Ask the Physician: Dr. Franks on Sports Concussions
The most common presenting signs of concussion are headache, dizziness, nausea, vomiting, problems with sound, problems with light, and problems with balance and/or coordination. Patients also may not respond to questions appropriately. Patients may look dazed or confused. If any of these signs are present, they should be referred to a healthcare provider for evaluation and treatment.
Once the concussion is identified, how soon does treatment begin?
Treatment begins immediately. We look at six different symptom classifications: cognitive, vestibular, ocular, emotional, sleep, and cervicogenic. Treatment paradigms are designed to address each one of these issues and are immediately executed depending on what type of symptomatology and/or combination of symptomatology the patient has.
Are there different levels or stages of concussion?
Right now, the differentiation is that 85% to 90% of concussions get better in two to three weeks and the rest do not.
Is treatment the same for everyone?
Treatment is not the same for everyone. It is very individualized. It generally depends on which of the six different types of concussion symptoms the patient has and is tailored to that particular patient. There are some general guides that are used for every particular patient. As concussion is essentially a problem with energy in the brain, it is recommended that patients maintain hydration and caloric intake. We generally recommended that they sleep seven to nine hours without any naps. We generally recommend that they walk to at least get some movement and exercise. We also recommend that if there is an emotional component, that that is addressed very quickly, either from the psychological or psychiatric standpoint.
How long does treatment last?
Treatment generally lasts until the patient meets three criteria. They are symptom-free, there are no medications to control the symptoms, and their ImPACT scores are either at baseline or at least average. They generally have to go to school without any academic accommodations for 24-48 hours and then complete a five-step return-to-play protocol.
Is there anything to avoid while being treated?
The patients should try to avoid anti-inflammatory medicines unless there is a cervicogenic component, as they can cause rebound headaches. They should try and refrain from being in any environment where they may be re-concussed. They need to be aware of very bright lighting and very loud noises that can interfere with treatment and make symptoms worse. They also have to be aware of classroom situations, which make their symptoms worse such as the use of SMART Boards or consistently looking up to the board and down to the paper for taking notes. They should avoid daytime sleeping.
Is there any follow-up treatment and/or testing?
Follow-up treatment is really dependent upon the patient. Patients will usually be evaluated every 14 to 21 days to address recovery or any worsening of symptoms. ImPACT testing is also usually done at varying intervals during treatment. Generally, it is first run about 72 hours after the concussion is sustained and then at the discretion of the physician or healthcare professional, who is treating this patient.
Is the patient who receives treatment different from the patient who does not?
In two to three weeks, most patients will get better on their own. Unfortunately, those patients who do not receive treatment can often take longer to recover and often have worse symptoms. Intervening quickly leads to diminution of symptoms, prevention of second impact syndrome, prevention of post concussive syndrome, and swifter return to play.
What are the long-term effects of concussion?
The long-term effects of concussion can be difficulty with memory and cognition, long-term psychological consequences, post-concussion syndrome, second impact syndrome, dementia-type symptoms, and possible CTE.
If a patient suffers another concussion, is the treatment the same?
Often concussions vary from patient to patient and/or within the same patient. The main six categories are often looked at in the patient and treatment is adjusted depending on which type of symptoms he or she expresses at the time of their present concussion. Treatment may be different even within the same patient from concussion to concussion.
How do I tell the difference between a concussion and just a "bump on the head"?
Experiencing a bump or hit to the head does not always mean a concussion has been sustained. Alternatively, a "ding" can mean more than just a quick bump, but a mild to moderate concussion. It is important to always pay attention to changes in symptoms and behavior, and follow up with a concussion specialist.
How long does the testing take? How long for results?
Most neurocognitive tests for concussion such as ImPACT, Headminders, and CogSport take approximately 30 minutes to complete depending on the individual. Some tests such as Sway Balance or King-Devick take less time. Results are available immediately upon completion.
How long do you need to be out from sports, school, or work?
Each concussion presents itself differently in each individual affected; therefore differences in treatment are necessary. Some individuals report initial signs of concussion, but recover quickly via their symptoms and neurocognitive test scores. Others will have prolonged symptoms, and will require a longer concussion management protocol and varying accommodations.
What is baseline testing? Is it covered by insurance?
Baseline testing is a neurocognitive screening given when you are in a healthy, non-concussed state. Measurements such as your reaction time, processing speed, and memory are recorded and scored, in order to provide a marker for comparison if a concussion is sustained. The test is not covered by insurance; however, many hospitals and schools will offer the baseline for a small fee.
I was wearing a helmet when I hit my head. Does that mean I prevented a concussion?
The primary purpose of a helmet is to prevent skull fractures and brain bleeds. While a helmet does absorb some force enacted on the head, it by no means prevents concussion.