Practical Management: Telehealth Examination for Sport-Related Concussion in the Outpatient Setting

Abstract

This article presents the telehealth version of the Buffalo Concussion Physical Examination (BCPE) (Tele-BCPE). It is a brief, focused telehealth PE for use in the outpatient setting by sports medicine physicians, pediatricians, neurologists, and primary care physicians. It is derived from the BCPE and includes general considerations for providers performing telehealth services and instructions for adapting traditional clinical tests for virtual use. The Tele-BCPE includes an orthostatic intolerance screen, examination of the cranial nerves, and tests of the oculomotor, vestibular, and cervical systems. It is meant to be used at initial and follow-up outpatient visits for patients acutely after concussion and in those with prolonged symptoms. This telehealth PE, when combined with other assessments, can help provide direct treatment to patients at any stage after concussion and reduce barriers to healthcare access posed by the COVID-19 pandemic and for patients living in rural or underserved areas.

Early Identification and Management of Cervical Impairments in Pediatric Patients With Concussion May Reduce Risk of Delayed Recovery

“…Clinical guidelines and published protocols have advocated for the assessment of the cervical spine in cases of suspected and/or diagnosed concussion, 5,17,[20][21][22] and the potential presence of cervical impairment after concussion is well described. 10,12,14,[23][24][25][26] There are several reports describing connections between concussion, concomitant cervical injury, and delayed recovery.…”

Service Delivery Models for the Management of Pediatric and Adolescent Concussion: A Systematic Review

“…Recent literature has attempted to assess the reliability and validity of telecommunication vs in-person assessments; however, this research is in the early stages. 46 , 47 Web-based interventions offer a potential cost-effective approach to concussion care 35 , 36 , 38 52 by providing self-management strategies for concussion, which have been shown to be useful for symptom management 37 and are a useful adjunct to professional diagnosis and management of concussion. Limitations of web and telemedicine care models include access to technology, technology proficiency, language proficiency, and increased attention demands.…”

Exercise-Induced Vision Dysfunction Early After Sport-Related Concussion Is Associated With Persistent Postconcussive Symptoms

“…6 This included a history of concussion symptoms linked to a head injury or injury to another part of the body with force transmitted to the head, followed by impairments on a visio-vestibular examination. 26,27 Participants were excluded if they had any of the following: (1) 3-point or less difference between current and pre-injury symptoms as measured by the Post-Concussion Symptom Inventory on the first day of evaluation 28 ; (2) moderate or severe TBI as indicated by a score of <13 on GCS; (3) injury involving lesion on CT/MRI and/or focal neurologic signs consistent with intracerebral lesion; (4) loss of consciousness for 30+ minutes or posttraumatic amnesia for 24+ hours; (5) inability to exercise because of lower extremity orthopedic injury or increased cardiac risk; (6) history of more than 3 diagnosed concussions; and (7) currently on medications that affect cardiac autonomic function, such as ADHD medications or mood stabilizers.…”