Concussion Management Collingwood
For decades, medical professionals have told concussed athletes to rest, avoid bright lights, and limit activity until asymptomatic. But emerging science recommends to avoid rest beyond 3 days, and to participate in active treatments which help to rehabilitate the brain, prevent mental health issues, and eliminate long-term consequences. A research article in “Pediatrics”, Feb 2015, reported concussed adolescents had more symptoms and slower symptom resolution with strict rest compared to those who had an active recovery.
At Maximum, we take a proactive approach to concussions by getting you or your child into the clinic for a pre-concussion baseline test. In the event that you do suffer a concussion, having baseline scores to compare to help to take the guesswork out of the return to work/school/activity decision. Getting your bell rung is no joke.
If you have a concussion, we offer a FOUR-STEP Concussion Care Plan:
1) The Assessment
- SCAT 5 – symptoms, memory
- Co-ordination, reaction time, balance, gait testing
- Visual, vestibular and cognitive function testing
- Oculomotor testing
- Musculoskeletal exam
- Neurological exam
2) Immediate Management
- Vestibular/visual treatment
- Cranio-sacral therapy
- Home programs
- Nutrition advice/referral
3) Return to Learn/Work
- Individual plans to modify school/work programs/activities
- Pacing and planning strategies
- Co-ordination with teachers/admin for appropriate learning/work environment
4) Return to Play
- Individual stepwise protocol
- Progression from low to high exertion
- Progression from non–contact to full contact (with appropriate sports)
- Sport specific component
- Cognitive/vestibular exertion testing
- Communication and co-ordination with doctors/coaches for updates and medical clearance
Concussion Diagnosis and Treatment (For Athletes):
A concussion can be difficult to diagnose because the signs and symptoms may be subtle and easily overlooked. Athletes may minimize or not recognize the signs and symptoms of a concussion and, therefore, may not seek medical attention. Suspected concussions have to be taken seriously. A concussion results from a traumatic impact which disrupts and causes damage to the brain. It is not always a direct blow to the head; this can happen from a number of types of impact, ranging from a rough shoulder check to whiplash.
If an athlete returns to sport too soon before symptoms from a concussion are fully resolved, it can be potentially dangerous. Second time around, it doesn’t take as hard a hit to cause symptoms, the symptoms are more severe, recovery takes longer, and full recovery is less likely. Many coaches, parents and athletes do not realize that days or weeks may be needed before concussion symptoms resolve.
Second impact syndrome is a rare but serious condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results. Second impact syndrome can result from even a very mild concussion that occurs days or weeks after the initial concussion.
In order to prevent returning to play prematurely, and risking a subsequent concussion, all athletes involved in a sport where collision is a possibility, should have pre-injury “baseline” testing done. This testing includes balance, coordination, vision, cognition, memory, comprehension, and recognition. Following a concussive injury, athletes can be re-tested. Re-test scores are compared to their own baseline results to determine any deficits present. Post-concussion testing assists in the difficult decision of returning to play safely, reducing the risk of another head injury.
There are many tests for concussions on the market today, but it is important that multiple areas are tested to cover all the facets of physical and cognitive function. Comprehensive treatment for a concussion helps to speed up the process of a safe return to work, school and activity.
Statistics do not need to be as high as they are for multiple concussions from sport. Relying on concussion testing guidelines for return to play can help prevent unnecessary brain injury.
About Concussion Management:
1. REST – For the first 2 days – stay home from school and work
Do not need to rest in a dark room
Limit screen time: texting, TV, phones, video games – to 5 min/hour
2. SLEEP – get plenty of rest and nap (in first 2 days only)
Go to bed and rise at regular time
Use bedroom only for sleeping
No electronics in bedroom at night (computers, digital clocks, phones)
3. MEDICINE – avoid all if possible!! Do not take ibuprofen (Advil, Motrin) or aspirin for headaches as they may increase bleeding. Acetaminophen (Tylenol) is fine.
4. FUEL – drink lots of water, follow a “brain recovery diet” (ask for ours!)
5. ROUTINE – establish and maintain. Sleep, meals, study (as tolerated)
6. LIGHT – If very sensitive to light, wear a hat and sunglasses when outside, and inside for fluorescent lights and screens- but slowly wean away from protection
7. NOISE – avoid noisy loud environments like arenas, music class, gym
8. SCHOOL/WORK – may need to take time off school/work initially. A progressive “Return to Learn/Work” program should be followed (ask us!)
9. EXERCISE – avoid activity with contact or impact initially. The brain is prone to being re-injured before it is fully healed from the first injury. Can go for easy walks for up to 40 min a day. Follow a progressive “Return to Play” protocol (we have one, of course!)
Go to EMERGENCY if you:
- have a suddenly worsening headache – have unequal pupils
- are bleeding/clear fluid from ear/nose – slur your speech
- have convulsions or a seizure – can’t be woken
- have repeated vomiting (> 2times)
- have unsteady gait
New research is constantly being done, and it is important for all those affected by concussions to find a health care provider who stays current with the literature to give the best care possible.
All of our Registered Physiotherapists at Maximum Physiotherapy are trained in running The Maximum Concussion Program. Call them to schedule a baseline or post-concussion test. 249-499-4382.