Assessment
Anne Mucha, DPT, Michael W. Collins, PhD, R.J. Elbin, PhD, Joseph M. Furman, MD, PhD, Cara Troutman-Enseki, DPT, Ryan M. DeWolf, MS, ATC, Greg Marchetti, PhD, and Anthony P. Kontos, PhD
Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues.
Linda Papa, MDCM, MSc; Gretchen M. Brophy, PharmD; Robert D.Welch, MD, MS; Lawrence M. Lewis, MD; Carolina F. Braga, BA; Ciara N. Tan, BS, MHSH; Neema J. Ameli, BS; Marco A. Lopez, AS; Crystal A. Haeussler, BS; Diego I. Mendez Giordano, BS; Salvatore Silvestri
Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have been widely studied and show promise for clinical usefulness in suspected traumatic brain injury (TBI) and concussion. Understanding their diagnostic accuracy over time will help translate them into clinical practice.
Pashtun Shahim, MD; Yelverton Tegner,MD, PhD; David H. Wilson, PhD; Jeffrey Randall, PhD; Tobias Skillbäck, MD; David Pazooki, MD, PhD; Birgitta Kallberg, BSc; Kaj Blennow, MD, PhD; Henrik Zetterberg, MD, PhD
Lack of objective biomarkers for brain damage hampers acute diagnosis and clinical decision making about return to play after sports-related concussion.
Aaron M. Yengo-Kahn, BS, Andrew T. Hale, BS, Brian H. Zalneraitis, BS, Scott L. Zuckerman, MD, Allen K. Sills, MD, and Gary S. Solomon, PhD
Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date.
Ventura RE, Balcer LJ, Galetta SL
Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Concussion, a form of mild TBI, might be associated with long-term neurological symptoms. The effects of TBI and concussion are not restricted to cognition and balance. TBI can also affect multiple aspects of vision; mild TBI frequently leads to disruptions in visual functioning, while moderate or severe TBI often causes structural lesions. In patients with mild TBI, there might be abnormalities in saccades, pursuit, convergence, accommodation, and vestibulo-ocular reflex. Moderate and severe TBI might additionally lead to ocular motor palsies, optic neuropathies, and orbital pathologies. Vision-based testing is vital in the management of all forms of TBI and provides a sensitive approach for sideline or post-injury concussion screening. One sideline test, the King-Devick test, uses rapid number naming and has been tested in multiple athlete cohorts.
This test is designed for use with subjects ages 9-40. When used with patients outside this age range, interpretation may vary. Abnormal findings or provocation of symptoms with any test may indicate dysfunction – and should trigger a referral to the appropriate health care professional for more detailed assessment and management.
James M. Gurleya,b,∗, Bryan D. Hujsakc and Jennifer L. Kellyc
Vertigo, dizziness, and imbalance are a symptom complex that is commonly found following concussion. Early metabolic changes following concussion may lead to worsening of the injury and symptoms in individuals not properly managed from the outset. When symptoms do not recover spontaneously, skilled vestibular rehabilitation can be an effective modality in an attempt to normalize the individual’s vestibular responses.
Kathy Aligene ,∗ and Emerald Lin
The purpose of this chapter is to provide an update on the clinical management of vestibular and balance dysfunction in a concussed athlete with a focus on diagnosis, initial work-up, and initial and continuing management. Although much is still unknown about the etiology of vestibular and balance dysfunction in a concussed athlete, we briefly review current theories about neural pathophysiology to help link proposed treatment methodologies.
