The diagnosis and management of concussions is one of the hottest topics in pediatrics and sports medicine. Some studies show that up to 50% of athletes experience concussion symptoms, yet only 10% report these symptoms. Often symptoms are vague, difficult to describe, and in some cases minimized by the athlete to hasten return to play, making the sideline diagnosis of a concussion more difficult. However, accurate diagnosis is paramount to treatment and recovery. CT scans and MRI scans of the brain are not typically able to detect the subtle changes that are thought to happen to the brain when a concussion occurs. Additionally, symptoms may not be noticed until two or even three days after the injury, making a quick diagnosis more difficult. However, until a concussion fully resolves, the patient is significantly more vulnerable to a more serious and prolonged concussion if subsequent trauma (even something very minor) is sustained.
Some of the most common symptoms of a concussion are headache, feeling “slowed down”, difficulty concentrating, dizziness, “fogginess,” fatigue, light sensitivity, blurred vision, memory difficulties and balance problems. Over 90% of patients with concussions do not lose consciousness, and loss of consciousness does not predict severity or length of the recovery period.
One of the best diagnostic tools today is a computerized battery of neuropsychological tests called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing), a test developed in Pittsburgh at the UPMC Center for Sports Medicine. Since it’s inception, it has become the standard of care to better diagnose and manage concussions. This test is a 30-minute computerized test taken on a computer in a physician’s office, an athletic trainer’s office, or at a certified concussion management center. This test can reveal impairment in any of the subtle categories that are often affected by a concussion, like spatial awareness, short term memory, and reaction time.
ALL ATHLETES, regardless of level of play, should receive a Baseline ImPACT test (i.e. a test done prior to the occurrence of an injury). It is now mandatory in most high schools for athletes to take this test prior to the start of the season. However, we recommend any child 11 and older have a baseline test done, even if they are not involved in sports. Concussions can happen during outside play, in physical education class, and even at home. Many pediatricians offer baseline ImPACT testing for a minimal fee. A baseline test allows doctors to compare test performance before and after a concussion, helping them to better diagnose and manage the concussion.
If a suspected concussion occurs, it is critical to remove the athlete from the game or practice. If symptoms are severe, a trainer may recommend a visit to the emergency department. If not, the athlete should rest, hydrate, and contact their physician for further recommendations. They should not attend school or any further athletic events until seen by a physician. Physical rest is often recommended, followed by a gradual progression through increasing levels of non-contact physical exertion. This is usually supervised by the athletic trainer at the school along with the guidance of the physician involved.
Based on the level of cognitive impairment, school attendance may be restricted. The school environment can exacerbate symptoms. Concussion often causes memory deficits, difficulty in concentration, and multi-tasking. If the student does return to school, it is often necessary for them to have academic accommodations until their symptoms resolve completely (i.e. reduced homework load, delayed academic tests, avoidance of note taking or computer usage). A trained physician or neuropsychologist can help decide which accommodations are appropriate.
Concussion recovery happens when all of the following have occurred: the patient is symptom free with rest and return to school, symptom free with non-contact exertion, and normalization of scores on ImPACT testing back to baseline.
A concussion can be frightening and frustrating for anyone to experience. However, with the proper treatment, almost 80% of concussions symptoms will fully resolve within 3 weeks. For the remaining 20%, specialized therapy at a concussion management center can assist in a full recovery and return to school and athletic participation.
This article originally appeared in InCommunity Magazine for Upper St. Clair and Bethel Park.
— The PediaBlog will have more on concussions tomorrow, including a new way to help prevent them. —