Concussion Rehabilitation and Concussion Phenotypes

Concussions, often referred to as mild traumatic brain injuries (mTBI), have been a topic of growing concern in the US and sports communities internationally. Recent research reveals that concussions can lead to cognitive deficits, mood disturbances, and even affective disturbances like depression. This is important for everyone, not just athletes because sports aren’t even the leading cause of mTBI in the US–falls are. To help patients, athletes, and their providers more accurately identify and assess potential mTBI, familiarity with the different categories or “phenotypes” of concussion is key. This article aims to build your familiarity with these phenotypes by using the “COACH CV” acronym introduced by Craton et al. to provide a brief overview of the topic.


COACH CV is an easy way to remember the 7 categories of concussion:

C – Cognitive (thinking)
O – Oculomotor (eye movement/vision)
A – Affective (mood/emotions)
C – Cervical spine (neck)
H – Headaches

C – Cardiovascular (autonomics/blood flow)
V – Vestibular (inner ear/balance)

These seven phenotypes highlight the 7 different categories of symptoms people with concussion can experience.

In sports, this acronym helps supplement sideline assessment tools like the Sport Concussion Assessment Tool (SCAT), which focus on immediate symptoms and are not comprehensive enough to capture the full range of potential issues. These tools have also been shown to lose reliability within the first 3-5 days of injury. That’s why the most recent recommendations from the Concussion In Sport Group consensus statement (2023) include a more comprehensive approach. This involves a detailed history and neurological examination that encompasses the components of COACH CV. Thorough evaluations that include every phenotype of concussion are critical for everyone, especially within the first few days post-injury, as delaying evaluation can significantly prolong recovery.

Another piece of information that’s important to know is that there is a significant overlap between these phenotypes. Symptoms like dizziness, for example, can stem from various sources such as cervical dysfunction, oculomotor difficulties, or cardiovascular and vestibular disorders. Without assessing the various potential causes of these symptoms or understanding the potential overlap they share across different phenotypes, patients can be left struggling to recover for longer than necessary. Recognizing and addressing these diverse manifestations early on helps healthcare providers better support patients in their recovery journey and minimize long-term complications. Therefore, seeking help from a clinician who is familiar with concussion phenotypes and can approach the case holistically ensures accurate diagnosis and appropriate treatment. This is key to concussion recovery of every phenotype.

Last Word

“COACH CV” is an important acronym and concept, so hopefully you found this brief introduction helpful. In coming articles, we’ll be digging deeper into each phenotype so you can better understand how these phenotypes may be impacting you and/or the care of someone you care about.



Craton N, Ali H, Lenoski S. COACH CV: The Seven Clinical Phenotypes of Concussion. Brain Sci. 2017 Sep 16;7(9):119. doi: 10.3390/brainsci7090119. PMID: 28926944; PMCID: PMC5615260.

Patricios JS, Schneider KJ, Dvorak J, et al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bjsports-2023-106898

“Traumatic Brain Injury.” Mayo Clinic, 2021,