Concussions – Part II

concussion, Concussions – Part II
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Recognizing a Concussion

by Dr. Bruce Buckman PT, DPT

It is important for on the field recognition of signs and symptoms of concussions. These  symptoms include signs that can be observed by an athlete’s coach or athletic trainer can include but are not limited to:

  • Appearing dazed or stunned
  • Confused about aspects of game/practice
  • Forgets instructions
  • Being unsure of score or opposition
  • Appearing clumsy
  • Answering questions slowly
  • Losing consciousness
  • Change in personality
  • Inability to recall events prior to trauma
  • Inability to recall events post trauma

Off the field, the use of pre-concussion baseline testing is just as important, and in some respect even more so in considering an athletes return to prior level of function. Computerized tests such as the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) are scientifically valid and reliable in determining such measures. Less mainstream, the Biodex Balance system can also be used as a more clinical oriented pre-concussive test. After an athlete exhibits signs of a concussion, these post-tests can track an athlete’s progress through a post-concussion rehab protocol.

What to Do After a Concussion is Sustained?

There are medical doctors who specialize in providing care specifically to patients who have sustained an insult to the brain, directly or indirectly through contact; however, it is not a necessity to see one of these specialists prior to seeking assessment by one of our doctors. Our physical therapists/chiropractic physicians perform a comprehensive evaluation of patients to assess musculoskeletal and vestibular functioning, as well as concussion related symptoms such as headache, nausea and/or vomiting. If a referral to a medical doctor is necessary, we can assist you in finding and scheduling an appointment. These specialists will coordinate care with your physical therapist and/or chiropractor in order to ensure the safest and quickest recovery and return to sport.

Post-Concussion Return to Play

The most important first step in post concussion management is cognitive rest until post-concussive symptoms resolve. This period of complete physical and cognitive rest may take days, weeks or even months. Before the initiation of physical therapy or chiropractic care, a symptom checklist should be reviewed with the patient and parents/guardians to ensure that the athlete has been asymptomatic for at least 24 hours. If the athlete experiences symptoms while in physical therapy or chiropractic care, the session should be terminated. The patient should have entire day off (of rest) before symptom checklist is re-assessed. If the patient scores a “zero” then that would mean a return to the previous stage. If asymptomatic for 24 hours, the patient may progress to the next stage at the following session. Typical sessions of physical therapy will last 30-50 minutes depending on the progression stage; furthermore, patients should be seen five days a week with appointments scheduled at the same time to assess 24-hour symptoms. Check out the Center for Disease Control and Prevention (CDC’s) graded return to play protocol below.

 

Rehabilitation Stage Functional Exercise at each Stage Objectives of each Stage
1. No Activity Complete physical and cognitive rest Recovery;

**Patient should have a score of zero on above checklist in order to begin physical therapy.

2. Light Aerobic Exercise Walking, swimming, or stationary bike, keeping intensity below 70% MHR, no resistance training Increase HR
3. Sport- Specific Exercise Skating drills in ice hokey, running drills in soccer, no head impact activities Add Movement
4. Non-Contact Training Drills

 

 

Progression to more complex training drills, e.g. passing drills in football; may start progressive resistance training Exercise, coordination, and cognitive load
5. Full Contact Practice Following medical clearance, participate in normal training activities Restore confidence and assess functional skills by contacting coaching staff
6. Normal Game Play

References

McCrory, P., Meeuwisse, W., Johnston, K., et al. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br J Sports Med 2009;43:i76–i84.

 

Cantu, RC. Posttraumatic Retrograde and Anterograde Amnesia: Pathophysiology and Implications in Grading and Safe Return to Play. Journal of Athletic Training 2001;36(3):244–248

 

Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Physician Sportsmed. 1986;14(10):75–83.

Center for Disease Control and Prevention. Heads Up: Brain Injury in Your Practice. A Tool Kit for Physicians. January 15, 2010. http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html.