Axon Ahead of the Game Website
Sample page from Axon Sports new online toolkit, Ahead of the Game.

New Axon Sports toolkit provides support to school, league and club administrators

Looking for a concussion program but short on time and resources to pull it together? Check out our new online toolkit, Ahead of the Game. For a limited time, it’s available from our home page.  After that, it will be available to registered account holders. You’ll find educational materials--customizable forms, videos, return to play permission slips, locker room posters, and other items to assist Schools, Leagues, and Clubs get started with safe and efficient concussion management programs.

It’s important that all stakeholders—Athletes, Parents, Coaches, Athletic Trainers, School Nurses, Athletic Directors, Officials, EMT Staff—understand concussions, including the cause, effects and recommended recovery.

Axon Sports Eastbay Ad
You'll find Axon Sports advertisemnents in Eastbay catalogs and on the web.

Eastbay Partnership Raises Awareness of Sports-Related Concussions

Today's Athletes are faster and stronger. The games they play -- more competitive and physical. Unfortunately, that can create an environment for head injuries and concussions. Fortunately, Axon Sports and Athletic Supplier Eastbay have embarked on a partnership to increase awareness of sports-related concussions and the role of Baseline testing as part of an Athlete’s overall preseason preparation.

Baseline testing is recognized by both the National Collegiate Athletic Association and the American Academy of Pediatrics as a best practice for Athletes in an effective concussion management program and plays a vital role by capturing a snapshot of an Athlete's cognitive (brain) function. As early as 2001, it was considered a “cornerstone” in concussion evaluation at the International Conference on Concussion in Sport.

Eastbay Logo“Eastbay strives to look out, and look ahead, for Athletes—to be a forerunner in providing what they need from head to toe,” said Sean Cummings, Eastbay Brand Director. “Increasing awareness of Baseline tests among our loyal customers underscores Eastbay’s commitment to support all Athletes and their athletic performance. From recreational to competitive leagues; from basketball and football to cheerleading and skateboarding, to fully protect themselves, every Athlete should have access to affordable and convenient Baseline testing.”

Learn more at eastbay.com/axonsports/

Peterborough Health Care Providers Unite to Address Issues of Concussion

YouthSportsConcussionProgramNew Canadian Concussion Program Provides Universal Access to Young Athletes – Features Axon Sports
The Peterborough Youth Sports Concussion Program will establish a best practice model in the prevention, diagnosis, treatment and management of concussions providing universal access to youth from across the City and County of Peterborough, Ontario, from the age of 10 right through until high school graduation.  The program, the first of its kind in Canada, is a collaboration between primary care providers and specialists and will establish standardized guidelines for concussion management for all health care providers across the five Peterborough Networked Family Health Teams

“Pre-injury cognitive assessments are an important part of the program, but the Peterborough Youth Sports Concussion Program will be standardizing best practices surrounding all elements of concussion prevention, diagnosis, treatment and management,” said Dr. Derek Krete, physiatrist.  “We will create strategies for injured players surrounding removal from play, return to school and return to play and we intend to engage with parents as well as our local sports associations and school boards, to create broader understanding of concussions and prevention of second impact syndrome.  We want parents within our community to feel confident that everyone involved in the circle of care for their children, our young athletes, from their family doctor to the first responder at a hockey game, are working from a universal approach in the highest standards of concussion management.”

Give it your Best Shot!

Editor’s note: “Sand-bagging” or intentionally failing Baseline cognitive tests has received national media attention recently, with the likes of Payton Manning and others openly admitting to taking this approach. (Payton Manning later said he was only joking.) Either way, his words send the wrong message to youth Athletes. Dr. David Darby, CogState Chief Medical Officer, addresses the importance of “best-effort” Baseline tests and underscores the danger in trying to “low ball” test results.

A pre-season Baseline test records your “best effort” performance. It’s important to give the Baseline test your full attention and honest effort because the data is stored for comparison purposes if you should suffer a head injury. If you do experience a concussion, knowing when your brain has healed is essential information for a qualified Medical Provider, who will likely help in any accommodations you may need for school and release you to return to practice and competitive play.

What sets Axon Sports’ tests apart from other cognitive tests in the market are the built in  “integrity” checks that must be met to succeed. If you don’t understand the test directions or if your effort is not your best performance--including deliberate under-performance or “sand-bagging” -- then the result may be unacceptable and you will need to try again.  

Because results are available immediately, you can quickly determine if your test effort is acceptable. To make it clear, the Axon Sports CCAT Report includes an icon that specifies whether or not the results are acceptable (a green checkmark) or try again (red X). The icon is designed to be an overall summary statement, with the Advanced Report containing more detailed information for your qualified Medical Provider.

If your performance is very poor in comparison to your peers (normative data) or if you have taken a Baseline test three times or more with unacceptable results, we recommend that you see your Doctor to determine if you have a pre-existing medical reason for your under performance.  

After Injury Test Report
David Darby, MB, BS, PhD FRACP, Chief Medical Officer for CogState also serves as a Neurologist and Medical Consultant for Axon Sports.

“Doctors play an important role in educating Athletes, Parents, Coaches, Athletic Trainers, and School Administrators about the importance of performing optimally whenever they use the Axon Sports Computerized Cognitive Assessment Tool (CCAT),” notes David Darby, CogState Chief Medical Officer and co-creator of the Axon Sports CCAT. “Failure to determine the cause and extent of pre-existing impairment until after an injury can lead to significant difficulties in assessing whether or not the impairment is new or existed prior to the injury.”
That’s why the best possible Baseline test result is a critical component to detecting subtle after-injury changes. Having a Baseline test result stored prior to the first contact practice of a sports season is important. Without an optimal Baseline, Doctors will have difficulty assessing your previous or pre-injury condition. So when you’re ready to take your test, bring your competitive spirit and give it your best shot!

Note to Medical Providers: Additional information about Axon Sports CCAT integrity checks are available on the sample Advanced Report and in the Axon Sports Medical Guide to the CCAT.

Medical Providers and Researchers
Alcohol, Fatigue, Change Scores and the Axon Sports CCAT

The Axon Sports Computerized Cognitive Assessment Tool (CCAT) is designed to be sensitive to any cause of cognition change in individuals. A benefit of this is the ability to compare the magnitude of the change seen after concussion with other causes of change in cognitive performance. For example, studies in college students have documented deteriorations in cognitive speed and accuracy with increasing levels of blood alcohol or sustained wakefulness over 26 hours. From these studies, it is known that a change in approximately 0.08 BAC% is equivalent to 1.8 standard deviation units deterioration in cognitive performance on the Axon Sports CCAT tasks, particularly the Processing Speed and Attention results. The same deterioration occurs with more than 24 hours of wakefulness. In addition, the lower graph on the Axon Sports CCAT Advanced Reports has the y-axis use standard deviation units. That’s why a change > 1.65 standard deviation units on the Axon Sports CCAT Change Score graph is roughly equivalent to a change in BAC% of 0.08. Typically after a concussion, an Athlete's Processing Speed or Attention results can deteriorate by several standard deviation units, which can be converted for illustrative and counseling purposes into BAC% equivalent changes to emphasize the magnitude of the deterioration caused by the concussion. It is a persuasive argument to make the analogy that the Athlete shouldn't be driving with a BAC% of 0.08, so why should they be sent back onto the playing field, or back to the classroom?

After Injury Test Report
James Moriarity, M.D.,
Head Team Physician at the University of Notre Dame

Ask The Expert
Q: Why is it recommended that an Athlete complete an acceptable Baseline test every year?

Dr. Moriarity:
Young brains, like bodies, develop and mature and do so at different rates, and each year some improvement in cognition may occur.  We find children mature and improve in both speed and accuracy performance on the Axon Sports CCAT to the ages of at least 15 years. That's why completing an annual Baseline test ensures an accurate and current record of the Athlete's true ability and aids detection of subtle declines in thinking ability that can occur after a concussion. In addition, having an annual Baseline test result can help detect changes from a prior Baseline (perhaps indicating a head injury during the off-season—a fall off a bike or snowboard, for instance) and ensure an accurate record of the Athlete's cognitive performance before any sporting contact occurs. For young Athletes annual Baselines are especially important as developing brains may be more vulnerable to concussions than Athletes who have reached the collegiate or professional levels. 

Also see “Age-Related Differences in Neuropsychological Testing Among High School Athletes,” by Tamerah N. Hunt, PhD, ATC, and Michael S. Ferrara, PhD, ATC; where the authors conclude, “Although scores appear to remain stable after 10th grade, we still recommend testing annually until additional research is conducted to confirm these findings.”

School, League, and Club Administrators
The Role of Cognitive Testing in a Concussion Management Program

By James Moriarity, M.D., Head Team Physician at the University of Notre Dame
Cognitive testing in the diagnosis and return to play of the concussed Athlete has been investigated for nearly two decades.  Axon Sports’ joint venture partner, CogState, was one of the early pioneers in the research and development of computerized cognitive testing in Athletes as an aid to Medical Providers in the management of concussed Athletes. More importantly, CogState was one of the first companies to promote (and publish) the concept that a system of cognitive testing was a tool, to be used by qualified Medical Providers experienced in the diagnosis and treatment of concussion, and, in conjunction with an overall concussion management plan. 

Axon Sports Computerized Cognitive Assessment Tool (CCAT), when properly administered to Athletes, is a reliable tool for assessing changes in cognitive (thinking) performance. As such, I have found it to be a valuable addition in the management and return to play of a concussed Athlete.

Cognitive testing, of any kind, is not a standalone tool for the evaluation of a head injured Athlete, and should never be used as the sole criteria for return to competition. For cognitive testing to have any real value, Athletes should be required to perform Baseline testing for comparison to After Injury testing in the event a head injury occurs.

Ahead Of The GameThe education of teams and staff on concussion recognition and care, the administration of Baseline and After Injury testing, and the coordination of Physician care and return-to-play decisions are all challenges for Administrators  responsible for the implementation of an effective Concussion Management Program. This is true whether you are an administrator for a youth soccer league or an  Athletic Director at the University of Notre Dame which has used versions of the Axon Sports CCAT for more than 10 years.

No matter what the size or skill of your Athletes, no matter what your ranking or record, no matter what the size of your budget permits, rest assured Axon Sports would like to help in this endeavor. Check out its online toolkit, Ahead of the Game, to get started.

Parents and Guardians
The Value of Portable Results

With Axon Sports, your Athlete’s test history stays with them through their athletic career. And, you manage access to their test results. Think of it as an electronic health record that travels with you as your child changes schools, teams, and sports. We encourage you to provide a copy of the test results or the certificate of completion to your child’s Coach, Athletic Trainer, and Medical Provider. We’ll store the results for 15 years. This allows you to direct care based on your established relationships with qualified Medical Providers, as well as your current insurance providers.It allows your Athlete to confidently play sports for multiple schools, clubs, and leagues throughout their childhood.

Coming to a state near you – Youth Concussion Laws

By Ashley Kalbes
Concussions are a hot topic beyond the playing field and locker room. You can also hear the issue addressed in the corridors and meeting rooms of our state capitols. Lawmakers are advocating the importance of concussion management for youth Athletes. If your state hasn’t already passed legislation, it’s likely coming. As of early May, nearly 20 states had passed laws and 35 states had introduced new or revised legislation.

You’ll note three common elements in the majority of laws.

  1. Education
  2. Removal  from Play
  3. Qualified Medical Provider makes the return-to-play decision

Generally speaking –
What this means for Coaches

Education on concussion signs and symptoms will be required regularly. Topics may include: what concussions are, what to look for in an Athlete with a suspected head injury, your school or activity concussion management policy, and return-to-play guidelines. You may be responsible for collecting signed, informed consent forms from Athletes and their Parents prior to allowing students to participate.

What this means for Athletic Trainers
It may be your responsibility to create and/or implement the concussion management plan for your school. For help, see our Ahead of the Game toolkit. You may play a role in educating Coaches, Athletes, Parents, and Volunteers. You are responsible to watch Athletes for signs and symptoms of concussion or brain injury and remove them from play as appropriate. Return-to-play guidelines may include a graduated activity scale you may oversee.

What this means for Schools
It is important to be aware of new legislation, interscholastic guidelines, and policies for your state, association, or school. You may be held responsible for providing educational materials for Athletic Trainers, Coaches, Parents, and Athletes. Athletic Trainers and School Nurses may play a key role in the concussion management policy.  (The new Axon Sports Ahead of the Game toolkit was created using concussion management best practices and contains necessary components to educate and assist all key players.)

What this means for Parents
Parents, concussion management may be included in your mandatory school sports meetings. You may be required to participate in annual education and to sign an informed consent form prior to your Athlete's participation in an activity. You may receive information explaining a Baseline testing system for your Athlete and their school. If your school does not offer Baseline testing as part of its concussion management program, you can buy, take, and store a Baseline at www.axonsports.com. We recommend that you share a copy of your Athlete’s test results with your Medical Provider so that if your Athlete has a suspected head injury he or she can be examined by your Medical Provider to help ensure return to play in a proper amount of time and not until your Athlete is safely healed.

What this means for Athletes
Athletes, you may have educational meetings at the start of the school year or sports season. You have a responsibility to be honest about potential head injuries and to look out for your teammates on the playing field and in the locker room. You may also be asked to sign an informed consent form prior to participating in an activity.

What this means for Medical Providers
It is important to be aware of new legislation, interscholastic guidelines, and policies for your state. You may be asked to manage the care of the Athlete and make decisions about returning to the classroom, practice and competitive play.  To aid you in these efforts, you can use the Axon Sports CCAT at www.axonsports.com. Baseline and After Injury tests are stored in Athletes’ accounts and different teams and sports can be managed by yourself and Coaches. The Axon Sports CCAT can help you in making decisions in the best interest for the safety of the Athlete.

It is up to everyone involved to ensure the safety of the Athlete. If there is no protocol in place today, there could be tomorrow. Maintain your responsibility to Athletes and activities by keeping informed of the issues.

Additional Resources:
American Academy of Neurology
National Conference of State Legislatures

National Summit on Sports Concussion Opens with Legislative Talk

Dr. Stan Herring opened the fifth annual National Summit on Sports Concussion May 6 with a discussion on Emerging Legislative Initiatives in Sports Concussion Management. A Seattle Seahawks team physician, Herring relayed the efforts to get Washington’s Zackery Lystedt Law passed. Assemblymember Mary Hayashi (D-Hayward) briefly talked about her efforts to introduce legislation in California. AB 25, which focuses concussions and the safety of young Athletes, will require written consent from a health care professional and legal guardian after a young Athlete has suffered a concussion in order to return to play

The featured speakers spoke about current practices in the evaluation and management of sports-related concussions and orthopedic injuries. In the concussion track, the experts mentioned “how far we’ve come” in the past five to 10 years, while recognizing “how much we still don’t know,” and how much more research needs to be done, especially with younger Athletes who don’t have the benefit of team physicians and Athletic Trainers.


Nashville, May 20-21
Dr. James Moriarity is discussing computerized cognitive testing at the Tennessee Athletic Trainers Society’s Concussion Discussion course at Lipscomb University

Denver, May 31-June 4
American College of Sports Medicine Annual Meeting, Booth #329
Meet Dr. David Darby, co-creator of the Axon Sports test

New Orleans, June 18-22,
National Athletic Trainers Association Annual Meeting, Booth #248

Fort Worth, July 24-27
Texas High School Coaches Association Convention


Peterborough Health Care Providers Unite to Address Issues of Concussion

Alcohol, Fatigue, Change baseline Scores
ask the expert:
The Value of Portable Results
National Summit on Sports Concussion