Understanding the various concussion tests (Part II)

Head Injury

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If you haven’t already, click here to read the first part of this article. 

In today’s world of sports and recreational activities, the word concussion comes up a lot. As more awareness is spreading about this mild traumatic brain injury, athletes and coaches are looking to minimize its risk as well as looking for the right assessment tools and diagnostics to prevent any long-term effects of its impact on the brain. 

Below are some additional concussion tests that are performed:

Glasgow Coma Scale4) Glasgow Coma Scale

If the patient is stable, awake and alert, the emergency doctor will assess the level of consciousness by the Glasgow Coma Scale (GCS). The scale combines points for 1) Eye opening response 2) Verbal response 3) Motor response. A score of 15 is “fully awake and alert” a score of 3 “is fully unconscious”. The Glasgow Coma Scale is also measured by the EMTs during emergency transport and this is considered the patient’s “baseline”.

 

 

 

5) CT scan and X-ray:

 The outcome of the examination along with the history of the injury will determine which x-rays needs to be taken. The head itself is always examined by a CT scan. This is to look for fractures of the face and skull. The neck can be examined by both x-rays and CT scans if the initial x-ray shows an abnormality. CT scans of the neck look for areas of bleeding around bony fractures.

 

Concussion Signs to look for at the end of ER visit include

  • Repeated vomiting. 
  • Loss of consciousness, or deterioration of consciousness (such as if a person becomes unable to answer questions correctly, appears confused, stops responding, or can’t be woken from sleep). 
  • A headache that gets worse over time. 
  • Changes in speech or coordination, such as slurred speech or clumsiness. 
  • Seizures. 
  • Changes to pupil size or responsiveness, especially if one pupil becomes bigger than the other. 
  • Lasting or recurrent dizziness. 
  • Obvious difficult with mental function or performing physical tasks.

6) Concussion test – Neurologist / Neurosurgeon

Specialists who follow up with concussions will conduct additional tests to see how the brain is functioning in the days and weeks after head injury. Tests may include: 

  • Vision testing, eye muscle assessment. 
  • Gait and balance testing sitting, standing and walking. 
  • Memory assessments with a series of words in a pattern or even backwards. 
  • Electroencephalograms, or EEGs – tests which measure the electrical activity of the brain.
  • These tests can tell doctors if the brain is still recovering from an injury, even if noticeable symptoms of concussion have disappeared.  Blood tests to look for chemical markers of brain injury, which can help doctors learn how much rest and treatment a patient need. 

 

7) Concussion test – Physical therapy

Besides checking for neck stiffness, poor posture and imbalance in neck muscles, physical therapy assessments after concussion usually focus on testing the function of the vestibular and ocular systems, and providing treatment or training as needed.

  • Symptoms of vestibular ocular disability usually include:
  • Dizziness 
  • Headache 
  • Nausea 
  • Clumsiness 
  • “Shaky camera vision,” in which your image of the world seems rocky and unstable because your muscles are not compensating for the movements of your body in order to stabilize your vision.

The best way to assess deficits in the oculomotor system is to look for abnormal saccades and smooth pursuits. While smooth pursuits allow for eyes to follow a moving object, saccades help the eyes jump from one object to another in a uniform manner, mostly tested when an object is in motion.

 

Some other clinical tests you want to get acquainted with are as follows:

  • Near Point of Convergence Testing:
  • Positive Fusional Vergence Test (PFV)
  • The Dynamic Visual Acuity Test
  • The Clinical Test of Sensory Interaction on Balance
  • The Bruininks-Oseretsky Test of Motor Proficiency: 124
  • The Head Impulse Test, or Head Thrust Test: 125
  • The Head Shake Test
  • Computerized Dynamic Posturography 166
  • Caloric Testing 165
  • VEMP Testing 167
  • Rotational Chair Testing

Although these tests and the results they produce are of utmost importance, prevention is key and the key to prevention is awareness. Educate to advocate.

Make yourself aware

Learn more on concussions, purchase your copy today: Concussion and Sports – What every parent needs to know

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