Concussion Treatment Information
Sidney Crosby was hit in the head during a hockey game on January 1, 2011. Though slow to get up, and visibly shaken, he finished the game. Just a few days later, on January 5, 2011, Crosby was hit hard into the boards, with his head taking significant contact. Concussion-like symptoms began appearing shortly thereafter, and he did not play again for another 10+ months – making his return to play the following season, on November 21, 2011.
Though concussions have occurred long before Sidney Crosby was injured, it took the serious (career threatening) injury of a superstar hockey player to bring the seriousness of concussions into the spotlight.
A concussion is a brain injury. It is not to be taken lightly.
In recent years there have been tremendous advancements in the research and management strategies to combat the damage of concussions.
A multi-faceted approach is now seen as the best strategy in managing concussions: Education, awareness, baseline testing, physical testing, therapeutic strategies and return-to-play preparation are all components of a high standard of care strategy.
Note that there is no current “gold standard” for the detection of a concussion. MRIs and CT-scans do not detect concussions (though they are important in that they detect brain bleeds, and skull fractures). A concussion diagnosis is made by a skilled health professional who performs a thorough evaluation on the individual, and is based on the presence of a combination of symptoms known to result from concussions.
A thorough testing protocol should include the following:
- Computerized neurocognitive testing
- Balance testing
- Strength and co-ordination testing
- Screening of visual motor skills
- Vestibular (or equilibrium) testing
- Gait assessment
- Generalized neurological screening
- Orthopedic assessment for secondary injuries (e.g. neck, shoulders)
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The traditional “wait and see” or “wait until symptoms resolve” approach is no longer considered good enough. There have been recent advancements in concussion management that show that computer-based neuro-cognitive testing to be effective in detecting subtle cognitive deficits that persist even AFTER obvious symptoms have disappeared (indicating that “symptom-free” is not an accurate measure of one’s readiness to return to play).
Management Strategies
Complete physical and mental rest are paramount. This is a given. But the “sitting in a dark room” strategy is only effective for so long. Like other sports injuries, concussions require proper management and rehabilitation. Having a health professional who is well-qualified in modern, evidence-based, concussion management guide you through the (sometimes difficult and frustrating) recovery process is of critical importance.
Each individual has a unique injury, with a unique combination and severity of symptoms. As such, management strategies are to be individualized and customized if recovery is to be expedited. A “cookie-cutter” approach blanketing all concussions is not recommended. Actually, it could impair long term recovery.
Strategies are case-dependent, but could include a combination of the following:
- Individualized resting strategies and home instruction
- Specific recommendations regarding employment / academic demands
- Manual therapy for associated complaints (neck pain, whiplash, etc)
- Visual motor rehabilitation
- Vestibular therapy
- Physical exertion testing and exercise plans for return-to-sport
Once symptom-free, it is recommended that each athlete undergo a step-wise process of physical exertion testing, strategically and gradually progressing to higher percentages of exertion to help prevent symptom relapse and premature return-to-sport. Again, a highly skilled professional is essential to guide you through the process.
If you have any questions or concerns, we encourage you to direct your questions to Dr. Carney, and he would be happy to answer your questions and discuss your case with you. He can be reached at drcarney@kawarthatherapeutic.com.