NFHS Advanced Techniques & Methods 3 — Questions and Answers
Question 1: In the context of the NFHS concussion protocol, what distinguishes a 'stepwise return-to-play' approach from simply waiting a set number of days?
- It requires a physician's signature at each step
- It links progression to symptom resolution and functional performance at each stage (Correct answer)
- It only applies to sports with high collision risk
- It mandates neuroimaging before each step
Correct answer: It links progression to symptom resolution and functional performance at each stage
Stepwise return-to-play is symptom-driven, requiring the athlete to be symptom-free at rest and tolerate increasing exertion before advancing each stage.
Question 2: Which advanced technique is used to objectively measure gaze stability deficits that may persist after a concussion?
- Saccadic tracking with the K-D test
- Vestibular/Ocular Motor Screening (VOMS) (Correct answer)
- Standard Snellen visual acuity chart
- Pupillary light reflex test only
Correct answer: Vestibular/Ocular Motor Screening (VOMS)
The VOMS assesses smooth pursuit, horizontal and vertical saccades, near-point convergence, and vestibulo-ocular reflex, capturing persistent post-concussive oculomotor deficits.
Question 3: When comparing computerized neurocognitive testing (e.g., ImPACT) to paper-based tests, which is a recognized limitation of computerized platforms in concussion management?
- They cannot measure reaction time
- Practice effects and variable testing environments can affect score reliability (Correct answer)
- They are not accepted by any athletic governing body
- They only assess physical balance, not cognition
Correct answer: Practice effects and variable testing environments can affect score reliability
Computerized tests like ImPACT are susceptible to practice effects, motivation variability, and environmental differences that can reduce score reliability without proper baseline controls.
Question 4: A high school football player is on Step 4 of the return-to-play protocol (non-contact training drills) and reports a mild headache. What is the correct action?
- Allow completion of Step 4 and monitor overnight
- Return the athlete to Step 3 and reassess when symptom-free (Correct answer)
- Advance to Step 5 if headache resolves within one hour
- Administer ibuprofen and continue Step 4
Correct answer: Return the athlete to Step 3 and reassess when symptom-free
Any re-emergence of concussion symptoms during return-to-play progression requires dropping back to the previous symptom-free step before advancing again.
Question 5: Near-point convergence (NPC) testing after concussion measures which specific oculomotor function?
- The ability of both eyes to maintain single binocular vision as an object moves toward the nose (Correct answer)
- Peripheral vision field width
- Pupil diameter response to light changes
- Speed of horizontal saccadic eye jumps
Correct answer: The ability of both eyes to maintain single binocular vision as an object moves toward the nose
NPC assesses convergence insufficiency—a common post-concussion finding—by measuring how close an object can approach before the athlete reports double vision or an eye breaks away.
Question 6: What is the primary purpose of establishing a pre-season neurocognitive baseline in concussion management programs?
- To legally protect the school from liability
- To provide an individualized comparison standard for post-injury assessments (Correct answer)
- To predict which athletes are most likely to sustain a concussion
- To replace the need for physician evaluation after injury
Correct answer: To provide an individualized comparison standard for post-injury assessments
Pre-season baselines capture the athlete's normal cognitive performance so post-injury scores can be meaningfully compared to their own norm rather than population norms.
Question 7: Which technique helps differentiate vestibular dysfunction from cervicogenic causes of dizziness following a concussion?
- Asking the athlete to jog in place
- Head impulse testing and cervical range-of-motion combined assessment (Correct answer)
- Standard BESS testing alone
- Blood pressure monitoring during exertion
Correct answer: Head impulse testing and cervical range-of-motion combined assessment
Combining head impulse testing (which stresses the vestibulo-ocular reflex) with cervical spine assessment helps clinicians distinguish inner-ear vestibular deficits from cervical musculoskeletal sources of dizziness.
NFHS Advanced Techniques & Methods 3
In the context of the NFHS concussion protocol, what distinguishes a 'stepwise return-to-play' approach from simply waiting a set number of days?