kauffman, et al. Balance is a critical parameter in orthopedic rehabilitation. Orthopedic Physical Therapy Clinics of North America; New Technologies in Physical Therapy 6:1 1059-1516, 1997 4.Freeman, Wyke. Articular contributions to limb muscle reflexes. Br J Surg 53:62-68, 1966 5.Wyke. Cervical articular contributions to posture and gait: Their relation to senile disequilibrium. Age Aging 8:251-267, 1979 6.Wyke. The neurology of joints. Ann R Coll Surg Engl 41:24-50, 1967 7.Goldie, et al. Postural control following inversion injuries of the ankle. Arch Phys Med Rehabil 75:969-975, 1994 8.Wilkins, Brody. Romberg's sign. Arch Neurol 19:123-126, 1968 9.Lehmann J.F. et al Quantitative Evaluation of Sway as in Indicator of Functional Balance in Post-Traumatic Brain Injury. Arch Phys Med Rehab 1990;71: 955-962
How it all began...
About ten years ago Tina Bonci, MS, ATC, LAT Co-Director, Division of Athletic Training/Sports Medicine at University of Texas was interested in establishing a concussion management program at UT...she had been following the work of Kevin Guskiewicz, who was heavily involved in posturography in return to play decisions. Bridgett Wallace PT, DPT was also using posturography and integrating additional vestibular testing and providing vestibular rehabilitation. After many discussions and review of the literature, they implemented a concussion management program that combined baseline testing of cognitive, balance and eye-head coordination. The findings were first used to identify potential at risk athletes and provide athletic enhancement exercises if needed.
The baseline testing was also used to compare the athlete's status following a concussion to assist the team
physician(s) in return-to-play decisions as well as provide appropriate vestibular exercises that would then be carried
out by the athletic trainer. |
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Play It S.A.F.E.® Concussion Management Program |
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Disclaimer:
The information provided is not intended to be a substitute for professional medical advice but as a guideline to assessing athletes following a concussion. Always seek the care of a physician or other qualified healthcare provider with any questions or concerns you may have about a medical condition. If there is any question/concern about the athlete’s status then recommend not returning to play.
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Step 1:
Concussion Management Education
- Support materials to educate athletes,
coaches, parents, administrators, doctors
and clinicians, including the CDC “Heads Up” Concussion in Youth Sports Materials.*
Step 2:
Preseason Baseline Testing
- Neuro-physical Testing: Get important baseline balance data on all athletes using
the Biodex Balance System SD or portable BioSway. The tests are quick and easy
to perform.
The Clinical Test for Sensory Integration of Balance (CTSIB) helps to determine which sensory system (visual, vestibular, or
somatosensory) an athlete relies on to
maintain balance. Research has shown that Mild Head Injury (MHI) populations rely more on visual cues from the environment than an able body population. (4)
- Neuro-cognitive Testing: Fully complimentary to any computerized cognitive software testing program including: ImPACT™, CogSport™, CNS Vital Signs™, CSMI SportsWare™ Concussion, HeadMinder™, SAC, SCAT2** or any program of choice.
Step 3:
Sideline Assessment
- Follow the Play It S.A.F.E.® Algorithm and Sideline
Assessment to screen for a
concussion and remove the athlete
from play if needed.
Step 4:
Follow-up Evaluation
- Repeat neuro-physical balance testing and
neuro-cognitive testing in the days following injury to track recovery using preseason baseline testing as a reference.
Step 5:
Return-to-Play Decision
- Doctors, athletes, parents, coaches and
administrators feel confident as decisions are
based on best practices objective data and clinical protocols.
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| Stores baseline balance testing for easy post-injury comparison– report is integrated with neurocognitive test results. |
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