If you missed “Part 1” of this post on how to prevent concussions, how they occur and symptoms you may experience, you can read it here.
Pre-Participation Evalutation (PPE): in my office, we conduct PPEs to establish a medical background from which medical decisions about physical activity may be made and medical clearance may be provided.
Baseline Testing: also available in my practice is a 20-minute computerized neurocognitive test (ImPACT testing) designed to measure the effects of concussion. After an athlete completes a baseline test, his or her data is stored on a secure, HIPAA compliant server. If a concussion is suspected in the future, a follow-up test is administered to see if the results have changed from the baseline. Traditional imaging procedures (CT or MRI) are helpful in identifying serious brain injuries, but they are not able to identify the functional effects of concussion. ImPACT can detect subtle changes in cognitive functioning that cannot be accurately measured by relying on athletes to report symptoms.
Other preseason testing include Maddox Questions (checks for memory), SAC (Standard Assessment of Concussion), BESS (Balance Error Scoring System); Sideline Concussion Assessment Tool (SCAT2); and NFL SCAT.
In addition to any necessary emergency response, the medical personnel on the field may perform various on-field and sideline assessments, such as a physical exam, neurocognitive and balance assessments, Neuropsychological (NP) Testing/Sideline Concussion Testing, and Return to Play evaluation.
• Dim/Quiet room
• Allow patient to sleep/rest!
• Very limited role of medications (OTC acetaminophen is most commonly prescribed)
• Seek medical attention if symptoms worsen acutely
Return to School/Play
Returning to school or play is a case by case management. Cognitive rest is needed – decreased concentration, reduced academic workloads, days off or shortened school days, extended test taking times and return to full academics when symptom-free. There should also be a progressive return to play: crawl -> walk -> run -> practice -> play. Talk to your doctor about treatments based on symptoms, age and medical history.
Before returning to school or play, there must be a medical clearance, be symptom-free, not taking medications and there must be a return to baseline based on the neurocognitive / physical / balance exams.
Keep in mind that a premature return to play can lead to a more severe concussion/prolonged symptoms. “Second Impact” syndrome is a second episode of brain trauma before the brain heals from the first. Cerebral arteries lose their ability to autoregulate (vasoconstrict), resulting in diffuse brain swelling/increased intracranial pressure. Second Impact syndrome involves a high incidence of brain herniation, coma and/or death.
Chronic Traumatic Encephalopathy
This condition is known in boxing as Dementia Pugilistica or Punch-Drunk Syndrome. It’s a progressive degeneration of the brain secondary to multiple brain injuries (concussions). Symptoms involve a change in mood (depression/suicidal ideation), cognition (memory loss), movement (parkinsonianism/balance dysfunction) and behavior (aggression).
Before engaging in activities or sports in which head injuries are common (football, soccer, basketball, volleyball, baseball, hockey, etc.), consult with a sports medicine physician regarding how to prevent head injuries, your risks for concussion, a PPE, and baseline testing to be proactive in managing possible concussions.
Dr. Fernando Manalac is a board certified sports medicine physician who practices at the Holy Cross Orthopedic Institute in Fort Lauderdale, FL. For referral information, call 954-900-6653.