Concussion Management

Concussion Management: Baseline Testing

The performance of both ImPACT baseline and post-injury neurocognitive testing is highly recommended in order to more accurately manage and care for young athlete’s concussions. These evaluations help physicians objectively assess each case and assist in tracing recovery for a healthy return to action/play.

“Baseline testing” is designed to be performed prior to suffering a concussion – so as to be able to compare ‘before” measures with those experienced “after” being concussed. While the computer-based ImPACT neurocognitive test is an important element in baseline testing, there are other key areas of brain function that should also be established as part of baseline testing. These include:

  • symptom load (22 possible symptoms with scores of 0 to 6 for each symptom)
  • balance assessment (BESS)
  • visual-ocular motor screening (VOMS)
  • eye convergence
  • coordination
  • neck range of motion
  • visual scanning (King-Devick testing)

This combination of baseline tests is highly recommended to ensure a more accurate assessment of concussion severity and more appropriate management and care for young athletes. These evaluations help physicians objectively assess each case and assist in fostering recovery for a healthy return to life’s daily routines, to the school learning environment and to physical activities, play and sports.




Concussion Management: Initial Management

If a concussion is suspected the following steps effectively help manage concussions:

  • Immediately remove athlete from the activity for the remainder of the game.
  • If there is a health professional available on site at the activity or game, be sure that individual assesses the child by performing a sideline assessment (SCAT test).
  • Closely monitor symptoms every half hour while the athlete is awake for the first 24 hours.
  • If symptoms worsen, the athlete should be taken to the nearest emergency department.
  • If symptoms are constant or improve, the athlete should continue to be closely monitored. Do not awaken while sleeping, but observe for normal breathing patterns and usual skin color.
  • The athlete should visit their primary care physician within one to two days following the injury to receive personalized care and follow up instructions.
  • Allow time for rest by preventing the athlete from participating in any physically or mentally demanding activities.

Goals: Return to “Life”, Return to Learn, Return to Sports

Depending on the number and severity of symptoms and the results of the various parts of the evaluation, the length of rest required and the timing for returning to normal activities of daily living, return to school and return to physical activity will vary considerably. While the goal is to determine the best amount of rest before returning toward normalcy, it is important to advance in small steps so as to avoid major setbacks in symptoms.

Concussion Care: Resting the brain

Rest is extremely important following a concussion. Physical and mental rest allows the brain to heal and eventually return to its normal state of functionality. Following a physician's assessment, a rest period will be recommended. During this period the recovering athlete should:

  • Rest quietly, undisturbed in a stress-free environment. Sleep when possible.
  • Avoid watching television, using computers, tablets, and mobile devices.
  • Avoid busy locations such as malls, sporting events, supermarkets, parties, concerts, large social gatherings, riding in a car at night, amusement park rides.
  • Avoid situations where another concussion may occur (driving in cars, riding bikes, motorcycles).

When returning to school, a variety of academic accommodations may be helpful and necessary; your physician should write a note to the school enumerating which accommodations should be enforced.

Medication

Medications are usually not prescribed for children with concussions during the first few weeks; however, in some cases, medications can be prescribed to ease symptoms. If medications are being taken, be sure to follow dosages and instructions that are given.

Return to Sports

Returning to play after a concussion is a sensitive process which can take place once the athlete’s symptoms have subsided and brain functions progress to a normal state. The child should be closely monitored by their physician and their school athletic trainer from the time of the concussion until the time of return to full competitive sports activity. For those athletes engaged in scholastic sponsored sports, following the return to play guidelines is mandated by state law. These guidelines ensure a progressive step-by-step re-introduction to competitive sporting activity. In case symptoms reappear, the risk for further complications is minimized because that athlete made only a small step from the prior level. The following guidelines may help a young athlete during their recovery process after experiencing a concussion:

  • Rest: As mentioned above, a complete rest period is essential for recovery. Rest is necessary until conditions subside. The time-frame for rest is different for all cases, which can last anywhere from a couple days to a number of weeks.
  • Light activity: Participate in activities such as walking and using an exercise bike. Be sure that there is absolutely no running, jumping, or weight lifting involved.
  • Moderate activity: Participation in moderate jogging, brief running, and moderate intensity exercise biking. Limit directional changes of head and body movements. Do not allow the athlete to sprint. Moderate weightlifting during this period is also accepted.
  • Non-contact activity: Participate in running, high intensity exercise biking, regular weightlifting, and non-contact sport-specific drills.
  • Practice: Participation in sport-specific practice. Gradually introduce contact situations.
  • Return to Play: Participation in regular competition.

Note: If during any point of the recovery process, should a child experience a return of symptoms, he or she should report the symptoms to their school athletic trainer or school nurse and see their doctor immediately. It is important that the child is patient during this process and that their brain is completely healed before returning to full activity in sports. If rushed back, the danger of second impact syndrome is possible.

Approval from your physician to advance to the next step is needed when going from step 1 to Step 2, Step 4 to Step 5, and a final confirmation when Step 6 has been achieved.