Following a concussion, the “sitting in a dark room” approach is only effective for so long. Concussions, like other sports injuries, should be properly managed and rehabilitated. While complete physical and cognitive rest is the mainstay of concussion care, having a health professional guide you through this step-by-step may prove to be invaluable. Dr. Laura is a certified SHIFT Concussion Management specialist and has been rehabilitating concussion patients for over a decade.
Recovering from a concussion can be a difficult and frustrating time. We understand that each athlete is affected differently and as such, requires individualized care. Management strategies are used to limit the amount of impairment as well as expedite recovery as much as possible. These strategies may include any one or a combination of the following and are case-dependent:
· Individualized resting strategies and home instruction for sleep and nutrition
· Specific recommendations around employment/academic demands
· Manual, soft tissue 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. Similar to weight training, athletes recovering from a concussion should not skip from 0-100% in a short time frame. Physical exertion testing is important not only for physical re-conditioning, but to safeguard against symptom relapse and help prevent premature return-to-sport.
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is the most widely used and scientifically validated computerized cognitive assessment tool available for concussion management. ImPACT is also the first medical device of its kind to receive U.S. Food and Drug Administration (FDA) de novo clearance.
The comprehensive ImPACT system was designed to help qualified practitioners properly manage concussive injuries and assist in return to play recommendations. The test battery takes approximately 20 minutes to complete, and measures several important cognitive functions including:
· Attention span
· Working memory
· Sustained and selective attention time
· Response variability
· Non-verbal problem solving
· Reaction time (measured to 1/100th of a second)
Though not used as a stand-alone tool, ImPACT is an integral component to concussion management and rehabilitation.
Concussions can produce a wide array of symptoms, which poses a challenge for coaches, trainers, parents, and health professionals involved in the care of an injured athlete. The time-course for recovery also varies widely from athlete to athlete, making it impossible to employ a “cookie-cutter” approach to concussion rehabilitation and return-to-play timelines. Currently, there is no reliable diagnostic test or marker that can be used to identify a concussion when it’s occurred, or similarly, determine when a concussion has resolved.
For this reason, a growing emphasis has been placed on objective baseline testing protocols that can be used to track an athlete’s recovery and serve as a tangible measurement for return-to-play readiness. By measuring an athlete’s “normal” level of functioning, we are better able to gauge the level of impairment that may exist post-injury by performing comparative testing. Our Team believes this requires a multifaceted approach and that no single test should be used in isolation.
That is why we follow the Shift Concussion Management Program and offer several testing components designed to assess:
· Neurocognitive Performance (ImPACT)
· Balance and Postural Sway
· Visual Coordination
Shift baseline testers also review and document previous concussive episodes and history of concussion-like symptoms to aid in individualized post-injury assessments should they be required.
Baseline values can vary widely from one athlete to the next, and in young developing athletes, these measures can change dramatically from year to year. It is therefore important to have record of each player’s baseline level of physical and neurocognitive functioning before the start of each season.
Should an athlete sustain a concussion during the season, Shift Practitioners have the ability to compare post-injury testing to baseline values. This allows for a more accurate and objective assessment with an otherwise elusive injury, and provides important information when making return-to-play decisions.
It is well known that neurocognitive performance may be impacted following a concussion, but other aspects of physical performance may also be hindered: e.g. balance and visual coordination skills. This type of testing is often overlooked during traditional baseline evaluations, but we ensure that these additional testing components are done to gain a more complete picture of our athletes.