Section 5: Examination of the Head

INTRODUCTION

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. When assessing the head and face, the primary outcome measures are clinician-rated. Vision tests and hearing screens are among the most common functional assessments. These are discussed in Chapters 18 and 19.

The evaluation, 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 (SCAT), provide scores for different subsections, allowing test-retest comparisons to gauge progress. Other scales measure the impact of headaches, depressive symptoms, and mood states.¹ Broad health-related, quality-of-life measures described in the Section 1 opener also provide helpful information regarding a patient’s progress.

PATIENT-REPORTED OUTCOME MEASURES

Headache Impact Test (HIT-6^TM)

The HIT-6™ assesses the effect of headaches on patient function and productivity.² Using a 54-item questionnaire, the HIT-6TM 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

• Minimum Detectable Change: 2.5⁴

• Minimum Clinically Important Difference: 1.5⁴

Beck Depression Inventory-II (BDI-II)

The BDI-II was developed to screen individuals for depression and has been used to monitor for depressive symptoms following concussion.⁵ Because it assesses the severity of depressive symptoms, the BDI-II can also be used to monitor progress.⁶ The BDI-II lists 21 symptoms, such as sadness, potential for suicide, and changes in appetite. The patient rates the severity of that symptom over the previous 2 weeks. Scores are tallied, with a range from 0 to 63. Higher scores represent more severe symptoms and are interpreted as follows⁷:

• Minimal range: 0–13

• Mild depression: 14–19

• Moderate depression: 20–28

• Severe depression: 29–63

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

• Minimum Detectable Change: Variable based on the condition being monitored

• Minimum Clinically Important Difference: Variable based on the condition being monitored

REFERENCES