Concussion Tests: Noninvasive Assessment of Brain Function

What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?

Concussion Tests

A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.

Tests

A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.

Measurements

Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.

Types of Tests

There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:

Online Checklists

• Several different online checklists are available for concussion screening.
• These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.

Baseline and Post-Injury Tests

• Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
• Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.

Standardized Assessment of Concussion – SAC

• This five-minute test can be done on the sidelines after a sports injury or later.
• It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)

King-Devick Concussion Test

• This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)

Post-Concussion Symptom Scale

• This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)

Sport Concussion Assessment Tool – SCAT

• This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
• An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)

Buffalo Concussion Physical Examination – BCPE

• A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
• After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.

Results

A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690

Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534

Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108

Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938

Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049