Diagnostics
Adequate diagnostics and interpretation of the results are the basis for initiating optimum therapeutic measures after head injuries. We provide a broad and multidisciplinary range of diagnostic methods.
Anamnesis and clinical neurological examination, as well as examination of the cervical spine
When dealing with head injuries, detailed assessment of the symptoms (anamnesis) and their interpretation is very important during the early stages after the event. A distinction must be made between a disorder of central functions, for example memory lapse, disorientation or eye movement disorders, or a peripheral cause, for example a disorder of the balance organ in the inner ear.
After the anamnesis, we conduct a symptom-oriented neurological examination and an examination of the balance organ and of the cervical spine.
Vestibular and oculomotor examination
Dizziness and balance disorders are among the most common symptoms after a head injury. The vestibular and oculomotor examination using advanced technology devices includes a variety of tests to assess the balance functions of the inner ear and brain: video head impulse test (stabilization of the gaze during rapid head movements), dynamic visual acuity (DVA) (visual acuity during head movements), sacculus test (measurement of neck muscle activity during acoustic stimulation of the inner ear), utriculus test (measurement of eye muscle activity during vibration of the hear), video-oculography with caloric measurement (recording of voluntary and involuntary eye movements under different conditions), fundus photography (degree of ocular torsion), pure tone audiometry (hearing test).
The examinations are selected on an individual basis, depending on the clinical results obtained beforehand.
Neuropsychological examination
The neuropsychological examination is an important component in the return-to-sport management after concussion. Cognitive impairment, such as disturbances of memory, attention, concentration or reaction time, can be identified in this way.
We mainly perform neuropsychological tests when athletes exclusively indicate specific neurocognitive complaints and/or after the symptoms have abated with regard to the return-to-sport decision. The results are interpreted by an experienced neuropsychologist.
SCC physio check
The SCC physio check is a central element in the diagnosis and contains the following components: short anamnesis, vestibulo-oculomotor evaluation, checks on postural stability, gait analysis, specific examination of the cervical spine and various functional tests (cardiovascular, coordinative and sports-specific abilities).
Based on these results and in consultation with the treating physicians and the medical support team, a rehabilitation programme is developed that is adapted to the individual needs of the athlete.
Dynamic posturography (equitest)
Dynamic posturography (equitest) is a dynamic balance analysis. After head trauma, this allows a differentiation between the components involved in the balance system (vestibular and visual perception and somatosensory system). In addition, there is the option of testing motor control. Impairments are recorded quantitatively and can be checked on during the rehabilitation phase.
Visuo-vestibular integration test (2D-Turntable)
This test objectively quantifies how information on self-motion in space is integrated by the brain. The aim is to find out whether disorientation, dizziness and nausea after a concussion are caused by an imbalance in the processing of information on self-motion from the visual system (i.e. seeing a movement as it happens on the train when looking at the passing train through the window) and/or the vestibular system (which detects the actual movement but only works optimally for fast, short head movements).
The patient sits comfortably on a rotating chair surrounded by a completely closed drum (2D rotating chair). During the test, the patient experiences a series of relatively slow, passive turns (1 turn in 6 seconds).
A concussion can lead to an improved response to visual movement stimuli making people more sensitive to visual stimuli that are normally filtered by the brain (e.g. scrolling the phone, watching TV, going to supermarkets). This so-called “hypersensitivity” can be objectified by 2D-evaluation and treated by desensitization.
Other methods of examination, such as cerebral imaging, for specific questions
A distinction can currently be made between (mild) concussion and other forms of traumatic brain injury (TBI) in that there is no structural damage can be detected based on conventional imaging techniques (CT or MRI of the brain).
Imaging of the brain should be requested with the primary question of whether there are any structural changes that are triggering the symptoms (e.g. a brain haemorrhage) in cases where there are specific signs or symptoms (such as memory lapse, confusion or increasing headache), where symptoms persist beyond the normal course of recovery, or with a view to a very early return to routine training and competitive sports. A specialist in neuroradiology will evaluate the images.
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