Concussion Management

What is a concussion?

A concussion is a type of traumatic brain injury caused by a direct blow to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.

It considered a mild, reversible brain injury that affects the normal functioning of the brain.

What is so special about the brain?

The brain is made up of billions of neurons and the communications between these neurons are how we think, move, and feel. We want to protect these neurons and connections so we can accomplish our day to day activities and long term goals.

What should be done if a concussion is suspected?

If the signs and symptoms of a suspected concussion are observed, it is imperative to immediately be removed from the activity (whether it be work, school, or a sport).

The individual should first be evaluated for any signs and symptoms that would warrant a referral to the emergency department. There are many tools designed to help with the detection of concussion, including the Sports Concussion Assessment Tool 5 (SCAT 5) which is intended to be used by licensed healthcare professionals and the Concussion Recognition Tool 5 (CRT 5) which is intended for use by anyone.

These tools help with recognition of the signs/symptoms of concussion, removal from the activity as well as provide guidance surrounding the immediate care of a suspected concussion.

How do you manage concussions (based on the Berlin International Consensus Statement)

It is important to be assessed by a healthcare professional if a concussion is suspected.

The assessment for concussion is multifaceted and may include evaluation of cognition, balance/coordination, neurological function, neck joints & musculature, and temporomandibular (jaw) joints & musculature based on the symptoms being experienced.

After the assessment is completed, the 24-48 hours immediately following a concussion require both cognitive and physical rest to ease discomfort and decrease demands on the brain during the early stages of healing. After this immediate rest and the acute symptoms resolve, both physical and cognitive activities can then be gradually incorporated once again provided they do not increase symptoms.

There are designated Return to School and Return to Sport protocols that will help to gradually increase cognitive and physical demands. Although these protocols can be performed simultaneously, returning to cognitive demands (such as school or work) are to be completed prior to physical demands (such as sports or rigorous physical activity).

The majority of concussions resolve on their own within 14 days for adults and up to 4 weeks in children. However, if the concussion does not resolve as expected, rehabilitation can be done based on findings of an individualized assessment.

Concussion Treatment may include:

• Cervicovestibular rehabilitation
• Manual therapy of the cervical spine and temporomandibular joints and
  muscles
• Adaptation, habituation, and balance exercises
• Gait and head movement
• Activity/sport-specific training drills”