Assessment and management of concussion

Key Points

1. Concussion is a prevalent injury in sports: Awareness and accurate assessment are critical for effective management.
2. Multifaceted assessment is necessary: Concussions affect multiple systems, requiring a thorough and varied diagnostic approach.
3. Active management improves recovery: Implementing a graded return-to-play protocol under professional guidance ensures safe recovery.
4. Clinical implication: Understanding concussion treatment can significantly reduce long-term effects and enhance patient outcomes.
5. Study limitation: Further research is needed to explore the effects of various treatments on different age groups and the timing of interventions.

What is concussion?

A concussion is a form of traumatic brain injury caused by biomechanical forces that result in a temporary disruption of brain function. This injury often occurs after a direct blow to the head, face, neck, or elsewhere on the body, with the force transmitted to the brain.

Concussions can cause a wide array of symptoms that may evolve over time, typically within the first 24 hours post-injury.

Concussions are generally considered to be functional disturbances rather than structural injuries, meaning that they do not usually show up on standard neuroimaging techniques like CT scans or MRIs. Symptoms can vary greatly but often include headaches, dizziness, confusion, and memory disturbances.

How do we assess a concussion?

Assessing a concussion involves multiple steps to ensure an accurate diagnosis and appropriate management plan. The assessment should begin immediately following the injury and continue through the recovery period to monitor the evolution of symptoms.

Initial assessment:

• Symptom Evaluation: A thorough evaluation of symptoms is the first step, looking for signs such as headaches, dizziness, confusion, and balance problems.
• Cognitive Testing: Tools like the Sport Concussion Assessment Tool (SCAT) are commonly used to assess cognitive function, including memory, attention, and reaction times.
• Physical Examination: A comprehensive physical examination should include an evaluation of the cervical spine, vestibular function, and balance, as these areas are often affected by concussions.

Ongoing assessment:

• Repeated Evaluations: Concussion symptoms can evolve, so repeated evaluations over the first 48 hours post-injury are crucial to capture any changes.
• Specialized Assessments: Depending on the symptoms, additional assessments may be required, such as neuropsychological testing for cognitive issues or vestibular assessments for balance problems.

Advanced diagnostics:

• Exertion Testing: For individuals with persistent symptoms, exertional tests, such as treadmill or bike tests, may be performed to evaluate how exercise affects their symptoms. This helps in planning a safe return-to-play protocol.

Sources of symptoms from a concussion

What is the recommended active management following a concussion?

Active management of a concussion focuses on a graded return-to-play protocol, ensuring that the patient progresses through various stages only when they are symptom-free at each level. This approach reduces the risk of prolonged symptoms or further injury.

Rest and Initial Recovery:

• Immediate Rest: In the first 24-48 hours post-injury, complete cognitive and physical rest is recommended. This includes avoiding activities such as reading, screen time, and any physical exertion.

Graded Return-to-Play Protocol:

1. Rest: Start with complete rest and then move to light activities that do not exacerbate symptoms.
2. Light Aerobic Exercise: Begin with low-intensity activities like walking or stationary cycling. Ensure these activities do not trigger any symptoms.
3. Sport-Specific Exercise: Progress to moderate activities that mimic the sport but without contact or risk of head injury.
4. Non-Contact Training Drills: Increase intensity and include more complex drills, still without any contact.
5. Full-Contact Practice: Once cleared by a medical professional, the athlete can return to full-contact practice.
6. Return to Play: The athlete can fully return to their sport if they remain symptom-free after full-contact practice.

Monitoring and Adjustments:

• Ongoing Evaluation: The patient should be monitored regularly throughout the return-to-play process. If symptoms recur, they should return to the previous step and rest until symptom-free.
• Individualized Care: Each patient’s recovery should be tailored to their specific needs and symptoms, with adjustments made to the protocol as necessary.

Contact us today to allow our Physiotherapists to assess and assist you as you return to sport! 

References

Schneider, K. J. (2016). Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 613-616. https://doi.org/10.2519/jospt.2016.0607

Frequently Asked Questions