The Most Current, Crucial Components to Address in Concussion Management

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Concussion Health answers your clinical questions about current assessment and treatment of patients suffering from dizziness and/or balance disorders.

Through its ongoing collaboration with physicians and clinical specialists, Concussion Health has gathered a comprehensive list of frequently asked clinical questions regarding the current assessment and treatment of patients suffering from concussions, dizziness and balance disorders.

With the growing interest in concussion management, the question “What would you do?” appears more and more often. It’s not a simple answer given the number of tools and digital apps available to help identify concussion signs and symptoms. As they say in the business world, “if you can’t measure it then you can’t manage it.” This reigns true in concussion management as well – using a variety of tools provides the most valuable information.

For those who have completed the Concussion Health modules or viewed the Concussion Health website, you’ll recall the two sets of pillars for concussion management:

1. Gather information per baseline, time of injury, post-injury and throughout the “return to life” process, and
2. Gather information about symptoms, cognition, balance and vision. There are clinical tools to gather data as well as more sophisticated ones – either through computerized and/or diagnostic tools.

A comprehensive clinical and diagnostic work-up is recommended for every patient post head trauma; however some clinicians may not have access to more sophisticated, diagnostic testing. In addition to a lack of resources, other factors may include not having adequate time to perform a variety of tests or lacking expertise specific to vestibular assessment.

Some questions we commonly hear are “What are the most common concussion signs and symptoms?” “What tests would you do if you didn’t have any equipment?” or “What would you do if you did not have access to a vestibular specialist?” These questions are the premise of why Concussion Health was launched -- to discuss “best case scenario” with a multi-disciplinary team yet recognizing that many individuals do not have access to such tools and/or medical providers.

The following summarizes the most commonly recognized patterns and represents “bare minimum” concussion testing recommendations:

Time of Injury

  • Concussion Symptoms: “Top 10” – most common post-concussion symptoms (Kontos, Elbin, Schatz, Covassin, Henry, Pardini, Collins. AJSM, 2012)
  • Cognition: Maddock’s questions for 13+ years of age (Maddocks DL, Dicker GD, Saling MM. Clin J Sport Med, 1995)
  • Balance: Romberg – feet together, eyes closed (Soochan K, Mijoo K and et al. Comm Comp & Info Sci, 2012)
  • Vision per oculomotor: initially assess whether pupils symmetrical then perform smooth pursuits and saccades (Capo-Aponte et al, Military Medicine, 2012)

Post-Injury -- expansion of time of injury assessment and must include information from past medical history to identify “at risk” indicators and / or concussion symptoms that are considered “red flags”:

  • Concussion Symptoms: Graded Symptom Checklist
  • Cognition: computerized testing is “gold standard.” If computerized testing is not available, use cognitive questions from SCAT2
  • Vestibular:

     >Modified CTSIB with head shake test (6 conditions)
     >Vestibular Ocular Reflex Testing per Dynamic Visual Acuity Test
     >Vestibular Ocular Cancellation Test
     >For further vestibular subjective, consider the Motion Sensitivity Quotient Questionnaire (need to plan for considerable amount of additional time)

  • Vision/Oculomotor:

     >Smooth Pursuit
     >Near Point Convergence

For more on the vestibular connection with concussions, registration opens July 2 for Concussion Health's Visual-Vestibular Approaches in Concussion Management, Friday, July 18, 1 p.m. to 2:30 p.m. CST.

The information above does not represent the most comprehensive approach but, at a minimum, does provide reliable clinical information. Two common areas are crucial components to address: 1.The vestibular ocular reflex due to the correlation with movement-related dizziness and difficulty keeping objects in focus, and
2.Ooculomotor due to the high level of sensitivity and specificity with central nervous system disruption.

Although these two areas are the most consistent cluster of concussion signs and symptoms, Concussion Health continues to support a multi-disciplinary approach. The more you can measure, the more information is available to manage. The above tools, however, provide a foundation for all clinicians to use and, above all, cost and time are no longer limiting factors. All the above are readily available and can be performed in less than 20 minutes.

About Concussion Health
Concussion Health provides the most comprehensive concussion management education through a competency-based course with certification upon completion. What sets its education apart is bridging the gap between assessment and rehab. Concussion Health’s medical staff provides instruction on how to take the findings from an assessment and put them into a comprehensive care plan for recovery. Below are additional benefits you will receive after joining the Concussion Health Community:

  • Approved continuing education on best practice and concussion management (six hours)
  • CHC videos — a place to highlight you and your efforts in concussion management
  • Case Studies Blog – What would you do?
  • Discounts on Webinars
  • Access to a private Concussion Health Community Forum
  • Quarterly Newsletters

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Jeseka Kreitner
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