Craig Hill: Familiarity with baseline concussion testing won’t let kids game system

The question was barely out of the test administrator’s mouth when my son unleashed his rapid-fire answer.

“Baby. Monkey. Perfume. Sunlight. Iron.”

“Wow,” the woman said as she made a notation on Alex’s baseline concussion screening form. “Smart kid.”

Alex smiled knowingly. Mischievously.

I couldn’t help but interject. “You know he cheated, right?”

OK, “cheated” might be a little strong. But he knew the questions before they were asked.

This young era of school district-mandated concussion baseline testing has reached the point where kids are taking the test for the second time. Baseline tests are required every two years for athletes in contact sports such as football and basketball. Experts say these tests are also a good idea for adults active in risky sports, such as cycling and skiing.

The tests are used to help determine when it is safe for a person to return to their activity after suffering concussion symptoms.

At one point during the test, the administrator reads five random words and asks the athlete to repeat them. They do this three times then move on to different aspects of the test such as balance. Toward the end of the test, they’re asked again for the five words.

It comes across as a surprise question the first time you take the test. But this was Alex’s second time and he was ready.

Alex confessed he’d repeated the five words to himself throughout the balance-testing phase. Later, he told me he rehearsed saying the months of the year in reverse on the way to the appointment, because he knew that was going to be a question.

Cute, I guess, but I was concerned by this and it left me pondering this question: Does familiarity with the test allow kids to game the system?

I posed the question to Josh Waltier, director of sports medicine at ATI Physical Therapy-Washington. Waltier has administered thousands of the tests and has helped determine when many athletes are able to return to actions. He has a passion for understanding concussions and helping educate others.

“Typical of kids, they start to figure out ‘Hey, I can ace this test because I’m competitive,’ ” Waltier said. “I’m going to do this fast and show them that I have the quickest brain in town or the best balance test. Or you have the other segment that says ‘I’m going to sandbag on this test.’ So we have both sides to think about and none of that matters when it comes to Return to Play.”

Return to Play is a set of sports specific mental and physical tests an athlete must pass to be cleared to play.

“First, we are looking for people to give an honest assessment,” Waltier said. “And if you have symptoms, you don’t even start your Return to Play.

“So, you’re wondering if my kid gets hit in the head is he going to have to really study to make it back? I’m going to tell you no. The reason is because when he comes back a couple days after his concussion and things have gotten clear in his head and he’s not having symptoms, we’re going to sit and go through the test again. And let’s say he doesn’t do as good, well, one point here or there is not going to change our ability to progress him forward.”

And knowing the test isn’t likely to result in a kid sneaking back onto the field after suffering a hit that results in concussion symptoms.

“If you’ve had a mechanism that would have caused the brain to rattle against your skull in any way, shape or form and that is followed by a report of symptoms, if any of that happens, we say you have a concussion,” Waltier said. “You are out. It doesn’t matter if you have stuff memorized or you don’t have stuff memorized. You’re out that day.

“When you begin to be symptom-free … or return to what is normal for you, then we begin the exertion phase.”

Waltier says the baseline concussion test and the Return to Play test has enough redundancy to determine if an athlete has a concussion regardless of how familiar they are with the test.

“I wouldn’t say we should put a lot of concern into whether or not they are sandbagging or they are practicing because they are kids and we know they are going to do that,” Waltier said. “The key is we look at every individual case specifically and get to know the kids if we can so we know if they are acting different. We talk to parents to see if they are acting different.

“If a kid sandbags and hides his symptoms and starts progressing, the exertion test should catch that.”

On the first day of the test they must exert themselves at about 70 percent.

“Some people could hide it (symptoms),” Waltier said. “We say ‘Good job, now come back tomorrow. Then they go 20-30 minutes at closer to 100 percent. Are they going to fake that? Probably not. The next day is a little longer and even more sports-specific drills that require them to perform mentally and physically. That’s what catches people in the process.”

Testing is still evolving and Waltier suspects future generations could see different, better testing. But for now, parents can rest easy knowing the current tests aren’t likely to be outsmarted by their kids.

This story was originally published February 5, 2016 at 2:39 AM with the headline "Craig Hill: Familiarity with baseline concussion testing won’t let kids game system."