got a concussion?

Concussions: Proper Diagnosis and Management

Concussions are very common and at times very difficult to detect. Because of this, it is very important to understand the symptoms, how an accurate diagnosis is made, as well as the management. Simply stated, a concussion results from the temporary disruption of neurons (brain cells). This disruption produces subtle changes that cause symptoms.  These symptoms may last many months if not properly diagnosed and treated by appropriately trained clinicians. Repeated injury may lead to permanent injury, making diagnosis and proper management very important.

Common symptoms of a concussion include headache, dizziness, nausea, confusion, and feeling mentally slow. These symptoms may vary from person to person, and from concussion to concussion. Any injury to the brain resulting in loss of consciousness, escalating headache, weakness or numbness requires prompt ER evaluation.

Diagnosing a concussion is obvious at times, but making a diagnosis of concussion may be tricky if the symptoms are only obvious to family members or the patient. Fortunately, there are newer, more objective tools that (when combined with a thorough neurological exam) can help document the presence of the injury. The most thoroughly validated test, used by professional athletes and many high schools and colleges, is ImPACT Testing. ImPACT testing provides trained clinicians with neurocognitive assessment tools that have been medically accepted as state-of-the-art “best practices”. They are used to help determine when it is to safe return to school, work, or play. A baseline test is recommended for anyone age 10 years or above participating in contact sports or activities that pose a risk of head injury. This would therefore include not only football players, but equestrians, cheerleaders, hockey players, volleyball players, and anyone else at risk for concussion due to recreational or professional activities.

ImPACT testing should be completed 48-72 hours after a concussion.  Follow-up ImPACT testing is recommended at 1-3 week intervals until the symptoms resolve and the ImPACT scores are in the normal range.  Initial, and follow-up ImPACT testing (along with neurological exam) allow the clinician to make and modify recommendations and restrictions as the brain heals. Common initial restrictions include strict cognitive rest as well as physical rest. Cognitive rest means no cell phones, video games, tablets, TV, or other things that can over stimulate the brain. Cognitive rest is important.  Patients that return to regular activity too quickly increase their odds of prolonging their recovery and worsening their symptoms.  The risk of a second concussion is also heightened if one returns to normal activities before the brain has had time to recover.  Once ImPACT testing and the neurological evaluation return to normal, a slow and graduated return to physical activities is considered by the certified concussion specialist.

Impact testing may also be useful long after an injury occurs to provide objective documentation of brain injury when the symptoms are subjective.

Yearly baseline ImPACT testing is recommended from ages 10 to 18, and  every other year thereafter. Too frequent one might ask? Not really if one considers how fast a child’s brain develops and that the brain is not completely developed until a person is in their early twenties.

For the most accurate baseline ImPACT test results, the following is required:  A quiet testing center with few distractions. A trained proctor.  A desktop computer with an external mouse. Immediate review of the results by a credentialed ImPACT consultant. Why bother with all the fuss? Simple. Failure to properly manage a concussion and allow for healing from the injury can result in lifelong cognitive changes. So be safe. Use proper safety equipment and make an appointment for your baseline ImPACT test prior to start of any activity that could increase your risk of head trauma.