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Tests we use to determine a concussion.

12 cranial nerves

Balance Error Scoring System

How to determine if an Athlete has an concussion

  • Balance Assessment
  • ImPACT
  • Testing for 12 cranial nerves

What is a Concussion?

  • The BESS consists of 3 tests lasting 20 seconds each, performed on a firm surface
  • Then on a piece of medium-density foam, all with the eyes closed, and scored based on the number of errors across trials:

The athlete first stands with the feet narrowly together, the hands on the hips, and the eyes closed

  • holds this stance for 20 seconds while the number of balance errors
  • opening the eyes, hands coming off hips, a step, stumble or fall, moving the hips more than 30 degrees, lifting the forefoot or heel, or remaining out of testing position for more than 5 seconds are recorded as errors.
  • The test is then repeated with a single-leg stance using the non-dominant foot,

A third time using a heel-toe stance with the non-dominant foot in the rear (tandem stance).

The advantages of the BESS are that it is inexpensive

  • easy-to-administer, and quick (5-7 minutes)

I. Olfactory – Smell. Insist that your neurologist checks this is you have any basis for concern.

II. Optic – Vision.

III. Oculomotor – Eye movement.

IV. Trochlear – Eye movement.

V. Trigeminal – Controls the muscle and senses of the face.

VI. Abducens – Eye movement.

VII. Facial – Taste, expression and facial and scalp movements.

VIII. Vestibulolocochlear – Hearing and vestibular system.

IX. Glassopharyngeal – Gag reflex, taste, throat and sinus reflex.

X. Vagus – throat, voice, gag reflex, coughing, dilations of the stomach.

XI. Accessory – rotate head, shrug shoulder, raising chin.

XII. Hypoglossal – muscles of the tongue.

Tests of the 12 nevers

ImPACT

  • The movements and reactions of the eye.
  • An examination of the eye using an ophthalmoscope.
  • A test of smell, of each nostril. This is particularly important in concussion cases, as a compromised sense of smell can be an indicator of frontal lobe damage. Sadly, this is the part of the test most often neglected.
  • The patient should be asked to whistle, smile and clench his teeth.
  • Hearing should be tested.
  • The muscles required to move the head around should be palpitated.
  • The patient is asked to do the classic hand and arm movements, in order to elicit evidence of tremors, unilateral or bilateral motor weakness and to evaluate coordination and position sense.
  • The neurological exam will also likely contain a rudimentary test of cognitive function, often the mini-mental status exam.
  • One important piece of the overall concussion evaluation and management process.
  • A sophisticated test of cognitive abilities.
  • The most scientifically researched concussion management tool.
  • A tool that can help health care professionals track recovery of cognitive processes following concussion.
  • A tool to help communicate post-concussion status to athletes, coaches, parents, clinicians.
  • A tool that helps health care professionals and educators make decisions about academic needs following concussion.
  • There is no clear definition of concussion.
  • Uncertain whether any damage to the brain occurs from a concussion.
  • CT scans and MRI scans typically do not detect any brain damage — such as bruising or bleeding — in concussion patients.
  • A concussion does,temporarily impair how the brain functions and processes information.

12 cranial nerves

The focus of a neurological exam after concussion is usually the nervous system, with a particular emphasis on the cranial nerves. The Cranial nerves are nerves which branch off of the brain stem, and primarily control the functions which are within the head.

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