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Introduction
Sport-related concussion (SRC) is a clinical diagnosis for which no single diagnostic test or biomarker has been identifed. 1 Complicating the diagnostic picture is the fact that the symptoms of SRC vary, occur frequently in non-concussed individuals, are not specific to concussion 2 (see table 1 ) and can change unexpectedly and dynamically. 3 A variety of approaches have been used for assessing concussion characteristics with a primary focus on the symptom clusters of cognition, neuropsychiatric symptoms, balance, sleep disturbances and migraine/headache. 4 Other common symptoms such as dizziness/vertigo and visual/ocular motor problems have been studied less frequently. 5
Signs and symptoms according to PCSS/SCAT3 | Possible aetiology | ||
Brain (concussion) | Labyrinth (vestibular) | Neck (cervical) | |
Difficulty concentrating | [checkmark] | [checkmark] | [checkmark] |
Difficulty remembering | [checkmark] | [checkmark] | x |
Feeling slowed | [checkmark] | [checkmark] | x |
Confusion | [checkmark] | [checkmark] | x |
'Don't feel right' | [checkmark] | [checkmark] | [checkmark] |
Fatigue or low energy | [checkmark] | [checkmark] | [checkmark] |
Trouble falling asleep | [checkmark] | [checkmark] | x |
Drowsiness | [checkmark] | [checkmark] | x |
Feeling like 'in a fog' | [checkmark] | [checkmark] | x |
Balance problems | [checkmark] | [checkmark] | x |
Dizziness | [checkmark] | [checkmark] | [checkmark] |
Irritability | [checkmark] | [checkmark] | [checkmark] |
More emotional | [checkmark] | [checkmark] | [checkmark] |
Nervous | [checkmark] | [checkmark] | [checkmark] |
Sadness | [checkmark] | [checkmark] | [checkmark] |
'Pressure in Head' | [checkmark] | [checkmark] | [checkmark] |
Headache | [checkmark] | [checkmark] | [checkmark] |
Neck pain | [checkmark] | [checkmark] | [checkmark] |
Sensitivity to light | [checkmark] | [checkmark] | x |
Sensitivity to noise | [checkmark] | [checkmark] | x |
Nausea or vomiting | [checkmark] | [checkmark] | [checkmark] |
Blurred vision | [checkmark] | [checkmark] | [checkmark] |
PCSS, Post-Concussion Symptom Scale; SCAT3, Sport Concussion Assessment Tool 3rd edition.
The variety of symptoms and disturbances associated with concussion necessitates the use of different assessment tests, batteries and strategies, which may help explain why there is little consistency in approaches to the diagnosis of concussion. One area of consistency that does emerge is the routine assessment of cognition with respect to rehabilitation, return to exercise, routine training and match play decisions. 6 7
The determination of preinjury status, mainly through the assessment of neurocognitive functioning, balance and symptoms at baseline, has become popular within the last decade, predominantly in elite sports. The comparison of preinjury and postinjury data was designed to identify changes or abnormalities due to SRC. Yet difficulties exist in the appropriate interpretation of test results due to the psychometric properties of the tests and a variety of potential confounding factors (eg, test conditions,...