How do online concussion assessments work?
Concussions can disrupt work, school, physical activity, and daily life in ways that feel unpredictable. While in-person assessments are often ideal, virtual concussion care has become a practical and effective option—especially in Ontario, where regulated health professionals can provide remote assessments within their scope.
Online concussion assessments are structured, evidence-based, and surprisingly thorough. They combine detailed history-taking with a targeted virtual physical exam and modern rehabilitation strategies that have strong support in the literature. Here’s how the process works.
A Detailed, Structured Clinical History
A high-quality history is the foundation of any concussion evaluation—virtual or in-person. Most of the diagnostic value for concussion comes from understanding the mechanism of injury, symptom progression, and functional impacts.
During an online assessment, patients can expect discussion around:
Mechanism of Injury (How the injury happened, was there loss of consciousness, was there direct impact to the head, etc)
Symptom profile (types of symptoms, including visual, vestibular or cognitive symptoms, presence and type of headache, aggravating and relieving factors, exercise tolerance, etc).
Medical history and risk assessment (previous history of concussions, other medical conditions and medications, prior psychoemotional problems, etc).
Current function (work, school or sport demands, goals for treatment, do you have a support system, other practitioners you are seeing, etc).
The Virtual Physical Examination
An online concussion exam is structured, reproducible, and adapted to a remote setting. While certain tests require in-person tools, many components of a concussion evaluation translate well to virtual care and allow high-level assessment and treatment to all concussion patients, irrespective of their access to in-person care in their community.
During an online physical examination, patients can expect the following tests to be performed:
Neurologic Screening (Orientation and recall, limb movement and coordination, cranial nerve function, speech or motor deficits, etc). These help rule out more serious pathology and ensure the presentation fits a mild traumatic brain injury rather than something more severe.
Oculomotor and Vestibular Testing (tests of visual function and inner ear function, and whether or not they are contributing to your concussion symptoms).
Balance and gait (tandem stance, single leg stance, instability testing, gait observation, etc).
Cervical Spine Screening (ranges of motion, muscle strength, self-palpation, dizziness, etc).
Evidence-Based Treatment Options Delivered Virtually
Current concussion research consistently shows that active, targeted rehabilitation is more effective than prolonged rest. Online care can deliver most components of an evidence-supported concussion recovery plan.
Your recovery plan may include any combination of the following components based on your individual symptom profile.
1. Symptom-Limited Aerobic Exercise
Graded aerobic activity, based on the Buffalo Concussion Treadmill/Bike framework, improves recovery times and autonomic regulation. Patients can complete assessments at home with guidance and progressions.
2. Vestibular Rehabilitation
For dizziness, motion sensitivity, or balance problems:
Gaze-stabilization exercises
Balance retraining
Visual motion habituation
Dynamic head-movement tasks
3. Oculomotor/Visual Therapy
For double vision, blurry vision, trouble focusing, headaches and sensitivity to light.
Pencil push-ups or Brock string exercises
Saccadic training
Smooth pursuit training
Integration exercises
4. Cervical Spine Rehabilitation
Persistent headaches, neck pain and/or dizziness often improve with:
Manual therapy strategies taught as self-management
Mobility drills
Deep neck flexor activation
Postural correction
Strength and coordination work
5. Cognitive and Return-to-Work/School Planning
Your return to work, school and sports will be faster and safer when using structured return planning rather than trial-and-error:
Modifying screens, workload, breaks
Gradual increase in cognitive and physical load
Strategies for attention, pacing, and task management
Coordination with employers, teachers, or sports organizations
Coordination of medical clearance testing for sports (SCAT, Gapski-Goodman Test).
6. Headache and Migraine Management
Depending on the type of headache presentation:
Lifestyle and sleep strategies
Trigger identification
Exercise and vestibular integration
Referral for medication when indicated
7. Integration with your other healthcare providers
After our assessment, we will coordinate your care with your other healthcare professionals, including if you need additional in-person therapy for specific components of the treatment plan. This can include communication and/or referral to a:
Medical doctor
Concussion specialist/ neurologist
Neuro-ophthalmologist
Other paramedical services (physiotherapy, athletic therapy, chiropractor, massage therapist, etc).
Immediate access to a qualified healthcare professional
A good virtual assessment includes clear triage and information on whether or not you should actually be seeking emergency medical care. Worrisome symptoms would include:
Worsening neurologic symptoms
Severe headache
Repeated vomiting
Focal weakness
Seizure
Suspicion of skull fracture
Visual changes not explained by concussion
Need for in-person vestibular or cervical testing beyond the scope of virtual methods
Most concussion cases can be managed virtually, but patient safety remains the number one priority of our clinic, whether we are delivering concussion care in clinic or virtually.
The Bottom Line
Online concussion assessments are structured, clinically rigorous, and built on modern evidence that emphasizes targeted rehabilitation. A thorough history and a well-designed virtual physical exam allow clinicians to identify which systems are impaired and build a personalized treatment plan. For many patients—especially those who are busy, injured, or living in remote areas—virtual concussion care provides accessible, effective support through the entire recovery process.