Concussion Clinic

Clinic Overview

OrthoNC is proud to now offer clinical concussion education, evaluation, and treatment. Through the OrthoNC Concussion Clinic you will receive comprehensive concussion management involving a thorough history, physical exam (including head, neck, neurological and cognitive function assessment), patient education, and treatment. In addition we use Neuropsychological (ImPACT) testing as an objective measure of brain function and may order neuroimaging if deemed necessary. Our primary goal is to help educate athletes, trainers, coaches, and parents on the prevention, recognition, proper evaluation, and treatment of concussions. We hope to get you back to participation as quickly as is medically safe.

General Facts

Sport related concussion (also called Mild Traumatic Brain Injuries, mTBI) is a common injury that likely goes under reported by pediatric, adolescent, and adult athletes. The Centers for Disease Control and Prevention estimate that 1.6 million to 3.8 million recreation and sports-related concussions occur in the United States yearly, although the true incidence is probably much higher.

Other concussion facts include:

  • Football has the highest incidence of concussion
  • Girls have higher concussion rates than boys in similar sports
  • Concussions represent and estimated 8.9% of all high school athletic injuries
  • Less than 10% of concussions result in a loss of consciousness
  • In female sports, rates of concussions are highest in soccer and basketball
  • Athletes who have had a concussion are at increased risk for another concussion
  • Children and teens are more likely to get a concussion and take longer to recover

Please visit The Centers for Disease Control and Prevention for more details

References

Centers for Disease Control and Prevention website Halstead M, Walter K, and The Council on Sports Medicine and Fitness. Clinical Report – Sport-Related Concussion In Children and Adolescents. Pediatrics. 2010; 126: 597-611

Concussion Definition

Concussions are a type of brain injury and are sometimes referred to as a Mild Traumatic Brain Injury (mTBI). A concussion is caused by the head moving rapidly back and forth. This may be from a direct blow to the head, face, or neck or by a blow to the body with a resultant movement of the head.

Concussions result in immediate symptoms that typically resolve spontaneously over a short period of time. These symptoms are not due to a structural change in the brain which is why there are no changes typically found on scans of the head. An athlete does not need loss of consciousness to have a concussion.

Signs and Symptoms

The public has become increasingly more aware of the dangers of concussions as the media has focused more attention to the topic. Athletic trainers, athletes, and coaches have also become more adept at recognizing the signs and symptoms associated with concussions. The signs and symptoms of concussion typically resolve in 7 to 10 days. There are some recoveries from concussions, however, that may take weeks to months.

Some typical symptoms associated with concussion include:

Physical: Headache, nausea, vomiting, balance problems, visual problems, fatigue, sensitivity to light or noise, dazed, stunned.

Cognitive (thinking): Feeling mentally “foggy” or slowed down, difficulty concentrating or remembering, forgetful of recent information, confused about recent events, answers questions slowly, repeats questions.

Emotional: Irritable, sad, more emotional than normal, nervous.

Sleep: Drowsiness, sleeping more or less than usual, difficulty falling asleep.

What to Do for Suspected Concussion?

The CDC has a four step process for a suspected concussion.

  1. Remove the athlete from play.
  2. Ensure the athlete is evaluated by a healthcareprofessional experienced in evaluating concussions.
  3. Inform the athlete’s parents or guardian about the possible concussion and give them a fact sheet on concussion.
  4. Keep the athlete out of play the day of injury and until a health professional, experienced in evaluating concussions, says they are symptom-free and okay to return to play.

Source: The CDC

Treatment

The initial treatment of concussions involves both physical and cognitive (mental) rest. Similar to other injuries of the body the brain needs as little stimulation as possible while it heals. This means limiting anything that stimulates or taxes the brain. Things that should be avoided or limited include exercise, sports participation, tests, studying, as well as things as simple as watching TV, listening to music, or playing video games.

Our clinic will evaluate the concussed athlete and follow their progression from symptomatic to asymptomatic while recommending the appropriate testing when needed (including Neuropsychological testing). We work closely with the athletes, athletic trainers, parents, teachers, and coaches to modify workloads, avoid exacerbation of symptoms, and start a progression back to participation. We then clear the athlete to return to play when medically safe.

Neuropsychological Testing

One of the newer types of testing used in evaluating concussions is neuropsychological testing. It is just one of several tools that a physician uses to evaluate an athlete with a concussion. This type of testing is designed to give an objective measure of brain function. Neuropsychological testing does not, by itself, determine if an athlete has experienced a concussion or when they may safely return to play.

We are happy to offer ImPACT testing at our concussion clinic. ImPACT is a widely used and studied form of neuropsychological test. ImPACT testing is used by the NFL, NBA, Major League Soccer, NHL, many Colleges and Universities, among others.

Ideally a baseline or pre-injury test of the athlete would be obtained. However, if this is not possible, the data collected will be compared to standardized scores (normative data).

To learn more about ImPACT testing visit their website at: ImPACTTest.com

Prevention

There is no way to completely prevent concussions in athletes. We can, however, attempt to reduce the risk of concussion. This includes modification of protective gear, rule changes, trying to identify athletes at risk, and continuing to educate everyone involved in sports about concussions.

Tips on Concussion Prevention

Tips on Proper Fitting of Protective Headgear

Visit The CDC for more information.

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