CCSP Concussion Evaluation and Management 4 — Questions and Answers
Question 1: Which symptom cluster in post-concussion assessment is associated with vestibular dysfunction specifically?
- Headache, fatigue, and sleep disturbance
- Dizziness, nausea, and balance impairment (Correct answer)
- Cognitive fog, irritability, and emotional lability
- Photophobia, phonophobia, and visual blur
Correct answer: Dizziness, nausea, and balance impairment
Vestibular dysfunction after concussion manifests as dizziness, nausea, and balance impairment due to disruption of the vestibular system and its connections to the brainstem and cerebellum.
Question 2: When should neuroimaging (CT scan) be ordered following a suspected sports concussion?
- Routinely for all concussions to rule out structural injury
- Only when structural intracranial injury is suspected based on red flag symptoms (Correct answer)
- After 72 hours if symptoms have not resolved
- Whenever an athlete loses consciousness, regardless of duration
Correct answer: Only when structural intracranial injury is suspected based on red flag symptoms
CT scanning is indicated only when red flag symptoms (focal neurological deficits, worsening headache, repeated vomiting, seizures, prolonged LOC) suggest structural intracranial pathology.
Question 3: A CCSP athlete assessment reveals prolonged oculomotor dysfunction after concussion. Which specialized rehabilitation approach is most appropriate?
- Cervical manipulation to reduce referred pain
- Vision therapy and vestibular rehabilitation (Correct answer)
- High-intensity aerobic training
- Cognitive behavioral therapy
Correct answer: Vision therapy and vestibular rehabilitation
Vision therapy combined with vestibular rehabilitation targets oculomotor dysfunction and vestibulo-ocular reflex impairment, which are common persistent concussion sequelae.
Question 4: What is the significance of 'symptom provocation' during sub-threshold aerobic exercise in concussion rehabilitation?
- It indicates the athlete needs complete rest for another week
- It suggests cervicogenic rather than concussive headache
- It identifies the aerobic threshold for safe progressive exercise (Correct answer)
- It confirms the diagnosis of post-concussion syndrome
Correct answer: It identifies the aerobic threshold for safe progressive exercise
Symptom provocation during sub-threshold aerobic testing (Buffalo Concussion Treadmill Test) identifies the heart rate threshold at which symptoms emerge, guiding safe exercise prescription.
Question 5: Which structure's injury best explains the cervicogenic component that can mimic or complicate concussion symptoms?
- Anterior longitudinal ligament
- Upper cervical facet joints (C1-C3) (Correct answer)
- Intervertebral discs at C5-C6
- Scalene muscles
Correct answer: Upper cervical facet joints (C1-C3)
Upper cervical facet joints (C1-C3) and related structures can generate headache, dizziness, and neck pain that overlap with concussion symptoms, making differentiation clinically important.
Question 6: In which scenario would a chiropractor be legally and ethically required to withhold an athlete from practice pending physician evaluation?
- Athlete reports mild headache that resolves within 15 minutes
- Athlete has a history of three prior concussions in the same season
- Athlete displays red flag signs including unequal pupils and worsening headache (Correct answer)
- Athlete fails only the symptom checklist but passes cognitive and balance tests
Correct answer: Athlete displays red flag signs including unequal pupils and worsening headache
Red flag signs such as unequal pupils and worsening headache suggest serious intracranial pathology requiring emergency physician evaluation and the athlete must be immediately withheld from participation.
Question 7: The Vestibulo-Ocular Reflex (VOR) can be assessed at the sideline using which quick clinical test?
- Dix-Hallpike maneuver
- Head Impulse Test (Correct answer)
- Tandem gait assessment
- Cover-uncover test
Correct answer: Head Impulse Test
The Head Impulse Test (HIT) assesses the VOR by observing corrective saccades when the head is rapidly moved, indicating vestibular pathway dysfunction relevant to concussion.
CCSP Concussion Evaluation and Management 4
Which symptom cluster in post-concussion assessment is associated with vestibular dysfunction specifically?