Concussion Clinic

Clinic Overview

OrthoNC is proud to offer sports-related concussion education, evaluation, and treatment. Care at OrthoNC’s Concussion Clinic includes comprehensive concussion management involving a thorough history and physical exam--including head, neck, neurological, and cognitive function assessment--as well as patient education and focused individualized treatment. OrthoNC uses neuropsychological (ImPACT ®) testing as an objective marker of brain function to aid the clinical decision-making process. Our primary goal is to help educate athletes, athletic trainers, coaches, and parents on the prevention, recognition, evaluation, and treatment of concussions. We hope to get each athlete back to participation as quickly and safely as possible. General Facts

Definition

Sport related concussion is a traumatic brain injury induced by biomechanical forces through an impulsive force transmitted to the head. This force typically results in the rapid onset of any range of symptoms, mainly the impairment of neurological function. These symptoms reflect a functional disturbance rather than a structural injury, therefore no changes are seen with brain imaging after a concussion. Concussion symptoms can also be affected by medications, injury, drugs and alcohol, or coexisting medical conditions. Every concussion for every person is different, so careful evaluation and treatment by trained medical professionals is extremely important. 

 Statistics

  • Children and teens typically take longer to recover than adults
  • As many as 7 in 10 young athletes with a possible concussion report playing with concussion symptoms.
    • Out of those, 4 in 10 said their coaches were unaware that they had a possible concussion.
  • Children and teens typically take longer to recover than adults
  • As many as 25% of the concussions reported among high school athletes result from aggressive or illegal play.
  • In almost all sports, concussion rates are higher during competitions than in practice.
  • Girls have higher concussion rates than boys in similar sports
  • Athletes may be less likely to tell their coach or athletic trainer about a possible concussion during a championship game or other important event.
  • Over two-thirds (70%) of concussions among young athletes result from contact with another athlete.
    • This is followed by player-to-surface contact (17%), such as hitting the ground or other obstacle.

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

Signs and Symptoms

The signs and symptoms of concussion usually resolve in 7-10 days in adults. In children and teens, concussion symptoms usually resolve within four weeks. However in some cases, signs and symptoms may last longer--we now classify this as concussion with persistent symptoms. Headache is the most common symptom, followed by dizziness, trouble concentrating, confusion, light sensitivity, and nausea. Cognitive functioning and balance can suffer in the early days after injury, being most significant within the first 24-72 hours. Typical symptoms associated with concussion include:

  • Physical: headache, nausea, vomiting, fatigue, vision problems, sensitivity to light and/or sound, balance impairment, gait unsteadiness
  • Cognitive: feeling foggy, confusion, slowed reaction time
  • Emotional: irritability, mood swings, behavioral changes
  • Other signs: drowsiness, sleepiness, insomnia, loss of consciousness, amnesia, neurological deficit

 

Concussion Action Plan

1.     Remove the athlete from play, and keep an athlete with a possible concussion out of play on the day of injury and until cleared by a healthcare provider.

2.     Record and share information about the injury, including how it happened and the athlete’s symptoms, to help a healthcare provider assess the athlete.

3.     A healthcare professional should re-evaluate the athlete with a follow-up examination including a comprehensive history and neurological examination. 

4.     The athlete should be restricted from play until symptom-free and given the go-ahead by a physician to begin their return to play.

 

Testing & Evaluation

Our clinic will evaluate the athlete with suspected concussion by following their symptoms and recommending appropriate testing if necessary. Neurophysiologic testing is one of several tools for concussion evaluation designed to provide an objective measure of brain function. ImPACT ® testing is a brief computerized cognitive tool that we employ for neurophysiologic baseline testing as well as evaluation after injury. Baseline and post-injury ImPACT ® testing are not required as mandatory aspects of concussion care for an athlete and are not the sole basis of concussion treatment, but they can be beneficial in assisting with management and return to play. 

 

Treatment

After a brief period of rest for 1-2 days immediately following the injury, an athlete can become gradually and progressively more active while staying below the threshold of symptom exacerbation. It is generally recommended for athletes to avoid vigorous exertion during recovery, but mild to moderate exercise has shown positive results on concussion recovery. In some cases, academic accommodations can be made for student athletes in their recovery. If symptoms of concussion persist for a prolonged time, a collaborative approach to treatment, including controlled cognitive stress, pharmacological treatment, and physical/cognitive/oculo-vestibular therapy, may be beneficial for an athlete’s recovery. 

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


 

Return to Play

The large majority of athletes recover clinically from a sports-related concussion within the first month of injury. The strongest and most consistent predictor of recovery time from a concussion is the severity of a person’s initial symptoms in the initial days after injury. Pre-existing psychological factors may play a significant role in symptom recovery and contribute to risk of persistent symptoms. Athletes with pre-existing conditions such as migraine headaches, mental health history, and learning disabilities (i.e. ADHD) should take special care to discuss these confounding variables with their healthcare provider. When a healthcare provider allows an athlete to return to participation in sports and school, they should follow a graduated stepwise progression to activity under the supervision of an athletic trainer or first responder. 

 

Prevention

There is no way to completely prevent concussion in athletes, but we can attempt to reduce the risk for concussion and improve education. With guidance from each sport’s governing body, adopting evidence-based protective gear and rule changes can decrease risk for concussion. Education of athletes to avoid dangerous actions during play, encouraging respect of rules and sportsmanship, and creating an open culture of reporting can decrease the impact of concussion on athletes. 

Tips on Concussion Prevention

Tips on Proper Fitting of Protective Headgear

Visit The CDC for more information.


Gfeller-Waller Concussion Awareness Act

OrthoNC’s concussion clinic functions in compliance with the Gfeller-Waller Concussion Awareness Act of North Carolina. This act was drafted and implemented to protect the safety of student athletes in North Carolina who have suffered a concussion. The act requires all student athletes to follow a graded stepwise progression of activity before return to full play. The act also requires that only a physician can give full clearance to a student athlete for competition. Please be aware that due to this state law, OrthoNC will be able to see athletes with concussion in our urgent care. However, because our urgent care is often staffed by Physician Assistants, clearance to play cannot be provided. For clearance of a student athlete, please formally schedule an appointment with one of our physicians who treats concussions.

 

References

CDC HEADS UP

https://www.cdc.gov/headsup/basics/concussion_prevention.html

Berlin || 5th Consensus Statement

http://bjsm.bmj.com/content/51/11/838

Gfeller Waller Concussion Awareness Act

gfellerwallerlaw.unc.edu


919-562-9410Fax: 919-562-9425Make an appointmentUrgent Care 9am – 9pm, everyday