A SCAT assessment modified for para-athletes could work for concussion assessment in some types of disabilities

By Keya Mookencherry. This article was initially published in the 6/13/24 edition of our Concussion Update newsletter; please consider subscribing.

A major concern with concussion policies in sports is that most current methods to diagnose concussions are inadequate for para-athletes with a wide variety of disabilities. A study published in the British Journal of Sports Medicine examined whether the sports concussion assessment tool, version 5 (SCAT5), could be utilized for para-athletes with a visual impairment, a spinal cord injury, or a limb deficiency. Authors Bryce Dyer et al. conclude that the SCAT5 could be conducted on athletes with spinal cord injuries or limb deficiencies with minor modifications. For those athletes with visual impairments, however, the study authors do not recommend using the SCAT5 “in its current form.” It should be noted that this study was conducted before the release of SCAT6, although most updates in SCAT6 do not affect the recommendations provided in this study.

The research team studied three types of impairments with high prevalence in para-sport: visual impairments (low vision or absent vision), limb deficiency (upper, unilateral, or bilateral lower limbs), and spinal cord injuries (quadriplegia and paraplegia). To evaluate the use of SCAT5 among these types of disabilities, the researchers established a 16-member panel and used the Delphi technique to develop a consensus opinion.

For para-athletes with a suspected concussion who had limb deficiencies or spinal cord injuries, the expert panel agreed that a modified SCAT5 evaluation would be effective once created. However, athletes would still need to complete a baseline assessment with modified SCAT5 to have a comparison point. For para-athletes with visual impairment, the authors found that “some tests were difficult, infeasible, or should be omitted entirely depending on the visual impairment type.” The researchers found that 31-41% of tests in the SCAT5 shouldn’t be used* in clinical assessment of suspected concussion in para-athletes, depending on the impairment. Further, 24-31% of SCAT5 tests need modifications before they can be used for para-athletes. (* See page 16.)

In a Bournemouth University press release, Dr. Bryce Dyer, the first author of this study, notes that “The issue is that most of the policy regarding concussion in sport is directed towards non-disabled athletes. While para-athletes are also assessed for suspected concussions, our current methods require tailoring to their unique needs, and this isn’t fully understood how yet, with no simple process to quickly do it.” Further research on identifying and validating alternative assessment methods is needed to examine how potential concussions can be more effectively evaluated in para-athletes with a wide variety of disabilities.