Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition: Summary 31
Common Tests • Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) : ○ Assess: memory composite (verbal and visual), visual motor speed composite, reaction time composite, impulse control composite ○ C3 Logix These tests assess various cognitive domains including verbal memory, visual memory, processing speed, and reaction time. Interpretation: Results should be interpreted in the context of clinical findings, baseline scores (if available), and the overall clinical picture. Neuropsychological testing has clinical value and contributes significant information but should not be used as an independent return-to-play tool. REHABILITATION TECHNIQUES Modern concussion management emphasizes active rehabilitation rather than prolonged rest. Key principles include: Gradual, progressive activity: in the first 48 hours, athletes should limit their amount of screen time. However, they should be encouraged to engage in light physical and cognitive activity, while staying below symptom thresholds. This approach has been shown to be safe and may facilitate recovery. Subsymptom threshold exercise: closely monitored active rehab programs involving a controlled subsymptom threshold with submaximal exercises have shown benefits in facilitating recovery. Multimodal approach: for athletes with persistent symptoms (>10 days), a multidisciplinary rehabilitation approach may be beneficial, including:
○ Symptoms: increased symptoms when inactive, normal VOMS • Ocular : ○ Signs: rarely wake with a headache, abnormal pursuits, saccades, and near point convergence. Each trajectory has characteristic symptoms, risk factors, and findings on specialized tests like the Vestibular/Ocular Motor Screening (VOMS). Psychological factors and severity of initial symptoms play a significant role in the recovery time. Comprehensive Assessment A thorough clinical evaluation should include: • Detailed symptom assessment • Neurological examination • Balance testing : ○ Balance Error Scoring System (BESS): ■ Balance with eyes closed: double leg, single leg, and tandem stance on a stable surface and foam over 20 seconds • Vestibular Ocular Motor Screening (VOMS) : ○ Assess for headache, dizziness, nausea, and fogginess in response to smooth pursuits, saccades, near point convergence, VOR, and visual motion sensitivity • Cognitive testing • Consideration of psychological factors It is crucial to understand that psychological factors play a significant role in symptom recovery and can contribute to persistent symptoms. NEUROPSYCHOLOGICAL TESTING LEARNING TIP!
Neuropsychological testing can provide valuable information about cognitive function following a concussion. Baseline and post tests are not required. However, it should not be used as a standalone diagnostic or return-to-play tool.
• Cognitive therapy • Vestibular therapy • Physical therapy • Psychological therapy • Graded exercise program
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