A concussion is defined as any trauma to the head that results in a transient disturbance in brain function. It is a complex physiologic process of which research is continuing to reveal new developments. California Concussion Institute is dedicated to using current diagnosis and treatment methods to keep our athletes safe while making sure they return to the activities they desire. For more information on the definition of a concussion, please click here.
The diagnosis of concussion is a clinical diagnosis. This means that there is no blood test or imaging test that gives your provider the diagnosis. It is a decision made by a trained clinician evaluating all of the current facts and information at the moment. Concussions can be diagnosed by a trained provider on the sideline, an urgent care, an emergency room or in your physician’s office. A possible concussion should be evaluated within 24 hours of the injury. Until that athlete is evaluated, a possible concussion should be removed from play. Sometimes symptoms do not show up for hours or even days. For more information on the diagnosis of a concussion please click here.
It is common to be confused as to where you should go when you have a concussion. Due to the evolving nature of concussions, multiple providers can be involved with concussion diagnosis and management.
Athletic Trainer (ATC) : May be on the sideline. A health care provider trained to identify concussion signs/symptoms and determine if the athlete/person needs an immediate referral to the Emergency Room/Urgent Care or if they can go directly to a concussion specialist. Not all concussions need to be seen in the Emergency Room.
Primary Care Provider/Pediatrician: Typically is the initial contact for a concussion. Ideally, should be evaluated and properly diagnosed within 24 hours of injury. As concussion management has changed over the last decade, even significantly over the past few years, every primary care provider/pediatrician will have a different comfort level with concussion.
Sports Medicine Provider/Concussion Specialist: Care for concussions at any step in the process, but many times get a referral from the Primary Care/Pediatrician depending on their comfort level. Skilled in the various trajectories of a concussion and works closely with visual therapy, vestibular therapy, exertion therapy, psychology, etc.
Neurologist : Specialist that sometimes cares for concussions. Highly trained in medication management, although depending on the neurologist may work with the subgroups defined above.
Therapists: Works with the treatment of concussion based on the subgroup that particular concussion is trending toward. Therapists include physical therapists, vestibular therapists, vision therapists, behavioral therapists, etc.
There is no absolute way to prevent a concussion. In light of that, there are many ways in which we can minimize the frequency of concussions as well as the duration. These aspects including playing your sport or activity in a safe environment with adherence to the rules, emphasis on reporting and proper initial management if a head injury occurs and counseling on style of play and safe techniques as part of their sport. For more information on the prevention of concussions please click here.
Management of concussions is straightforward most of the time but can get very complicated depending on the course of the concussion. Once there is an initial diagnosis and identification of the subgroup, treatment begins. This typically includes a limited rest period (days to a week) and then gradual returning to activity. Current research shows us that returning to noncontact activity after a short rest period leads to a faster recovery.
This includes returning to some activity even though symptoms may still be present. Multiple aspects of the athlete are taken into account in order for clearance. These include symptoms, physical exam findings including vestibular/ocular motor testing, neurocognitive testing and balance.
Neurocognitive testing is one aspect that should be back at baseline prior to clearance. There are multiple ways to evaluate this but most commonly ImPACT testing is used for this. ImPACT testing is a computer based neurocognitive test that is compared against a baseline or national norms, if a baseline is not available. Please click here to be directed to the ImPACT website for additional information.
Every organization should have a head injury/concussion action plan in place. This includes the following components: removing the athlete from play, keep the athlete out of play until cleared by a healthcare provider, record/share information about the injury to aid in athlete diagnosis and management, inform the parents or guardian, and make sure that you are aware of restriction on returning to sports/academics including documenting all clearance notes for return to play.