August/September 2021 - 21

Concussions
BRIEF INSTRUCTIONS
Patient seated unless noted otherwise. 9‐40 y/o, 1 day
or > after injury.
Pursuit ‐ One stick, 3' away and level with athlete's
nose, move stick slowly 1.5' to the left and 1.5' to the
right. Repeat moving stick vertically. Slow: 2 seconds to
go L to R & again L to R. 2 repetitions each direction.
Saccade ‐ Start 2 sticks, 3 feet away and level with
athlete's nose. Each stick 1.5' to the left and right of nose.
Look over & back 10x. Repeat vertically. The athlete is to
move eyes as fast as they can.
NPC ‐ One stick, 3' away and level with patient's
nose. Move stick slowly towards the nose. Stop when
they report seeing double or you see an eye turn/drift.
Measure distance to the nose.
VOR ‐ Hold one stick, 3' away and level with athlete's
nose. The speed of head movement, 180 bpm.Patient
turn head 20 degrees left and right, 10 times maintaining
focus on the target. Repeat vertically.
Visual Motion Sensitivity ‐ Standing, the patient holds
stick or thumb; arms reach in front of the nose. While
maintaining fixation on a stick, rotate head arms and
trunk left and right 80 degrees 5x @50 bpm.
Once the detailed history and physical assessment of
the concussed athlete have concluded the athlete might
need to be referred to a physician trained in the evaluation
and treatment of sports-related concussions depending on
your state's concussion laws. If the athlete has unresolved
symptoms of a concussion longer than the typical recovery
time of seven to ten days, it is recommended that the
athletic trainer refer the patient to a physician trained in
the management of a concussion. Again, all findings from
the physical examination should be given to the attending
physician, along with any neurocognitive testing results
including baseline results if available.
It is imperative that we understand that the SCAT5 alone
is not enough when examining the student-athlete who has
sustained a sports-related concussion. The athletic trainer
needs to perform a detailed examination that includes
all the above tests and assessments so that there is a
thorough blueprint for the athlete's medical team. The postconcussion
physical exam will be critical in the development
of the appropriate treatment plan, return to learn plan,
and the return to play protocol. The detailed examination
performed by the athletic trainer at the time of injury or
before the visit to the physician will help the athlete's
physician determine the extent of the concussion and when
and how the return to play protocol should be initiated. n
A longer version of this story will appear on
CoachAD.com.
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August/September 2021

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