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The physical assessment examines the patient for objective data that defines the patient's condition, and aids in formulating the nursing care plan. The purpose of physical assessment is a health status appraisal, which includes identifying health problems, and establishing a database for nursing intervention.
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Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials
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A Practical Concussion Physical Examination Toolbox.

Jason M Matuszak1, Jennifer McVige2, Jacob McPherson3

  • 1Excelsior Orthopaedics, Amherst, New York.

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|March 30, 2016
PubMed
Summary

Standardizing concussion physical exams is crucial for consistent patient care. While elements like ocular, balance, and mental status exams show promise, more validity data is needed for these concussion assessments.

Keywords:
concussionmTBIphysical examination

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Area of Science:

  • Neurology
  • Sports Medicine
  • Physical Therapy

Background:

  • Growing awareness of concussion necessitates standardized assessment and management protocols.
  • Current concussion physical examinations lack standardization and robust evidence.
  • Key questions persist regarding the optimal physical examination for concussion.

Purpose of the Study:

  • To review and identify pertinent physical examination elements for concussion assessment.
  • To synthesize evidence regarding the utility of various physical examination components for concussion.

Main Methods:

  • Comprehensive literature review of ClinicalKey, Cochrane, MEDLINE, and PubMed up to July 2015.
  • Search terms included concussion, mild traumatic brain injury (mTBI), physical examination, and specific neurological/musculoskeletal components.
  • References of relevant articles were also reviewed for additional sources.

Main Results:

  • Key concussion physical exam components include cranial nerve assessment, manual muscle testing, deep tendon reflexes, head/neck inspection, cervical range of motion, Spurling maneuver, balance assessment, ocular screening, and mental status examination.
  • Additional elements to consider include upper motor neuron testing, cervical proprioception, coordination, pupillary reactivity, visual acuity, temporomandibular joint, thoracic spine, fundoscopy, orthostatic vital signs, and screening for psychological comorbidities.
  • Elements like ocular examination, cervical musculoskeletal assessment, balance testing, and mental status examination appear useful but lack validity data.

Conclusions:

  • Several physical examination components, including ocular screening, cervical musculoskeletal assessment, balance testing, and mental status examination, show potential utility in evaluating concussion.
  • There is a significant lack of empirical data to support the validity of these physical examination elements for concussion.