Concussion is an injury to the brain that occurs as a result of a direct blow to the head, or a sudden acceleration or deceleration (start and stop) or rotation of the head. Reported occurrences of concussion have increased in recent years as people have become more aware of the signs and symptoms. However, many concussions remain unreported. A new injury before full recovery, called second impact syndrome, can cause serious brain damage and even death.
The Center for Disease Control and Prevention (CDC) estimates that 300,000 concussions are sustained during sports-related activity in the United States and more than 62,000 are sustained each year in high school contact sports. The CDC is now classifying concussion as a traumatic brain injury. Only about 10 percent of concussions result in loss of consciousness, and often a concussion is not the result of one large impact but rather a series of small collisions to the head. Awareness and education are proving to be the keys to effective treatment and symptom management.
Symptoms to note immediately after head injury are:
- Loss of memory
- Impaired information processing speed
- Loss of consciousness
Other symptoms and signs of concussion that may appear, some of which may be delayed are:
- Easy distractibility or poor concentration
- Feeling “in a fog”
- Inappropriate behavior
- Seeing stars or flashing lights, vacant stare
- Blurred or double vision
- Dizziness or lightheadedness, loss of balance
- Nausea and vomiting
- Change in coordination
- Slurred speech
- Ringing in the ears
- Low tolerance for frustration
- Personality changes
- Anxiety or nervousness
Concussion is a functional change in the brain, that is, a change in how the brain works; most imaging studies of the brain do not show function, but rather show structure or how the brain looks (such as swelling or bleeding). Therefore, diagnostic studies such as CT scans or MRI scans are normal with mild concussion. Features that indicate the need for brain imaging with CT scan or MRI are: loss of consciousness, amnesia, worsening headache, difficulty awakening or recognizing people or places, repeated vomiting, increasing confusion or irritability, seizure, arm or leg weakness, unsteady gait or slurred speech.
Several grading systems are used for concussion, but there is controversy over their value since they emphasize duration of loss of consciousness and amnesia but do not include other features of concussion.
If you suspect that you or someone in your care has sustained a concussion, it is critical that you contact your Pediatrician, Primary Care Physician or visit the Emergency Department. Every concussion is different, so symptoms may vary. But a medical professional should evaluate all head injuries. After the initial assessment your physician will advise you if additional care is necessary.
Hunterdon Healthcare’s affiliated physicians and providers offer services that address the needs of individuals with a concussion. We carefully outline a plan for you to follow that allows the brain to rest and recover, both at home and upon return to school or work. We then offer tools for returning to full function, including Physical Therapy and a standardized Step Program to guide the patient back to normal activity.
Baseline ImPACT Testing
Baseline ImPACT Testing is a computerized neuropsychological test that is available as part of the comprehensive concussion management plan. This testing can be an important component to assess recovery, and be part of the treatment plan.
Impact Testing is available through the Child Development Center. For more information or to schedule an appointment, please call 908-788-6396.
The Role of Physical Therapy in Concussion Care
Hunterdon Healthcare’s physical therapists offer a comprehensive evaluation of the symptomatic patient following a concussion. They begin by evaluating the patient’s:
- Manual Muscle Testing
- Range of Motion
- Vestibular (balance and spatial orientation)
After a thorough evaluation, the physical therapist develops a treatment plan tailored to the patient’s unique symptoms. Treatment progresses using the Step Program outlined below and by paying careful attention to any reemergence of symptoms.
All Hunterdon Healthcare providers and physical therapists use a Step Program for returning patients to normal activity. Stepwise return to activity is critical to ensure complete healing. ALL symptoms must be resolved before the patient moves to the next step and any recurrence of symptoms should indicate a move back one step for at least 24 hours:
- Step 1 – complete rest until no symptoms are present
- Step 2 – light aerobic movement with no resistance training
- Step 3 – sport specific exercise such as running or gradual resistance training
- Step 4 – non-contact training drills, gradually increasing resistance training
- Step 5 – full contact training
- Step 6 – return to full play
During recovery from a concussion, “cognitive rest” is also necessary. That is, return to academic schoolwork should be gradual.
Children generally require more time to recover from concussion than adults. Athletes with multiple concussions can sustain cumulative effects.
Mild concussions resolve in 7-10 days. Most concussions recover within 2-12 weeks.
Return to Play
Return to Play is provided by specially trained physical therapists. Return to Play includes an evaluation of muscle strength, range of motion, sensation, balance, vestibular function and gait to develop an individualized treatment program. The step program is used to help patients return to normal activities.
Return to Play is available at Hunterdon Sports and Physical Therapy located on 222 Route 31 in Flemington. For more information or to schedule an appointment, please call 908-237-7096.
Return to Learn
Return to Learn provides assistance with school based accommodations and academic interventions; cognitive, learning and speech/language evaluations as needed.
- Provides support and education to students/families
- Assists with school based interventions
- Conducts additional evaluations as needed, to include ImPACT testing
Additional services which may be part of “Return to Learn”:
- Individual/family counseling
- Cognitive rehabilitation
- Long term school based interventions
- Occupational/physical therapy
- Speech-language therapy
For more information or to schedule an appointment, please call 908-788-6396.
Recognizing the risks associated with concussion the News Jersey Legislature passed a Youth Sports Concussion Law in 2010 designed “to ensure the safety of student-athletes.” The law acknowledges that “it is imperative that athletes, coaches, and parents and guardians are educated about the nature and treatment of concussions and other sports-related head injuries, and that all measures are taken to prevent a student-athlete from experiencing second-impact syndrome.”
Under the New Jersey Youth Sports Concussion Law:
- The New Jersey Department of Education has implemented an interscholastic athletic head injury safety training program school physicians, coaches and athletic trainers.
- Each New Jersey school district has been required to developed a written policy concerning the prevention and treatment of sports-related concussions and other head injuries among student-athletes.
- A student who participates in an interscholastic sports program and who sustains or is suspected of having sustained a concussion or other head injury while engaged in a sports competition or practice must now be immediately removed from the sports competition or practice. The student must not be permitted to participate in further sports activity until he or she is evaluated by a physician or other licensed healthcare provider trained in the evaluation and management of concussions, and receives written clearance from a physician trained in the evaluation and management of concussions to return to competition or practice.
- All athletic trainers, as a condition of biennial license renewal must complete 24 credits of continuing athletic trainer education, which must include a specific number of credits of instruction on topics related to concussions and head injuries, as determined by the State Board of Medical Examiners.
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