The Physical Examination of Concussion: A Paradigm Shift in Diagnosis

A focused physical examination is critical for a thorough evaluation.

The assessment of sports concussion is modeled after a system conceptualized by Jeffrey Barth at the University of Virginia more than 20 years ago. The procedure requires first a “preconcussion” evaluation and then postevent assessments of cognition and symptoms. The current authors, from the University of Buffalo, provide an evidence-based review of study findings on using the physical examination (PE) to diagnose concussion.

In addition to assessments of cognition, mood, and anxiety, the PE has several central elements:

Examination for autonomic dysfunction, including orthostatic hypotension and exercise intolerance with symptom exacerbation (e.g., the Buffalo Concussion Treadmill Test).
Assessment of cranial nerve abnormalities, especially …

Reviewing Author

Jonathan Silver, MD

Disclosures

RoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions

Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience

Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)

Jonathan Silver, MD

Disclosures

RoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions

Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience

The Physical Examination of Concussion: A Paradigm Shift in Diagnosis

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Reviewing Author