Figure Skating Concussion Evaluation (Trevor Laak)

Competitive figure skaters are subjected to high acceleration impacts on a regular basis, making it likely that they will be more prone to concussive injuries than the broader population.  Most ice rinks do not have medical personnel on staff, so injuries at the rink during figure skating sessions almost always must be handled, at least initially, by the coaches on the session.

As a general rule, figure skating coaches have no formal training in concussion detection.  Thus, the purpose of this page is to offer suggestions to coaches in how to handle potential concussion situations on the rink in a limited amount of time.

First and foremost, coaches see tens or hundreds of skating falls every day.  By keeping their radar up, coaches can often tell how much a fall hurt a particular skater or if the skater may be behaving strangely after a fall.  Some but not all skaters will volunteer their thoughts and feelings after a bad fall, sometimes with crying or other facial or emotional displays or restricted physical movement.  However, detecting a concussion is particularly challenging for skating coaches because a direct blow to the head is not required for a concussion to happen.  Thus, nearly any fall has the potential to cause a concussion which may have no outwardly observable symptoms to the skating coach.

Determining conclusively whether a skater has a concussion is usually not possible in the limited time available to a coach in the non-ideal environment of the ice rink.  Trained medical personnel usually take 10-30 minutes of testing and observation to determine whether an impact has resulted in a concussion and the severity of the concussion.  And they usually do it in a relatively controlled environment of a locker room or medical treatment room.

Probably the most commonly used test for a concussion by sports trainers is the Sport Concussion Assessment Tool 2 or SCAT2 for short.  Traditionally the SCAT2 is a paper checklist filled out by the medical trainer, but there are now convenient and free apps for tablet computers such as the iPad.  In either case, the process is straightforward and involves a series of physical and mental tests to infer potential loss of cognitive ability.  The detail of knowing “how” the test is administered is nontrivial but an example is provided below.

Here is a good explanation of the test including a fairly detailed demonstration.  All figure skating coaches should watch this video and be familiar with this process, even if they will never administer this test themselves.  This test offers insights which we will use in a moment to come up with a less rigorous but much faster test that is practical for figure skating coaches to administer on the ice immediately after a hard fall.

As discussed in the above video, we can break down the SCAT2 formula into:

1. Signs and symptoms
2. How the injury happened
3. Balance and coordination test
4. Memory and cognitive skills

You can review the SCAT2 test directly to see the details of the test.  Unfortunately, it is simply impractical for a figure skating coach to administer this entire test every time a skater takes a bad fall.  However, it does make sense that skating coaches perform some of these tests or simplified versions of this overall test.  In the interests of the figure skater, it makes sense to do some preliminary testing to determine whether the skater should be allowed to continue skating or should leave the ice and seek further testing or medical treatment.  In all but the rarest cases, if a concussion of any severity is suspected, the skater should probably leave the ice immediately for rest or further testing.

Here is a potential test that most skating coaches can administer quickly and easily on the ice.  Keep in mind that any skater that experiences loss of consciousness or cannot remember the fall should leave the ice and undergo further and more thorough testing.  The following test is not comprehensive and was not developed by a medical professional.  Use this test at your own risk and discretion as a way simply to attempt to decide if a skater should be allowed to remain on the ice and continue skating.  Neither the originator of this test nor the publisher of this article is liable for anything associated with it’s use.

Simple On-Ice Testing for Potential Concussions for Figure Skaters

1. Signs and symptoms: Ask the skater if they have a headache, neck pain, nausea, dizziness, or any vision or balance problems.  Essentially the goal here is to see if the skater is feeling “out of sorts” in any way with special attention to any head or neck pain.  If the skater has any of these symptoms, the prudent action is to remove the skater from the ice for further testing.

2. How the injury happened:  Coaches that see the fall will immediately have a sense for the severity of the impact.  In cases where the skater falls and there are no reliable witnesses, it is imperative to ask the skater for details of the fall.  In particular, find out if the skater’s head made impact with the ice.  If the skater’s head hit the ice, the skater should probably leave the ice immediately for further testing.

3. Balance and coordination test:  Ask the skater to stand at the boards on two feet with their eyes closed for 10-20 seconds and observe their balance (they can use the boards for spotting).  Next ask them to open their eyes and touch their index finger to their nose several times.  If coaches want to be more thorough with this section of the test, have the skater stand at the boards and balance on one foot with eyes open while using the boards only for spotting.  Most skaters can balance on one foot unassisted for 10+ seconds when healthy.  Assuming a skater could do these skills prior to the impact but has difficulty after the fall, they should probably leave the ice for further testing.

4. Memory and cognitive skills:  Ask the skater what is the current date and day of the week.  Ask the skater to recited the months of the year backwards, starting with the current month.  Finally, ask the skater to repeat a list of words, saying them at the rate of one word per second.  Coaches should select a list of words directly from the SCAT2 test that are easy for them to memorize and use.  The words in the lists in the SCAT2 test are chosen for a reason as they involve more complex function than lists of related words.  Figure skating coaches seem to have a particular affinity for the lists (candle, baby, finger) and (sugar, perfume, blanket).  The coach should use some common sense when determining if a skater should leave the ice based on these tests.  (Some skaters can’t recite the months of the year backwards when totally healthy!)

Continued Monitoring: If a skater passes the above tests and is allowed to continue skating, it is prudent for the coach to check in with the skater again within 5 to 10 minutes. At that time, ask the skater again if they now have a headache, neck pain, etc.  At that time also test their longer term memory by asking them to name some of the words in the lists you had them recite in step 4 above.

Because concussion injuries typically can have a significant effect on motor skills, an observant coach can usually determine whether some degradation of brain function has occurred due to a fall simply by watching the skater skate.  If a skater seems out of sorts after a bad fall and is skating more poorly than usual or seems to be making poor decisions on the ice, it may make sense to have the skater leave the ice for rest or further testing.

Figure skating coaches that wish to be more thorough in their assessment of their skaters should watch the above video and print out the SCAT2 test and keep it with them.  Other tests are also available and effective but are generally not free, such as the King-Devick Test (also available as an iPad app for $45!).

 

Add to “My Favorites” (Beta testing)