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Concussion Management


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A concussion is a mild traumatic brain injury (TBI) that happens when a blow to the head or body alters brain function. Concussions are among the most common injuries to affect Americans, with almost half experiencing at least one during their lifetime. In fact, they affect up to four million Americans per year, and primarily occur from falls in the young and elderly.

While not everyone will have lasting effects, multiple concussions can cause long-term damage and change the brain forever. This presents a serious concern for people who are at high risk of recurrent blows to the head, such as people in the military or high-level competitive sports. Proper evaluation, treatment, and protection are vital factors in all cases.

While they have historically been treated with watchful waiting, the past decade of research on the short and long-term effects they have on military personnel and professional athletes has led to a better standard of care for everyone. Concussion management starts with stopping the sport/activity immediately and getting evaluated by a medical professional. The primary goals are then providing symptom relief, preventing reinjury while the brain heals, and ensuring readiness for return to school, work, activities or sports.

The first thing a person with a suspected concussion should do is seek medical evaluation. A trained professional will first screen for emergency medical conditions, such as declining consciousness, skull or spine fracture, severe headache, seizures, and artery damage. They will then perform a neurological exam to test vision, hearing, strength, sensation, balance, coordination, and reflexes. Next comes cognitive testing, where memory, concentration, and information recall are examined.

After evaluation, the next step is treating the immediate symptoms, which can be correlated. For instance, a person may experience dizziness, nausea, vomiting, and/or neck pain after a concussion. The neck pain may stem from a whiplash associated with the concussive blow, which can also cause dizziness and nausea.

Once a person has cleared for any urgent medical issues, a Physical Therapist can begin rehabilitation. They may perform a neck and back exam, and look for signs of inner ear (vestibular), eye movement, and motor dysfunction. Guidance will be provided about how to monitor symptoms as they start to return to cognitive tasks and exercise. Staying in a dark room is no longer recommended, and each individual will need their own plan for recovery based on symptom severity and anticipated work, activity or sport demands. Early rehabilitation can involve graded cardiovascular exercise, balance training, neck strength and proprioceptive training and visual training tasks. The Physical Therapist will may use also manual therapy for loosening up a stiff or guarded neck to reduce headaches, neck pain and any associated dizziness. Purposed Physical Therapy will provide return to learn guidelines.

The next, and perhaps most important step in concussion management, is preventing another concussion. Recurrent concussions can be more dangerous as they can have a cumulative effect. It is imperative to protect the person while their brain heals and prepare them for full return to participation. A person is most vulnerable to getting another concussion in the first 7-10 days after injury, so it is of utmost importance that the person avoid sports and high-risk activity during this time. Reinjury vulnerability in the first week happens because a person's coordination and balance are already impaired, their neck may be weakened from an associated whiplash, and their brain is not functioning at its best. After the early days post-concussion, a progressive return to participation program will be developed to ensure the individual’s balance, speed, proprioception, visual acuity, and neck strength are back to pre-injury levels. Leaving any of these areas under-trained can leave the individual vulnerable to another concussion.

Concussions are complex injuries that rarely present the same way twice. It is recommended that concussion screening testing be completed before starting a new season. Concussions can have long-term effects, with one in five people experiencing symptoms for more than one month. If you have had a concussion, contact your Physical Therapist at Purposed Physical Therapy for more information today!

References

1. Jackson, W. T., & Starling, A. J. (2019). Concussion Evaluation and Management. The Medical clinics of North America, 103(2), 251–261. https://doi.org/10.1016/j.mcna.2018.10.005.

2.Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., Iverson, G. L., McCulloch, K. L., Dams-O'Connor, K., Reed, N., McCrea, M., & American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest Group Mild TBI Task Force (2020). Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines. Archives of physical medicine and rehabilitation, 101(2), 382–393. https://doi.org/10.1016/j.apmr.2019.10.179

3.Quatman-Yates, C. C., Hunter-Giordano, A., Shimamura, K. K., Landel, R., Alsalaheen, B. A., Hanke, T. A., & McCulloch, K. L. (2020). Physical Therapy Evaluation and Treatment after Concussion/Mild Traumatic Brain Injury. The Journal of orthopaedic and sports physical therapy, 50(4), CPG1–CPG73. https://doi.org/10.2519/jospt.2020.0301

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