What To Expect At Your First Concussion Assessment

When you make your first appointment, you will be sent a document to fill out and submit back so that your health practitioner will be prepared with what you are dealing with before you even walk in the door. First, you will be asked detailed questions as to how the concussion occurred, if there was any loss of consciousness, any amnesia before or after the incident, or any immediate symptoms such as dizziness, vomiting/nausea, headaches, confusion, or neck pain.

Next you will be asked if you have seen your family doctor or any other medical professional, and if any imaging (CT, X-Ray, MRI) has been done. Note imaging can not diagnose a concussion, and is not usually required, but it is used to rule out more serious conditions such as fractures or bleeds.

Lastly, you will discuss in detail the symptoms you have been and currently are experiencing, and how they are effecting your home life, work/school life, activities, sleep, mood, and normal daily tasks such as being in a vehicle, screens, busy environments, and so on.

Physical Assessment

For this part of the assessment, your rehabilitation professional will use the information from the history to guide their evaluation. Your examination will consist of specific functional testing done in a clinical setting, and may focus more on those particular symptoms to determine the root cause and most appropriate course of treatment.

In most cases, the exam will start with a series of tests done on the cervical spine (neck). This includes range of motion, orthopedic tests, and examning the musculature of your neck. In many cases, whiplash is associated with a concussion, and the symptoms of either often mirror each other. Headaches and dizziness can often come from the spine and muscles of the neck, so it is important to see if that is contributing to the ongoing symptoms that are occurring.

Next, a series of neurological tests to rule out a more serious injury. Cervical proprioception tests may also be done at this time – this system signals the position of the head relative to the trunk, coordinates the vestibular and visual systems, and controls posture and balance.

Then, a series of tests known as the Vestibular Occular Motor Screening will be done. These tests evaluate your eye tracking, convergence, saccadic movements, vestibular ocular reflexes, and eye-head coordination to see how your visual and vestibular systems are functioning. These tests will often cause the current concussion symptoms you are experiencing, and help tailer your treatment plan, of if a referral to a vestibular/ophthalmology specialist is required. While some people may try to hide their concussion symptoms, these tests will show the practitioner if in fact something is not right.

After that, a series of balance tests may be done with your eyes open, eyes closed, on a foam pad, and with different feet positions to see if there is any deficit. Sometimes people don’t realize their balance may be an issue and contributing to some of their symptoms until they undergo these tests.

Additionally, your practitioner may do some additional tests that require you to move your head and/or body to see if dizziness is triggered by certain movements or exposure to motion in your environment.

In a follow up visit, if you have tried physical activity after your concussion and it has caused an increase in symptoms, a Buffalo Concussion Treadmill Test (or modified version of this) will be done. This test monitors your heart rate every minute while you walk at a specific pace while the incline is increased every minute. This is done to see that your heart rate is increasing at a steady rate, and to see what your heart rate is at when your symptoms start to increase. Your health practitioner will then send home an exercise plan to help raise the threshold of your symptoms until you are able to exercise without symptoms at all.

Plan of Management

Once the history and physical examination findings are compiled, your healthcare provider will inform you what they found and provide you with education surrounding the findings of your assessment, your injury and diagnosis, what to expect from your recovery, and whether any specific treatment and rehabilitation strategies would be beneficial. This may include exercises for your vestibular-occular systems, treatment and exercises for your neck, activity based exercise program, cognitive support strategies, and an outline of some do’s and don’ts that includes advice on sleep, nutrition, and mental health support. If needed, a detailed return to school/work/sports plan will be provided which you can take home with you to give to whoever is needing it. And of course, any remaining questions you may have will be answered.