Novel Assessment for Interpreting and Documenting an Absence of Suspicion of Injury Including Protocols based on Recognizable Clinically-Relevant Neurophysiological Methods

ObjectiveOur goal was to develop and validate a neurophysiological assessment that provides objective evidence useful for interpreting and documenting an absence of suspicious injury by the sports-neuro community.BackgroundAs concussion awareness gains public notoriety, the pressure on athletic organizations for timely diagnosis has risen, leading to an increase in assessments detecting brain injuries. Furthermore, legislation has mandated evaluations of suspicious injuries before returning athletes to play. However, validation and standardization of these current tests have been remiss, and their data is often not familiar to athletic trainers.Design/MethodsWe conducted exams on 18 University of Cincinnati athletes from various sports teams. The 18 athletes were assessed after being pulled-from-play, sometimes including failed pulled-from-play, to document the athlete’s return-to-play. All 18 athletes were referrals sent by athletic trainers unsure of the presence of neurotrauma. The list of assessments includes: stereopsis measurements, phoria, oculomotor performance, near-point of convergence, pupil responses, visual suppression, and balance.ResultsAfter examination of the 18 participants, 4 were diagnosed having high suspicion of concussion while the other 14 were cleared to return-to-play. Of the 14 cleared athletes, 0 were found to exhibit any persistent or newly developed symptoms. These results suggest that this assessment can provide useful data for clinical concussive injury evaluation. These demographics can also be examined for developing normative data and increased sensitivity with baselines.ConclusionsWe feel that current concussion assessments for athletic organizations are inadequate. We identified a series of neurophysiological tests that are more clinically-relevant, easy to perform, and document as evidenced from the evaluations used on the University of Cincinnati athletes for diagnostic and return-to-play decisions. This assessment’s functionality goes beyond the sideline, providing valuable insight for documenting presence or absence of suspicious injury post-competition. We feel this model has enhanced clinical utility compared to the current widespread concussion sideline assessments.