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Table 1 Clinical examination tests utilized at initial evaluation

From: Clinical examination factors that predict delayed recovery in individuals with concussion

System

Assessment Method

Abnormal Findings

Reference

Cognitive

Standardized Assessment of Concussion (SAC)

Score < 26, mean score 26.6 (1996 McCrea)

McCrea M, Kelly J, Randolph C. Standardized Assessment of Concussion (SAC): Manual for Administration, Scoring and Interpretation. Waukesha, WI: CNS Inc.; 1996.

Cervical

Active ROM

Palpation of spinous processes and musculature

Pain

Decreased ROM

 

Visual

King-Devick (KD)

Symptom provocation during test

Galetta KM, Barrett J, Allen M, et al. The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology. 2011;76 (17):1456–1462. doi:https://doi.org/10.1212/WNL.0b013e31821184c9.

Balance

Balance Error Scoring System (BESS)

Score > 19, normal scores 12.03 ± 7.34

Guskiewicz KM. Postural stability assessment following concussion: One piece of the puzzle. Clin J of Sport Med. 2001;11 (3):182–189.

Vestibular

Vestibular Oculomotor Screen (VOMS):

(1) smooth pursuit, (2) horizontal and vertical saccades*, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR)*, and (5) visual motion sensitivity (VMS)

*Performed for 10 s

Symptom provocation with any of the tests

Mucha A, Collins MW, Elbin RJ, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions: Preliminary Findings. Am J Sports Med. 2014;42:2479–2486.