The Carlisle United first team and U18 squads were put through a challenge of a different kind last week as the Blues became one of the few clubs outside the top tier to adopt new cognitive testing procedures to assist with the assessment of recovery from head injuries, in particular concussion, using a more evidence-based approach.
It was very much a ‘back to school’ feel as the players found themselves in exam conditions to take on a series of mentally challenging questions – but all with a very serious purpose.
Dr David Millar, the Consultant Neuropsychologist who developed the testing procedure, explained: “We’re trying to encourage clubs at all levels to adopt a more evidence-based method of managing incidents of concussion by introducing procedures which have previously only been available to clubs and organisations at the upper levels of their disciplines.
“It’s something I’m very passionate about because it’s ultimately about protecting players, and that has to be right at the top of everybody’s agenda, whatever level you’re playing at. If you can remove the guesswork as much as possible when you’re treating something as complicated as concussion it means you’re doing a much better job for your patient, which can only ever be a good thing.
“At another level it also protects the clubs who adopt this procedure as their standard, because it will mean that they’re also doing as much as they can to make sure their player is fully recovered and fit to continue as normal from what can often be a very complex type of injury.”
Defender Clint Hill, who admitted prior to the test that he’d suffered from concussion a number of times through his near 650-game career, was quick to praise the new procedures and steps forward which have been taken with the after-care for players who have suffered head injuries.
“Going back a few years, it was a case of having a chat with the physio and agreeing that you were fine after maybe just a few days or so,” he commented. “From there you were back in training and back in the team. Don’t get me wrong, you were still very well looked after and closely monitored, but there’s no doubt that the steps forward that have been taken in the last few years are huge in terms of treatment and assessment.
“A lot of the lads are worried when they come up against tests like this but the point of it is to give the medical team an idea of how each individual thinks and works when they haven’t had a knock on the head. I think it’s really good and it gives you confidence that you’ll be treated properly should you get a bang like that during a game.”
But what exactly were the players made to do?
“There are tests of memory, concentration, information processing speeds and things like that,” Dr Millar told us. “Some of it is quite difficult, but that’s deliberate. It’s about remembering lists, words and images and about how quickly they can complete certain tasks.
“It is a demanding test, and you can see some of them get quite frustrated with it, but the important thing is that there is no pass or fail. The theory is that, having completed the test, it gives us a controlled starting point with each individual player.
“We have the evidence there for how he performed on the test when he was fit and well, which is effectively his baseline, and if they suffer concussion they then go through the same testing procedure.
“If the score is markedly different it tells us they haven’t fully recovered, and they can be treated accordingly. It’s concrete information the medical staff can use to help with what, in the past, were often subjective decisions.”
Speaking more about the process, Dr Millar said: “The programme has been developed by an American company called ImPACT, and it’s a good one. We’re very pleased with it, but we’re always looking to fine tune and improve it.
“We’re delighted that Carlisle United have seen the benefits of it. As I said earlier, when it comes to the well-being of your players there is nothing more important, and we hope that it goes on to become the standard at as many levels of the game as possible.
“By working with the existing medical team at clubs, we introduce them to some of the existing technology and that puts them in a better position to manage concussions in terms of knowing when a player has fully recovered.
“These tests are nothing about removing people from play. The physio and doctor at the game still have their immediate medical assessments to do, and they will use their knowledge and experience to determine whether or not a player can continue.
“This is more about helping the medical team to determine when a player who has suffered a concussion is fit enough to return to full involvement. That’s why it’s really important to do these tests because the timescale from picking up the concussion to full recovery will be different in every case, and for every player you come across.
“By having these test results in place, you’re giving yourselves as a club a better measure for when that should be. The thing to bear in mind is that if players come back too soon it can make them more vulnerable to future concussions.”
“I have to stress that this is just one part of the evaluation process a player who has suffered from concussion needs to go through,” he concluded. “There are other clinical tests and evaluations which need to be done, but this test provides an extremely useful tool because it’s quantifiable and measurable, rather than just relying on symptoms and comments from a player who is probably really keen to get back into action.
“Hopefully the players will stay clear of concussion but, if it does happen, Carlisle United are now in a stronger position to deal with it.”
