In Kaino's case, the Blues skipper clashed heads with a Lions forward when cleaning out a ruck halfway through the first half of the defeat at North Harbour a fortnight ago. Kaino, who had blood streaming from his head, clearly couldn't maintain his balance on all fours, and then stumbled when attempting to walk. However, he also passed a test and re-took the field only to fail one straight after the match.
He was unavailable for his team's defeat to the Hurricanes a week later.
Blues doctor Stephen Kara said he was unsighted when Kaino injured himself.
"It was on the far side of the ruck from me," he said. "What I saw was him holding his head and looking at his hand and he had blood on his hand.
"I saw the video from our analyst the next day and I saw him get up and stumble. He said he felt dizzy and light-headed. Afterwards, yes, you could say he had 'ataxia', or the inability to walk straight. In hindsight, if I had seen that, it would have been a case of 'that's enough for me'. I have a low threshold for getting guys off. It's just a game of rugby."
If players are suspected of having concussion, they must undergo an off-field test — a Head Injury Assessment Tool — which involves a series of simple questions (see above), plus a balance test and the requirement to repeat back to the doctor a series of random words and a string of numbers. There is no definitive test for concussion.
But there are several indicators which result in permanent removal without the need to use the test, including, "confirmed loss of consciousness, suspected loss of consciousness, balance disturbance and definite confusion".
Last weekend, Blues flanker Luke Braid was removed from the field after being knocked unconscious by Hurricanes lock James Broadhurst, for which Broadhurst was cited and suspended.
In the same match, Blues lock Josh Bekhuis passed an off-field concussion test after colliding with Tony Woodcock and played on, only to fail one after the match.
The major area of improvement must be the identification of head injuries as they happen. Kara said he usually followed a game behind the play — to see who doesn't get up from a ruck, for example — rather than seeing contacts as they happen.
One person who presumably can help in this area is the television match official yet, on the whole, they are reluctant to get involved.
Kara said more assistance would be a good thing, "because it relies on one of those three people [team doctor, match doctor or referee] to witness it".
"I've been in games where players have told me, 'this guy can't remember the lineout calls'. I've not seen anything. It may have been an innocuous event. Obviously those guys come off and often fail [tests] straight away."
Kara said professional players were lucky to have the support they received.
"The biggest problem is at the community level — at a school game, for example, with no doctors on the sideline. That's our biggest risk area."
