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Concussion Management for Healthcare Professionals: Summary
THE TEST HAS 5 COMPONENTS AND INCLUDES A SYMPTOMS CHECKLIST • Smooth Pursuits : Head stays in one place while the eyes slowly follow the object along a path • Saccades : Eyes moving rapidly while focusing on one object to another • Convergence : Focusing on a close specific target without producing double vision • Vision Motion Sensitivity (VMS) : Being able to stop eye movement when the vestibular system is functioning History Questions A history exam is subjective information taken from the patient that is pertinent information towards an injury. Clinicians should be as detailed as possible. Sometimes the story doesn’t come out completely until there have been a couple of meetings, where 80% of an evaluation or diagnosis can be performed by simply asking medical history questions that can help aid the practitioner in determining their differential diagnosis while the other 20% of an evaluation is based on special testing or diagnostic testing. History questions include: • Do you take any medications? • What equipment were you wearing? • What do you remember? • Does an individual repeatedly ask you the same questions? • This could suggest that an individual has a brain bleed • Do they exhibit behavioral changes? • Do they know where they are? Outcome Measures: Self-Reported Questionnaires • Post-Concussion Symptom Scale (PCSS) : The severity and impact of symptoms was measured by the PCSS. The PCSS consists of a list of 22 symptoms in which participants rate the intensity from 0 (none) to 6 (severe). A total score was calculated with a maximum of 132 points • Neck Disability Index (NDI) : The NDI evaluates the neck pain-related disability • Headache Disability Inventory (HDI) : The HDI evaluates the headache-related level of disability. This is known for populations with migraines. The score is out of 100 points • Dizziness Handicap Inventory (DHI) : The DHI evaluates disability linked to dizziness-like symptoms • Numeric Pain Rating Scales (NPRS) : The levels of neck pain and headache were captured separately with an NPRS. The score is recorded on a Likert scale ranging from 0 (no pain) to 10 (the worst pain ever felt)
LEARNING TIP! BESS assesses a person’s balance and can be used in a quiet clinical environment or on the sideline of a sporting event
• Eyes are closed and your hands are on your hips during this test. The stance is with your feet shoulder- width apart, one foot in front of the other (with the non-dominant foot behind the dominant one) and a single leg stand on your non-dominant leg: ○ All stances are held for 20 seconds • Errors: ○ Movement of hips >30 degrees ○ Inability to get into the position and hold the position for longer than 5 seconds ○ Lifting the big toe up or having your heel come up as a strategy to help re-balance ○ Inability to hold one of the positions: ■ Toe touch ■ Bouncing around ■ Hands off hips ■ Legs touching each other ○ Not keeping eyes closed Biomechanics • The idea of biomechanical analysis when assessing a concussion is providing objective data for postural stability (static and dynamic) and eye movement • Reaction time could fit in this category as well, but the best analysis seems to come from postural stability and eye movement • Measuring postural sway with force plates • Using an X-Box 360 camera with the KONG-IQ platform allows a practitioner to measure postural sway and look at postural accommodations when balancing appropriately VOMS (Vestibular/Ocular Motor Screening) This is a brief 5-10 minute concussion screening tool that can serve as a single component in a comprehensive approach concussion assessment. The VOMS can aide in outcome prediction for individuals following a concussion or mild traumatic brain injury (mTBI) as part of the concussion assessment battery. Equipment/materials for VOMS include a target with a 14 point font print and a metronome.
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