[Free Download] Clinical Decision Flow Chart #2: Connecting the dots between the intake and clinical tests
The intent of the download is to provide a quick reference tool for connecting the dots between the intake and clinical tests. The flow chart begins with risk factors associated with a prolonged recovery and how to create a working diagnosis from the patient's symptoms. These clues provide the health care provider with system trajectories associated with concussion and a reference of standardized tests to perform in the examination. The intent is not to confirm a medical diagnosis.
There is currently no single test to diagnose a concussion. Thus, concussion evaluation can be a challenge for health care providers. Cognitive testing has long been the cornerstone for sports-related concussion (SRC). However, evaluating the vestibular and ocular motor systems post head trauma is critical due to the high incidence of abnormalities in this population(1).
A comprehensive concussion evaluation begins with a review of the patient’s past medical history and an objective measurement of symptoms such as the Post-Concussion Symptom Scale(2) or Concussion Symptom Inventory(3). The provider can obtain clues from the intake to create a working diagnosis and determine what series of test are most appropriate. Performing a clinical examination of cognitive, oculomotor and vestibular function at minimum is key. When used in combination, these tests have a relatively high predictive rate in identifying a concussion but not when used in isolation(4).
For example, cognitive testing may be normal but the individual may still have a concussion. On the other hand, oculomotor and/or vestibular testing may fall within normal limits but the individual may be concussed. Additional areas of consideration include the effects of a cervicogenic component, abnormal sleep patterns, poor nutrition and/or an emotional component as contributing factors to an individual’s signs and symptoms.
Hopefully, this tool proves helpful as a clinical guide. However, it is not intended to serve as a tool for confirming a medical diagnosis or treatment protocol.
Keep your eyes peeled for our next download connecting the dots between simple clinical tests and more sophisticated tools!
1. Ciuffreda KJ, Kapoor N and et al. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. J Optom. 2007;78(4):155-161.
2. Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13(2):9–26.
3.Randolph C, Millis S, Barr WB, McCrea M, Guskiewicz KM, Hammeke TA, Kelly JP. Concussion Symptom Inventory: An empirically-derived scale for monitoring resolution of symptoms following sports-related concussion. Arch Clin Neuropsych. 2009;24(3):219–229.
4.Mucha A, Collins MW and et al. A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: Preliminary Findings. Am J Sports Med. 2014;42(10):2479-2486.
Free Download #1:
Dizziness Differential Diagnosis: Clues from the patient's history - CLICK HERE
Free Download #2:
Free Download #3:
Connecting the dots between standard clinical tests and more advanced testing - CLICK HERE
Free Download #4:
Connecting the dots between objective findings and recovery - CLICK HERE