Concussion: Recognition & Diagnosis

About a month ago, I provided a general overview of concussions, including basic definitions, signs and symptoms to look for, initial treatments, and protocols for return to sport and other activity. Today, I want to delve deeper into the details of initial concussion recognition and medical diagnosis.
As a reminder, concussions occur when an external force results in excessive contact between the brain and the skull. Loss of consciousness may occur, but it is not the determining factor.
Concussions often occur during participation in sports. While higher contact sports such as football and hockey have a higher prevalence of concussions, all sports have potential for concussions to occur. Incidents such as head impact into another player, head impact into the ground, and severe whiplash events can lead to concussion.
Often, a concussion includes two impacts between the brain and skull – the initial contact or blow (known as the coup) and the secondary contact or blow (known as the contrecoup) that results as the head rebounds.

Initial signs and symptoms to look for when attempting to recognize a potential concussion include:
– Dizziness
– Headache
– Balance/Coordination Deficits
– Blurred Vision
– Nausea/Vomiting
– Fatigue
– Insomnia
– Confusion
– Difficulty Concentrating
– Sensitivity to Light or Sound
– Loss of Consciousness
When a concussion is suspected, an athlete should immediately be removed from any strenuous activity, including sport. Continued participation in activity or sport can result in more serious brain injury.
Initial diagnostic testing of the athlete should be performed in a quiet, controlled environment. Several tests may be administered, and symptom provocation with any test should be noted. Tests may include:
– Cervical Range of Motion – Neck mobility is measured
– Gross Strength Assessment (Manual Muscle Testing) – Neck, Arm, Trunk & Leg strength is assessed
– Gaze Stabilization – Eye movements are assessed in various ways (e.g. horizontally, vertically, extremes of peripheral vision)
– BPPV Testing – Use of the Hallpike-Dix maneuver to assess for true vertigo may be performed
– Balance Assessment – Double limb, single limb, and tandem stance (i.e. heel-toe stance) may be assessed both with eyes open and eyes closed
I hope that this information is useful and will allow everyone to recognize concussions and avoid any potential complications for our athletes.
Thanks for reading and have fun but stay safe!
– Rob Kohutanycz, PT, DPT

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