Considerations for Diagnosis and Management of Concussion

Mucha, Anne; Trbovich, Alicia

doi:10.2519/jospt.2019.8855

Cited by 15 publications

(44 citation statements)

References 138 publications

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“…For clinicians, understanding the responsiveness of an assessment tool is critical to inform clinical decision-making with regard to rehabilitation management of individuals with impaired postural control. In an athletic population, current sideline assessments have limited diagnostic accuracy outside of the acute of time following injury and not sensitive enough to capture more subtle impairments which may increase risk for future injury with premature return to play [20,21]. These findings suggest that field-expedient systems, such as the Biodex BioSway™, may offer reliable posturographic testing when gold-standard methods are not available.…”

Section: Discussionmentioning

confidence: 99%

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™

Miner

Harper

Glass

et al. 2022

BioMed Research International

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Background. Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols. Purpose. The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an adaptation of the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) which adds two head shake conditions to challenge the vestibular contributions to postural control. Study Design. This was a correlational time series cohort study completed in a biomechanics laboratory. Methods. The sample consisted of nineteen healthy adults (10 females, 9 males). Sway Index, Equilibrium Score, and the area of the ellipse enclosing 95% of the anterior-posterior (AP) and medial-lateral (ML) center of gravity (COG) displacement (AREA95) are the 3 summary variables. Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) are also reported. Results. Test-retest reliability was generally poor with limited exceptions. Moderate to good reliability was observed for the more challenging stance conditions (ICC range 0.58-0.81), including those with head shake. Conclusions. Field-expedient systems, such as the Biodex BioSway™, may offer reliable posturographic testing where gold-standard methods are not available. Clinicians should be aware that less demanding test conditions have limited reliability; however, test-retest reliability of this assessment tool is improved with more challenged stance conditions and the inclusion of a head shake task.

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Section: Discussionmentioning

confidence: 99%

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™

Miner

Harper

Glass

et al. 2022

BioMed Research International

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“…The diagnosis, evaluation, management, and determination of recovery from concussion relies largely on clinical assessment. Currently there is no sole instrument sufficient to assess concussion in isolation, and research supports comprehensive, multidomain assessment approaches to concussion, and a multi-disciplinary approach to care for post-concussion symptoms (45). Research suggests that a one-size-fits-all method of concussion care is ineffective (46).…”

Section: Discussionmentioning

confidence: 99%

Stakeholder Recommendations to Increase the Accessibility of Online Health Information for Adults Experiencing Concussion Symptoms

Beaton

Hadly

Babul

2021

Front. Public Health

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Background: Concussion is a global public health problem. In Canada, concussion is among the top five reasons for workplace time-loss. Concussion results in physical, cognitive, and/or emotional symptoms that temporarily worsen with physical and mental exertion, such as viewing electronic screens. The Internet is the primary source of consumer health information. Studies on the end-user needs of adults with brain injuries in regards to digital health technologies largely focus on informational content. There is little to no research on the accessibility of screen-based informational websites and smartphone applications among this population.Objective: The aim of this research was to involve stakeholders in the design of a comprehensive educational resource to guide concussion recognition, recovery, and return-to-work, called the Concussion Awareness Training Tool for Workers and Workplaces (CATT WW). In order to ensure both relevant content and appropriate delivery of the information to the target groups, participants were asked whether adaptations could increase the accessibility of online health information for the general adult population experiencing concussion symptoms.Methods: Data have been generated through semi-structured in-depth interviews and focus groups with participants from across British Columbia (BC): workers from various industries who were in the concussion recovery process or had returned to work (n = 31); and healthcare or workplace professionals who support concussion diagnosis, recovery, and return-to-work (n = 16). Data were analyzed using NVivo 12. Before commencing data collection, ethical permission was granted by the University of British Columbia Research Ethics Board (H18-00604), and approval was received from WorkSafeBC Research Services.Results: Participants (n = 47) recommended twenty adaptations or supplements to electronic screen-based digital health technologies.Conclusion: Given the high prevalence of concussion among the working adult population, the symptom exacerbation commonly caused by prolonged use of electronic screens, and the demand for online educational resources, these findings can guide clinicians, researchers, technology developers, employers, and occupational health and safety committees to further support adults in concussion recovery and return-to-work.

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“…The importance of assessing the Vestibular-Ocular-Motor (VOM) system post SRC has been highlighted in recent papers (8)(9)(10)(11)(12). VOM function is reliant on the integration of the vestibular, ocular and somatosensory systems and dysfunction can cause many different symptoms (10).…”

Section: Introductionmentioning

confidence: 99%

“…The Balance Error Scoring System and Sensory Organisation Test are traditionally used as measures for assessment of the vestibular system; however, they only characterize the vestibulospinal component of the vestibular system (10). The Vestibular-Ocular-Motor Screening (VOMS) tool and King-Devick test are reported to assess both the vestibular and ocular components of VOM function (9,15). The King-Devick test has come under scrutiny for high rates of abnormal baseline performance (16,17), false-positive tests post-exercise (18,19), practice effects (18) and low sensitivity (60-62%) and specificity scores (39-84%) (20,21).…”

Section: Introductionmentioning

confidence: 99%

“…Impairment of VOM function has been reported in research to affect between 42-81% of student-athletes diagnosed with SRC (25)(26)(27)(28)(29). VOMS has been recommended to be an integral component of SRC baseline and post-injury assessment (7,9,(30)(31)(32) due to VOM impairments deleterious effects on academic performance (33,34), gait and balance (29,35), delayed recovery (25,26,33,(36)(37)(38)(39) and delaying return to learn (25,38,40) and play (12). It is therefore essential to identify student-athletes with VOM impairment to successfully manage and rehabilitate student-athletes through a gradual return to learn with a multifaceted approach (40)(41)(42)(43).…”

Section: Introductionmentioning

confidence: 99%

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Does Vestibular-Ocular-Motor (VOM) Impairment Affect Time to Return to Play, Symptom Severity, Neurocognition and Academic Ability in Student-Athletes following acute Concussion?

et al. 2021

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Introduction: Research indicates Sports-Related Concussion (SRC) impairs Vestibular-Ocular-Motor (VOM) function. The aim was to explore if VOM impairment correlates with longer Return To Play (RTP), symptom burden, neurocognitive performance and academic capability. Participants; 40 (61.4% male) Loughborough University, UK, rugby union student-athletes sustained 42 SRC's. Methods: Student-athletes completed an assessment battery during pre-season (baseline), 2, 4, 8 and 14 days post SRC and prior to RTP and were managed according to the rugby Football Union' community pathway. Outcome measures; Vestibular Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Perceived Academic Impairment Tool (PAIT) questionnaire and percentage of academic activities specifically missed due to SRC.Results: VOMS scores were significantly (p<0.005) greater than baseline at all time points except RTP. Prescence of VOM dysfunction at 14 days post SRC significantly correlated with a longer RTP, greater symptom burden and increased odds ratio at 2, 4 and 8 days and academic time loss at 2, 4 and 8 days post-SRC.Conclusion: VOM impairment is associated with an increased symptom burden and impaired academic capability, and a longer time to RTP when present at 14 days post-SRC.

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Considerations for Diagnosis and Management of Concussion

Cited by 15 publications

References 138 publications

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™

Stakeholder Recommendations to Increase the Accessibility of Online Health Information for Adults Experiencing Concussion Symptoms

Does Vestibular-Ocular-Motor (VOM) Impairment Affect Time to Return to Play, Symptom Severity, Neurocognition and Academic Ability in Student-Athletes following acute Concussion?

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