Concussion Management for Wheelchair Athletes: Evaluation and Examination

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This book arises from the challenges and difficulties involved in the evaluation and management of concussions in wheelchair athletes. Concussions are most readily identified in the ambulatory population via identifying gross motor instability or when athletes lose their balance and stumble after a blow to the head or neck region. Because wheelchair athletes participate in sport while sitting down and using a wheelchair, clinicians must be extra attentive to identify a potential concussion. Once a potential concussion is identified, there are many challenges in evaluation of the wheelchair athlete population due to their comorbidities. At baseline, they may have signs and symptoms that mimic a concussion, and their impairments can also alter their cognitive and balance assessments. Therefore, it is critical to make a distinction between these athletes’ baseline comorbid impairments and potential new exam findings in a concussion. 

Filling in a critical gap in the literature, this is a concise pocket guide for any clinician, trainer, or rehabilitation specialist who is involved in wheelchair sports. It focuses on the unique challenges in evaluating a concussion in the wheelchair athlete, including baseline testing, the process of evaluating the signs and symptoms of a concussion, cognitive and vestibular examination, new clinical techniques specific to wheelchair athletes, and the return to play process. A Concussion Management Program (CMP) for use on the sideline as well as in the office is included. 

Practical and timely, Concussion Management for Wheelchair Athletes is a valuable resource to increase awareness, provide guidance on the unique challenges within this population, and generate interest in future research and investigation.

Author(s): Kenneth Lee, Michael William Harper, Michael Joseph Uihlein, Michael McCrea
Publisher: Springer
Year: 2021

Language: English
Pages: 247
City: Cham

Preface
Acknowledgments
Contents
Contributors
Editors
Authors
About the Editors
1: Introduction
Introduction
Background
Mechanism of Injury
Common Symptoms
Evaluation
Concussion Complications
Persistent Postconcussive Symptoms
History and Epidemiology of Concussion in Wheelchair Athletes and Parasport
Challenges to Evaluation in Wheelchair Sports
Concussion Mimics in the Wheelchair Athlete
Objective of This Handbook
References
2: Concussion Baseline Testing
Introduction
Concussion Baseline Testing
Purpose
Structure
General Tools
Pitfalls
Heterogeneity of Athletes’ Functional Abilities
Confounding Factors
Unnecessary Removal from Participation
Wheelchair Athlete-Specific Tools
Research
Able-Bodied
Wheelchair Athletes
Gaps in Evidence
Future Goals
Barriers
Recommendations
References
3: Evaluation of Signs and Symptoms
Introduction
Signs and Symptoms
Physical
Cognitive
Emotional
Sleep
Assessment Tools and Scoring Scales
Conclusion
References
4: The Cognitive Exam
Introduction
Purpose and Principles of Sports Cognitive Testing
Do Wheelchair Users Have Any Issues That Could Interfere with Standard Cognitive Testing?
What About Wheelchair Users with Upper Extremity Deficits?
Other Comorbidities Affecting Cognitive Performance
Spinal Cord Injury
Traumatic Brain Injury
Stroke
Multiple Sclerosis
Amyotrophic Lateral Sclerosis
Cerebral Palsy
Amputation
Summary
Cognitive Tests
Sideline Tests
SCAT
Wheelchair-Specific Limitations
SAC
Wheelchair-Specific Limitations
Concussion Recognition Tool
Wheelchair-Specific Limitations
Abbreviated Westmead Post-traumatic Amnesia Scale
Wheelchair-Specific Limitations
Clinical Tests
MoCA
Wheelchair-Specific Limitations
SLUMS
Wheelchair-Specific Limitations
MMSE
Wheelchair-Specific Limitations
Computerized Neuropsychological Tests
ImPACT
Wheelchair-Specific Limitations
ANAM
Wheelchair-Specific Limitations
Axon
Wheelchair-Specific Limitations
Summary
Neuropsychological Testing
Test Interpretation
Summary
References
5: Balance Testing in Wheelchair Athletes
Introduction to Balance
Concussion Effects on Balance
Balance Assessment in Concussion
Balance Assessment in Wheelchair Athletes
Firm Surface Test
Balance Disc Test
Wheelie Test
Recommendations for the Future
Conclusion
References
6: Clinical Reaction Time
Reaction Time
Clinical Reaction Time (RTclin)
Measuring Clinical Reaction Time
Baseline Testing
Evaluating SRC
Conclusion
References
7: Vestibular Examination
Introduction
Concussion
Cortical Concussion
Labyrinthine Concussion
Assessment
History
Pupil Reactivity
Dizziness Handicap Inventory (DHI)
Vestibular/Ocular Motor Screening (VOMS)
Conclusion
References
8: Return to Play
Introduction
Current Return-to-Play Protocol/Progress
Unique Return-to-Play Considerations for the Wheelchair Athlete
Persistent Symptoms After Concussion
Conclusion
References
9: Future Areas of Interest
Introduction
Chapters
Chapter 1: Baseline
Chapter 2: Signs and Symptoms
Chapter 3: Cognitive
Chapter 4: Balance
Chapter 5: Reaction
Chapter 6: Vestibular
Chapter 7: Return to Play
Technology
Blood Biomarkers
Conclusion
References
Wheelchair Sport Concussion Management Program
Purpose
Definition of Concussion
Education
Coaches Education: Fact Sheet and Acknowledgment
Wheelchair Athletes Education: Athlete Responsibility and Fact Sheet
Sports Health Staff Education: Acknowledgment
Evaluation and Management of Suspected Concussive Injuries
Reducing Exposure to Head Trauma
Administrative
Appendix A: Pre-participation Evaluation Form for Athletes with Disabilities
Appendix B: Sport Concussion Assessment Tool – 5th Edition (SCAT5)
Appendix C: Concussion History Questionnaire
Demographics
Concussion History
Appendix D: Symptom Evaluation Checklist for the Wheelchair Athlete (SEC)
Wheelchair Athlete Considerations
Appendix E: The Standardized Assessment of Concussion (SAC) Form A
Appendix E: The Standardized Assessment of Concussion (SAC) Form B
Appendix E: The Standardized Assessment of Concussion (SAC) Form C
Appendix E: The Standardized Assessment of Concussion (SAC) Form D
Appendix E: The Standardized Assessment of Concussion (SAC) Form E
Appendix E: The Standardized Assessment of Concussion (SAC) Form F
Appendix F: Wheelchair Error Scoring System Manual (WESS)
Wheelchair Error Scoring System (WESS)
Wheelchair Error Scoring System Score Card
Factors Affecting Balance Survey
Appendix G: King-Devick Test (K-D)
King-Devick Concussion Screening Test Instructions
King-Devick Concussion Screening Test Score Sheet
Establishing a King-Devick Test Baseline
King-Devick Concussion Screening
Appendix H: Clinical Reaction Time (RTclin)
Clinical Reaction Time Test Protocol (RTclin)
Making the Device
Appendix I: Concussion Testing Summary Table
Appendix J: Graduated Return-to-Sport (RTS) Strategy for the Wheelchair Athlete
Appendix K: Concussion Take-Home Instructions
Concussion Take-Home Instructions
Appendix L: Concussion Fact Sheet for Coaches
Appendix M: Acknowledgment of Coach Concussion Education
Appendix N: Acknowledgment of Health Staff Concussion Education
Appendix O: Concussion Fact Sheet for Athletes
Appendix P: Statement of Wheelchair Athlete Responsibility
What Is a CONCUSSION?
Facts About CONCUSSION
Signs and Symptoms of CONCUSSION Include the Following
Why Knowing You Have a CONCUSSION Is Important
Statement of Wheelchair Athlete Responsibility
Index