MAC Alliance also offers comprehensive cognitive assessments to further evaluate the impact of TBI and concussions on brain function. These assessments help to identify cognitive deficits, such as memory problems, attention issues, and executive function impairments, that may result from a head injury.

In addition to the oculomotor treatment program, MAC Alliance provides personalized rehabilitation plans that incorporate various therapeutic modalities, such as physical therapy, occupational therapy, and speech therapy, to address the specific needs of each individual recovering from a TBI or concussion.

By combining cutting-edge technology with evidence-based rehabilitation strategies, MAC Alliance aims to optimize outcomes for individuals recovering from head injuries and support them on their path to full recovery and improved quality of life.

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Even minor concussions can result in functional vision challenges and balance issues. Eye movement irregularities, often overlooked, can indicate underlying health issues. Functional visual impairments may present as headaches, balance difficulties, reading challenges, and decreased attention spans.

Using the latest version of RightEye, we can efficiently analyze eye movement patterns and compare test results for immediate feedback. Enhanced data analysis allows us to provide informed suggestions to alleviate post-concussion symptoms.

It is crucial to address these visual impairments early on to prevent long-term complications. Neglecting these symptoms can lead to prolonged recovery times and potential worsening of conditions. Early intervention through targeted vision therapy can significantly improve outcomes and reduce the risk of persistent issues.

By leveraging innovative technologies like RightEye, healthcare professionals can accurately assess and monitor visual function post-concussion, allowing for personalized treatment plans tailored to each individual’s needs. This personalized approach not only enhances recovery but also enhances overall quality of life for patients recovering from concussions.

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RightEye’s tools offer benefits to both athletes and non-athletes by providing rapid and objective eye-tracking screenings, diagnostic indicators for TBI, precise severity assessments, non-invasive screening methods, clear post-concussion monitoring, and performance enhancement through eye movement analysis.

For individuals with concussions or TBIs, RightEye’s technology offers a comprehensive approach for diagnosis, monitoring, and treatment, in line with MAC Alliance’s extensive network spanning multiple states.

In addition to the mentioned benefits, RightEye’s technology also allows for personalized treatment plans based on individual eye movement patterns, facilitating targeted rehabilitation strategies and improving overall outcomes for patients with brain injuries. The integration of advanced analytics and real-time feedback enables healthcare providers to deliver more precise and effective care, ultimately leading to better recovery and enhanced quality of life for those affected by concussions or TBIs. This innovative approach aligns with the cutting-edge solutions provided by MAC Alliance, reinforcing their commitment to improving brain health across various communities.

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All patients suspected of acute concussions should undergo a comprehensive physical examination including neurological and cervical spine assessments to identify traumatic injuries. Additional tests may be recommended based on presenting symptoms and the clinical judgment of healthcare professionals.

Refer to Tool 2.1: Physical Examination for a detailed summary of tests for the neurological and cervical spine evaluations.

It is advised to exercise clinical discretion when conducting and interpreting components of the virtual physical examination due to factors like visual quality and environmental conditions.

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Mental status: Documenting patient alertness and orientation is crucial. Alternatively, record the Glasgow Coma Scale score and assess speech during the evaluation for any abnormalities.

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Extraocular movements: Utilizing appropriate camera angles, evaluate ocular alignment, eye movements, and gaze tracking for irregularities. Assess smooth pursuits and facial symmetry, noting any asymmetries or abnormalities.

• Facial sensation: Test touch sensations along trigeminal nerve distributions, and assess movement of the palate and tongue for symmetry.

1: Evaluation of physical condition.

2: Heart rate under 70% of maximum for age at initial assessment

3: Symptoms of post-concussion syndrome

4: Heart rate at or above 70% of maximum for age at initial assessment

5: Symptoms of post-traumatic disorder

Continuing from the provided section on the Physical Examination, here are some additional details to consider:

Steps for Physical Examination

– Assessment of Overall Health: It is important to also take into account the patient’s general appearance, skin color, and any signs of distress during the examination.
– Testing of Cranial Nerves: In addition to the standard evaluations of CN I-XII, it may be beneficial to test for additional functions specific to certain nerves, depending on the patient’s symptoms.
– Ophthalmoscopic Examination: Apart from using a standard ophthalmoscope, specialized tests like visual field testing or color vision testing can provide further insights into potential visual disturbances.
– Pupil Response: Along with checking for pupil reactivity, assessing for any signs of anisocoria (unequal pupil size) can help identify potential neurological issues.
– Ocular Movement Assessment: In cases where there are concerns about eye movements, additional tests such as the Hirschberg test or cover-uncover test can be performed to assess for strabismus or other abnormalities.
– Saccadic Eye Movements Assessment: Evaluating saccades for accuracy and speed can be done using tools like an infrared oculography system for more precise measurements.
– Vestibulo-ocular Reflex (VOR): To further evaluate VOR function, techniques like head impulse testing can be used to assess the vestibular system’s contribution to eye movements.
– Near Point of Convergence (NPC) and Accommodation: While using an Accommodation ruler, it is essential to also assess for vergence facility and excess phoria to rule out any underlying convergence insufficiency issues.
– Neck and Sub-occipital Region Examination: Incorporating myotome and dermatome testing can help differentiate between cervical spine-related symptoms and those stemming from a concussion.
– Balance Assessments: Including dynamic balance tests like the Sensory Organization Test or the Modified Clinical Test of Sensory Interaction on Balance can provide a more comprehensive evaluation of balance impairments post-concussion.
By expanding on these aspects and incorporating them into the physical examination process, clinicians can gather a more detailed understanding of a patient’s condition following a concussion.

Supplementary Testing

Clinicians may face challenges determining whether symptoms are concussion-related or require additional testing. The Buffalo Concussion Treadmill Test (BCTT) is valuable for assessing exercise tolerance in patients with persistent post-concussion symptoms (PPCS).

Limitations

The brief concussion physical examination amalgamates elements from the SCAT5 and VOMS while focusing on autonomic function, dynamic balance, and cervical assessment. It is suitable for outpatient settings.

In addition to the assessments mentioned, the BCPE also includes evaluation of orthostatic vital signs, which are crucial in identifying potential autonomic dysfunction following a concussion. Orthostatic vital signs measure changes in blood pressure and heart rate when moving from lying down to standing up, providing valuable information about how the body is responding to postural changes. Monitoring orthostatic vital signs can help healthcare providers identify and manage symptoms such as dizziness, lightheadedness, and syncope that may occur as a result of autonomic dysfunction post-concussion.

Supplementary Material

Acknowledgments

This publication has been supported by the National Institute of Neurological Disorders and Stroke under award number 1R01NS094444. The authors are accountable for the content.

We would like to express our gratitude to the research participants who generously volunteered their time and effort to take part in this study. Their contributions are invaluable to advancing our understanding of neurological disorders.

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