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Concussion Assessment and Treatment

ConcusionComprehensive concussion/traumatic brain injury management, from assessment to diagnosis to treatment and rehabilitation.

Our team includes nationally-renowned experts in the field of clinical practice providing cutting edge assessment, treatment and concussion rehabilitation programs designed to get patients better…faster!!

The concussion management protocol includes the use of the ImPACT system, a computerized neurocognitive evaluation system specifically designed for detecting the effects of sports concussion, measuring the severity of the injury and gauging recovery.

-Sports injuries
-Motor vehicle accidents
-Falls
-Assaults

The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most-widely used, and most scientifically validated computerized concussion evaluation system. It is used by the NHL, the NFL, and NBA. Developed in the early 1990′s by Drs. Mark Lovell and Joseph Maroon, ImPACT is a 20-minute test that has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages.

Given the inherent difficulties in concussion management, it is important to manage concussions on an individualized basis and to implement baseline testing and/or post-injury neuro-cognitive testing. This type of concussion assessment can help to objectively evaluate the concussed athlete’s post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion. In fact, neuro-cognitive testing has recently been called the “cornerstone” of proper concussion management by an international panel of sports medicine experts.

A concussion is a disturbance in the function of the brain caused by a direct or indirect force to the head. It results in a variety of symptoms (like those listed below) and may, or may not, involve memory problems or loss of consciousness.

What is a Concussion?

  1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.
  2. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.
  3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
  4. Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  5. Concussion is typically associated with normal neuroimaging studies such as MRI or CT scans.

It should be recognized that the reporting of symptoms may not be entirely reliable. This may be due to the effects of a concussion or because the athlete’s passionate desire to return to competition outweighs their natural inclination to give an honest response. Remember, concussion should be suspected in the presence of ANY ONE or more of the following:

Signs:

  • Appears dazed/stunned
  • Confused about assignment or position
  • Forgets sports plays/tasks
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can’t recall events prior to or after incident

Symptoms:

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems/dizziness
  • Double/blurry vision
  • Sensitivity to light and noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration/memory problems
  • Confusion/Does not “feel right”

Treatment Recommendations:

Allowing enough healing and recovery time following a concussion is crucial in preventing any further damage. Research shows that the effects of repeated concussion in young athletes can be cumulative. Most athletes who experience an initial concussion can recover completely as long as they are not returned to contact sports too soon. Following a concussion, there is a period of change in brain function that varies in severity and length with each individual. During this time, the brain is vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of more serious brain injury increases.

The following treatment of a sports related concussion is recommended:

REST
The most important thing you can do following your concussion is rest. Rest allows your brain to heal and return to normal function. It is very important that the athlete increases their amount of sleep time as this helps the healing process. They may hear the term “relative rest”. Relative rest means that you should restrict your physical and mental activity as much as possible. You should only do the minimum activity you need to do to complete your schoolwork, housework etc. This includes limiting your participation in sports and physical education as well as limiting your computer use, video game playing and other activities that can stimulate your brain.

COMPUTERIZED NEUROPSYCHOLOGICAL TESTING
The ImPACT Computerized Concussion Test to help provide an objective measurement of how your brain is functioning. This tool assists the physician and health professional in determining the severity of the injury and when it is safe for you to return to play. We recommend taking the ImPACT test within 48- 72 hours of your injury. This will be repeated to measure progress or deterioration of the condition.

PHYSICAL EXERTION TESTING
Once you are symptom free at rest, the physicians will generally allow you to resume gradual physical activity. If this activity is tolerated without a return of symptoms, it can be progressed by your school’s Licensed Athletic Trainer.

RETURN TO PLAY
Once you are symptom free at rest, your neuropsychological test is back to normal (if applicable) and you are symptom free with exertion and sports specific activity, your physician may allow you to return to sports participation. If at any time during your return to play you experience a return of your concussion symptoms, it is very important that you notify your coach, parent, Licensed Athletic Trainer or Physician.

Concussion Testing and Rehabilitation Program Fees

Frequently Asked Questions (FAQ)

My son suffered a concussion on Wednesday; will he be able to play in Friday’s football game?
It is recommended that an athlete should not return to competitive sports until they are symptom free, both at rest and with exercise and their neuro-cognitive function returns to normal. Return to play should only occur with permission from your Physician.

Can I give my son/daughter any pain medications?
We do not recommend that the athlete take medicine without your physician’s permission. Aspirin, Non-Steroidal Anti Inflammatory Drugs (Advil, Ibuprofen, Aleve), blood thinners and drugs that cause drowsiness should be avoided. Headache intensity may worsen with too much activity; therefore, rest instead of medicines should be the first choice for treatment. Alcohol use should also be avoided.

Can my child participate in school, work or other activities?
Returning to school or work activities will be at the discretion of the Physician. Some school and work activities may need to be monitored, for example: the athlete may need to participate in only ½ days of school with frequent break periods, homework may need to be monitored, and he or she may need to avoid loud music and video games. Academic tests and written papers may also need to be postponed.

What are the long-term effects?
It is the opinion of experts that if concussions are properly treated, there are no long-term effects for the vast majority of people.

My daughter’s teammate just suffered a concussion and she was allowed to return to play sooner than my daughter, why is that?
Each concussion should be treated individually. Concussion symptoms and severity are different for each head injury and the return to play decisions vary based on the individual.

What happens if my child returns too soon?
If your child is under the care of a Credentialed ImPACT Consultant or qualified physician he or she will make sure that the athlete is cleared mentally, physically, and neurologically before the athlete returns to play. However, if your child’s concussion is not properly managed they could suffer what is called Second ImPACT syndrome. Second ImPACT syndrome occurs when an athlete sustains a second head injury before symptoms associated with the first have cleared. Although, very rare, Second ImPACT syndrome can be fatal.

If my child has a negative MRI/CT scan why can’t they play?
MRI’s and CT scans are tests to rule out more significant injuries such as bleeding in the brain or skull fractures. We rely on other tests to help determine the appropriate return to play. We evaluate physical and cognitive symptoms as well as neurological deficits. While we do use the ImPACT Computerized Concussion Test to help assess your sons’ or daughters’ neuro-cognitive function, it is only one of the tools we use to assist in determining the level of their concussion.