Unlike other body regions, many of the primary outcome measures used for the structures and systems located in the head are clinician rated. The head and face, including the eyes, ears, mouth, and nose, are the primary systems for the major senses of sight, hearing, taste, and smell (the fifth major sense, touch, is assessed using upper- and lower-quarter screens). Vision tests and hearing screens are among the most common functional assessments. These are discussed in Chapters 18 and 19.
The diagnosis and management of concussions rely on both patient-reported symptoms and clinician- and patient-rated function. Measures of balance, coordination, memory, and neurocognitive function used during the course of care are described in Chapter 20. Standardized assessments such as the Sport Concussion Assessment Tool provide scores for different subsections, allowing test–retest comparisons to gauge progress. Other scales can measure the impact of headaches, depressive symptoms, and mood states.1 Broad health-related quality-of-life measures described in the Section I opener also provide helpful information regarding a patient's progress.
Headache Impact Test (HIT-6™)
The HIT-6™ assesses the effect of headaches on patient function and productivity.2 Derived from a 54-item questionnaire, the HIT-6™ measures the level of headache-related dysfunction using a global score and four subscores: functional, psychological, social, and therapeutic. The resulting impact is then rated as "little to none," "moderate," "substantial," or "severe." 3
Beck Depression Inventory II (BDI II)
The BDI was developed to screen individuals for depression and has been used to monitor for depressive symptoms following concussion.5 Because it assesses for the severity of depressive symptoms, the BDI II can also be used to monitor progress.6 The BDI II list 21 symptoms such as sadness, potential for suicide, and changes in appetite. The patient selects an option relating to the severity of that symptom over the past 2 weeks. Scores are tallied, with a range from 0 to 63. Higher scores represent more severe symptoms and are interpreted as follows7:
Profile of Mood States (POMS)
The POMS has a wide range of uses and is a common instrument in sports psychology. This instrument assesses the patient on six mood subscales: tension–anxiety, depression, anger–hostility, vigor, fatigue, and confusion. In the subscales of tension–anxiety, depression, anger–hostility, fatigue, and confusion, lower scores indicate a more positive mood state. In the subscale of vigor, a higher score is indicative of a positive mood state.5