Practical Management: Telehealth Examination for Sport-Related Concussion in the Outpatient Setting

This paper presents the Telehealth version of the Buffalo Concussion Physical Examination (Tele-BCPE). It is a brief, focused telehealth physical examination (PE) for use in the outpatient setting by sports medicine physicians, pediatricians, neurologists, and primary care physicians. It is derived from the the BCPE and includes general considerations for providers performing telehealth services as well as instructions for adapting traditional clinical tests for virtual use. The Tele-BCPE includes an orthostatic intolerance screen, examination of the cranial nerves, and tests of the oculomotor, vestibular and cervical systems. It is meant to be used at initial and follow-up outpatient visits for patients acutely after concussion as well as in those with prolonged symptoms. This telehealth physical examination, when combined with other assessments, can help providers direct treatment to patients at any stage after concussion and reduce barriers to healthcare access posed by the COVID-19 pandemic and for patients living in rural or underserved areas.