Assessing Concussion

Baseline Testing Speeds Diagnosis & Recovery 

Concussion has become a hot topic in recent years, not only within the medical and scientific communities, but within the mainstream media as well. Starting a little more than 10 years ago, concussions became viewed not as just a nuisance or “part of the game,” but as a traumatic brain injury not to be taken lightly. 

With more awareness, more injuries are also coming to the attention of healthcare providers. Approximately 4 million sports-related concussions occur each year in the United States and account for almost 15 percent of all injuries sustained by high school athletes, according to recent studies. 

What is a Concussion? 

A concussion is a functional brain injury, which means there is no real acute structural damage to the brain. It typically stems from an impact injury to the head, although it can occur with an impact to the body while the head undergoes an acceleration and deceleration process known as whiplash. This impact or whiplash injury disrupts the normal functioning of the nerves in the brain so that certain parts of the brain become a little hyperactive and others do not function well at all. 

Why Worry About Concussion? 

Doctors are still learning about the long-term effects of concussions, which can range from nothing to rare learning and memory deficits, depression, personality changes and dementia. Each time someone sustains a concussion it increases the risk of having another one in the future. Also, if an athlete continues to play before a concussion has fully resolved, there is a high risk of sustaining a more significant concussion and prolonging recovery time—sometimes by weeks to months— and therefore a higher risk of having long-term cognitive deficits. In addition, there have even been controversial reports of a Second Impact Syndrome, where deaths have been attributed to severe brain swelling stemming from a second head impact while still concussed. 

How is a Concussion Diagnosed? 

Because there is no visible injury to the brain, this makes it difficult to diagnose through objective measures such as imaging tests like CT scan or traditional MRI. If these tests are performed, it is usually to evaluate for a more significant injury such as bleeding within the skull or brain. Currently, there are no accepted blood tests to diagnose concussion, either. As a result, physicians mostly rely on the patient reporting an impact of some sort, either to the head or the body, along with some of the symptoms of concussion mentioned above. 

However, there are some objective tools that can help not only diagnose but also more effectively manage concussion. Proper diagnosis and management of concussion in young athletes helps keep them safe and protect their brains while speeding their recovery to safely return to school and the playing field. 

These tools include balance testing, questionnaires about symptoms and computerized neurocognitive tests. These procedures measure short term memory, processing speed and reaction time, all of which can be disrupted in a concussion. The computerized test that is most commonly used nationwide is the ImPACT test, and it is available at McKay-Dee Sports Medicine as well as all the sports medicine physician offices within Intermountain Healthcare. 

Concussion Symptoms: 

> Headache 

> Nausea, sometimes vomiting 

> Blurred vision 

> Dizziness 

> Feeling dazed, fuzzy or slowed down 

> Difficulty concentrating on things, like schoolwork, reading, etc. 

> Loss of memory before and/or after the injury 

> Slow reaction time 

> Difficulty remembering new things 

> Sleepiness 

> Anxiety, nervousness 

> Intolerance to bright lights 

> Intolerance to loud noises 

Baseline Testing 

The ImPACT and other tests mentioned above work best if athletes have baseline scores, meaning they take the test before sustaining a concussion. Typically this is done before the season starts, and is updated about every two years. Those scores are saved in the system, and if a concussion occurs, doctors can compare the athlete’s new scores to the baseline. 

If the ImPACT test confirms the diagnosis, doctors can use that information to guide the treatment process. They can also use the individual scores within the test to guide recommendations for school, such as allowing more time for tests, reducing homework load, or no school altogether. 

How is it Treated? 

Most concussions resolve within seven to ten days, with only a few (about 10 to 15 percent) lasting more than three weeks. It is impossible to predict how long the concussion will last for each patient. Recovery estimations can be made based on the particular symptoms immediately after the concussion such as the number of symptoms present, age, gender, and if the patient has had a concussion in the past or certain other medical or psychological conditions. 

Recovery time often depends upon proper management and supervision. A concussion will last longer if it continues to be aggravated, either through physical activity, schoolwork, visits to the mall, playing video games, working on the computer, or even just reading or watching TV. Sleep is vital for optimal recovery, and lack of proper sleep can prolong symptoms and delay healing. There is no pill or procedure that can resolve this injury, although certain medications may be used to treat some of the symptoms of concussion. Sometimes it is helpful for the concussion patient to attend physical therapy. 

During the course of the concussion a patient will continue to be assessed through follow-up visits and phone calls. Once the symptoms have resolved, another ImPACT test is recommended. This is important because it is known that a concussion can still be present even after the symptoms have completely gone away. Once the test scores are back to baseline, then patients can begin the process of returning to sport. This is done in a gradual, progressive manner, sometimes supervised by an athletic trainer at the school, or can be done by a parent after receiving education in our clinics on the process with occasional phone calls from staff to answer questions and check progress. 

Utah state law requires all kids involved in recreational or school-affiliated sports teams receive official medical clearance by a concussion certified healthcare provider before returning to play. Treating concussions must be within the scope of regular practice for such providers, who also must have attended a certified continuing education class on concussion within the past three years. 

If your child has sustained a concussion, or if you would like to inquire about baseline testing, please contact the offices closest to you.