By Dave Biberdorf, OD, FCOVD
Sports medicine specialists are uniquely positioned to assess acute-phase sports related concussion and see an athlete throughout their recovery. Although there are tools available within the athletic community to assess an athlete’s concussive status and track recovery, such as the King-Devick Test or ImPACT Test, these tests require a baseline and are therefore susceptible to “sandbagging” by an athlete.
Provocative vision tests can be extremely useful tools to help with concussion and post-concussion syndrome diagnosis as the symptoms they provoke can be difficult if not impossible for an athlete with a sports-related concussion to conceal. And for the over 50% of people who sustain a concussion without access to baseline testing because they are not involved in organized sports, these provocative tests can be invaluable.
While we wait for objective biomarkers of concussion to emerge, it may be important to reconsider the value of subjective provocative tests for concussion and post-concussion syndrome. While there are a number of tests you can use, in my experience, the four tests below are some of the most rapid, inexpensive and dramatic symptom-provoking tests that should be included in a concussion health care providers’ toolbox.
Strong responders to these tests are common in the concussed population and will generally exhibit an aversive physical reaction, such as pulling back, closing the eyes, pushing the target away, facial distortions, alteration of breathing, complaints of dizziness or nausea or demands that the test be stopped.
Observing the behavioral responses to these provocative tests or recording the patient’s subjective disturbance on 1-5 scale, for example, will help the clinician in their decision-making.
I believe that sharing these provocative vision tests with members of your sports medicine team will not only help them determine when an athlete should be removed from play, but will aid in return-to-play/learn/drive/work decision-making as well!
Click on the links below for descriptions of each of these tests, along with video examples of each.