Clinical Profiles Screening (CP-Screen)
CP-Screen is a validated 29-item self-report, clinical profile-based symptom inventory survey that measures the following five concussion clinical profiles: anxiety/mood, cognitive/fatigue, migraine, ocular, and vestibular; and the following two modifying factors: sleep and neck.
Vestibular-Ocular Motor Screening (VOMS)
The Vestibular/Ocular Motor Screening (VOMS) assessment is a brief, performance-based screening tool that evaluates vestibular and ocular motor function across several domains including smooth pursuits, saccades, vestibular-ocular reflex (VOR), visual motion sensitivity (VMS), and near point of convergence (NPC). When administered after concussion, the VOMS can provoke and quantify symptom responses, providing objective insight into vestibular-ocular dysfunction that often accompanies concussion.
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized neurocognitive test battery widely used in both research and clinical settings to assess cognitive domains affected by concussion, including memory, processing speed, attention, and reaction time.
Dynamic Exertion Test (EXiT)
The Dynamic Exertion Test (EXiT) is a physical exertion protocol designed to assess physiological, performance, and clinical responses following a concussion. The test begins with a two-minute warm-up on the treadmill and transitions into a 10-minute interval protocol in which the treadmill speed increases every 30 seconds, challenging cardiovascular capacity and monitoring for symptom provocation. Immediately after the treadmill portion, athletes complete a dynamic circuit that incorporates functional, sport-relevant movements—including squat jumps, side-to-side push-ups, medicine-ball rotations, jump-ball tosses, and agility tasks such as zig-zag and arrow running patterns. This combination of aerobic exertion and multidirectional movement allows clinicians to observe symptom changes, movement quality, and exercise tolerance under progressively demanding conditions.
Risk Factors
Psychological Health
Our research indicates that pre-existing psychological health conditions can increase the risk of sustaining a concussion. During a concussion, the brain attempts to protect us by shifting into a “fight or flight” mode, which is controlled by the autonomic nervous system. This response can increase symptoms such as anxiety, irritability, sadness, and fatigue. For individuals with pre-existing anxiety, depression, or stress-related conditions, an overactive nervous system can make symptoms feel much stronger and harder to shut off. Anxiety in particular keeps our brain on high alert, making us more aware and sensitive to common concussion symptoms like headache, dizziness, bright lights, and loud noises. This means that those who experience higher levels of stress in their daily life, are much more susceptible to more severe symptoms. Essentially, a brain fighting stress all day does not have the energy to also deal with a concussion.
Motion Sickness
Individuals with a history of motion sickness are pre-disposed to impairments in the vestibular system, which is commonly decompensated during concussion. This may lead to more severe vestibular symptoms such as dizziness, nausea, balance issues, and visual sensitivity which require targeted rehabilitation and are associated with prolonged recovery. Concussion often targets weak points in the brain and disrupts systems that were already vulnerable. In the case of motion sickness, because vestibular function at baseline is not working as it should, even a mild injury can overwhelm their brain’s ability to compensate for its natural vestibular deficiency. This leads to a more persistent and complicated symptom profile than someone who is not prone to motion sickness and has a fully-functional vestibular system at baseline.
Concussion History
If not treated properly, having a history of concussion may make a person more susceptible to re-injury. If symptoms are allowed to linger, the brain may become accustomed to working from a deficit, which makes it harder to re-teach your systems how to work properly. This is why it is important to seek evaluation as quickly as you can after injury. However, when all symptoms of concussion are completely and appropriately treated, the brain is able to fully recalibrate and restore to normal functioning, from which point there is no cumulative risk of experiencing further concussions. Having a history of untreated or mismanaged concussions may set you up for a higher risk of future injury and long-term symptoms, but properly managed concussions do not increase risk for further injury once a patient is cleared.
Sex/Gender
Sex and Gender differences are still being explored in relation to concussion. What we do know is that women have a higher prevalence of migraines than males. As a result they are much more likely to experience symptoms of post-traumatic migraine and are at risk for longer recovery times. In addition, women on average report greater symptom burden during their initial evaluation which project more complex paths to recovery. Further research and ongoing work in the field is being performed to determine why this is the case and how we can better understand the ways these differences drive treatment.
Migraine History
Headache, or post-traumatic migraine (PTM), is the most frequently reported symptom of concussion. Both personal and family history of migraine is associated with greater likelihood of PTM, suggesting a genetic predisposition to migraine may serve as a catalyst for its onset. This means that those who experience migraines at baseline are more likely to undergo a worsening of their headache symptoms after a concussive incident, even if that incident is mild. Additionally, migraine and concussion share many of the same symptoms: nausea, headache, blurry vision, and sensitivity to light and sound. When someone with a history of migraine experiences a concussion, the brain is further debilitated, and all of those symptoms can turn up in intensity.