Concussion Tests

Concussions = mild brain injuries

Assessing impact on patient rather than damage or degree of injury.

Not all headaches are concussions but all concussions have headaches, so we need to test balance because balance is related to the cerebellum.

Balance Error Scoring System (BESS)

• 20 seconds for each

• Stand with eyes closed

• Both of FIRM and FOAM surface

Double Leg Stance

Single Leg Stance

Tandem Stance

An error is given when any of the following occur: moving hips off the hips, opening the eyes, stumbling or falling, abduction or flexion of the hip beyond 30 degrees, lifting part of the foot off the testing surface, or remaining out of position for over 5 seconds.

VOMS (Vestibular/Ocular-Motor Screening)

Baseline Symptoms – Record: headache, dizziness, nausea & fogginess on 0-10 scale prior to beginning screening

• Smooth Pursuits:

  • Test the ability to follow a slowly moving target

  • The examiner holds a fingertip at a distance of 3 ft from the patient. The patient is instructed to maintain focus on the target as the examiner moves the target smoothly in the horizontal direction 1.5 ft to the right and 1.5 ft to the left of midline. One repetition is complete when the target moves back and forth to the starting position

  • Two repetitions

  • Should last around 2 seconds

  • Also repeated in a vertical direction

  • After, record: headache, dizziness, nausea & fogginess ratings

• Saccades = test the ability of the eyes to move quickly between targets

• Horizontal Saccades:

  • The examiner holds two single points (fingertips) horizontally at a distance of 3 ft from the patient, and 1.5 ft to the right and 1.5 ft to the left of midline so that the patient must gaze 30 degrees to left and 30 degrees to the right

  • Patient needs to move their eyes as quickly as possible from point to point

  • 10 repetitions

  • After, record: headache, dizziness, nausea & fogginess ratings

• Vertical Saccades:

  • Repeat the test with 2 points held vertically at a distance of 3 ft from the patient, and 1.5 ft above and 1.5 ft below midline so that the patient must gaze 30 degrees upward and 30 degrees downward

  • Patient needs to move their eyes as quickly as possible from point to point

  • 10 repetitions

  • After, record: headache, dizziness, nausea & fogginess ratings

• Convergence:

  • Measure the ability to view a near target without double vision

  • The patient focuses on a small target at arm’s length and slowly brings it toward the tip of their nose

  • The patient is instructed to stop moving the target when they see two distinct
    images or when the examiner observes an outward deviation of one eye

  • 3 repetitions

  • After, record: headache, dizziness, nausea & fogginess ratings

  • Abnormal: convergence ≥ 6 cm from the tip of the nose

• Vestibular-Ocular Reflex (VOR) Test:

  • Assess the ability to stabilize vision as the head moves

  • Examiner holds a target of approximately 14 point font size in front of the patient in midline at a distance of 3 ft

• Horizontal VOR Test:

  • The patient is asked to rotate their head horizontally while maintaining focus on the target

  • 10 repetitions

  • After, record: headache, dizziness, nausea & fogginess

• Vertical VOR Test:

  • The test is repeated with the patient moving their head vertically

  • 10 repetitions

  • After, record: headache, dizziness, nausea & fogginess

• Visual Motion Sensitivity (VMS) Test:

  • Test visual motion sensitivity and the ability to inhibit vestibular-induced eye movements using vision

  • The patient stands with feet shoulder width apart, facing a busy area of the clinic

  • The patient holds arm outstretched and focuses on their thumb. Maintaining focus on their thumb, the patient rotates, together as a unit, their head, eyes and trunk

  • 5 repetitions

  • After, record: headache, dizziness, nausea & fogginess