August/September 2021 - 20

Concussions
experiencing which then can help the athletic trainer
choose the appropriate rehabilitation.
The use of vestibular ocular-motor screening (VOMS)
allows clinicians to better identify patients who may
require specialized vestibular and vision therapy early
in the recovery process. This better understanding of
vestibular ocular-motor symptoms and their relationship
to recovery can better help the athletic trainer develop
rehabilitation and ultimately help improve outcomes for
their patients in the quest to return to full learning and
athletic participation. Athletic trainers and the concussion
management team must use a multidimensional approach
to assess and manage sports-related concussions since
we currently do not have a " stand-alone " objective tool
to diagnose sports-related concussions or a way to
determine the length of recovery.
The athletic trainer should perform the physical
examination of the athlete periodically during the
recovery phase of the injured athlete to assess the
athlete's road to recovery and to determine what
adjustments need to be made to the rehabilitation plan.
The multidimensional post-concussion evaluation should
be conducted at a minimum weekly on the athletic and
should take the athletic trainer about 15 to 20 minutes
to perform. The evaluation should consist of assessment
tools but not limited to which include a detailed history of
the event, symptom score, SCAT5, balance testing, and
Vestibular Ocular-Motor Screen (VOMS). All findings of
the concussion assessment should be made available to
the athlete's medical team to ensure all parties are on the
same page and all efforts are coordinated for the best
interest of the athlete.
The detailed history of the event and athlete's medical
history is a critical component in the assessment process
which should include:
1. How many head injuries has the patient had in the past?
* When did they occur?
* How did they occur?
* What type of symptoms did the athlete have?
* How long did the symptoms last?
* Did they lose consciousness?
*
Did they have amnesia (anterograde or retrograde)?
2. Are the current symptoms and injury associated with
loss of consciousness or amnesia and what type?
3. Does the athlete have a history of motion sickness?
4. What kind of headache does the athlete have and
does it worsen with exertion or mental work?
5. Does the athlete get dizzy with movement?
6. Is the athlete more sensitive to light or noise?
7. Is the athlete more distracted?
8. Is the athlete moody or irritable?
9. Does the athlete feel " foggy " or " removed " ?
10. How long did it take the athlete to recover from
past concussions?
11. Did the athlete have incidents/symptoms from any
20 | Training & Conditioning | August/September 2021
hits to the chest, neck, or face that radiated to the head
(e.g., whiplash) that were not reported as a concussion?
The physical examination should first include the SCAT5
and the BESS examination, which should be conducted
on the sidelines but when appropriate the physical exam
should be conducted in a distraction-free environment
(e.g., locker room or medical room) rather than on the
sideline. The SCAT5 alone should take about 10 minutes
to thoroughly conduct. Additionally the SCAT5 this a
physical exam that consists of vital signs, analyses of
speech and gait, cranial nerve testing, visual field testing,
upper extremity sensation, lower extremity sensation,
range of motion, muscle strength, deep tendon reflexes,
Romberg's test, pronator drift test, tandem walk, heel to
shin test, finger to nose testing, and vestibular ocularmotor
screening (VOMS). It is highly recommended that
the athletic trainer and medical staff include VOMS testing
as part of the physical exam because of the importance the
vestibular-ocular system plays in concussions.
Let's take a closer look at some of these important
physical exam tests that should be performed on the
post-concussion patient in the clinic:
ROMBERG'S TEST: (BALANCE/ PROPRIOCEPTION
TESTING)
The athlete is asked to stand with his or her feet close
together, arms by the side, and eyes open. Any significant
swaying or tendency to fall is noted. The athlete is then
asked to close his or her eyes. Postural swaying is again
noted and compared with that observed with open eyes.
FINGER TO NOSE TESTING: (COORDINATION
TESTING)
This test is performed by the athlete fully extending
their arm and touching the athletic trainer's finger. Then
touching the nose repeats the motion from extending
an arm to the nose. To increase the difficulty the athletic
trainer can move their finger in different locations. An
abnormal test is when the athlete cannot perform the
task smoothly and rapidly.
VOMS: (VESTIBULAR-OCULAR MOTOR SCREENING)
Modified from Mucha A, Collins MW, Elbin RJ, Furman JM,
Troutman‐Enseki C, DeWolf RM, Marchetti G, Kontos AP.
Smooth Pursuits - The capacity for the athlete to
follow a slowly moving target.
Saccades - The capacity for the athlete's eyes to move
quickly between two targets.
Convergence - The capacity for the athlete to view a
near target without double vision.
Vestibular-Ocular Reflex (VOR) Test - The capacity
for the athlete to stabilize vision as the head moves.
Visual Motion Sensitivity (VMS) Test - The athletes
capacity to inhibit vestibular-induced eye movements
using vision.
August/September 2021

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