Monday Medical: Team up to manage concussions
August 21, 2011
Steamboat Springs — The school year is about to start in Routt County. For many students, this means playing fall sports. Participating in sports activities brings with it a risk for sustaining a concussion. About 10 percent of all student athletes in contact sports suffer a concussion during the season.
A concussion is a common injury defined as a direct or indirect force on the head that produces a disturbance in the normal metabolic function of the brain causing multiple symptoms: physical, cognitive, emotional and sleep-related dysfunctions.
Symptoms of a concussion can include dizziness, headache, nausea, vomiting, irritability, vision problems, difficulty concentrating and more.
No longer is a concussion considered "just a bump on the head." A concussion is a traumatic brain injury, which can be rated mild to severe, but even a mild concussion can have significant side effects.
Recovery may take days, weeks or even months. Proper management of the injury is the first step in avoiding long-term complications.
"Concussions can be complex. No two concussions are the same, and the effects on each athlete vary greatly," physical therapist Lance Pugh explained. Pugh conducts the concussion management program at Yampa Valley Medical Center.
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"The athlete should be removed from play and examined by qualified personnel," Pugh said. "If in doubt, take the player out. You would not return a player to the field with a torn ligament or muscle, so we advocate taking the same consideration with a head injury."
The developing brain in a child or teen is very different from the adult brain. Concussion symptoms may show up later — hours or days after the initial injury — and last longer. If the child is not evaluated and given time to rest and recover, there could be long-term problems.
A key element to managing concussions is to endorse a team approach among coaches, athletes, families, school personnel and health care professionals. Everyone plays an important role.
More than 80 percent of concussions resolve very successfully if managed well within the first three weeks. Research shows that this is the average recovery time for a child or adolescent, a little longer than the average recovery time for an adult.
After the child has been evaluated and determined to have a concussion, the immediate focus is to reduce the potential for further injury or stress to the brain. For the athlete, this means immediate removal from the sport with gradual return.
This also means a reduction from mental activity. Academic and physical accommodations also should be made, especially during the first week after injury.
Physical therapist Scott Blair, assistant director of SportsMed at YVMC, explains.
"We cannot emphasize enough the importance of a collaborative treatment plan for the athlete/student," he said.
"Once the initial assessment of the concussion is made and confirmed by the medical team, there needs to be periodic symptom assessment by the family and school teams which must be shared with the medical team. The key to success is communication and collaboration."
Neurocognitive or neuropsychological testing has been proven to have significant clinical value in concussion management, especially with teenagers and especially when baseline scores are available. We are fortunate to have this testing available in our community.
This testing can help determine whether an athlete can safely return to sports and the classroom. One such testing system is called Immediate Post-Concussion and Cognitive Testing.
This testing is available at YVMC SportsMed clinics in Steamboat Springs, Hayden and Walden, and at Soroco High School and Steamboat Springs High School athletic departments.
Once the baseline test has been completed, the data is kept for two years. If the athlete suffers a concussion, then trained personnel can compare a post-accident test with the baseline test in order to properly assess and manage the concussion.
The best practice for concussion management is the team approach where a consensus is reached among the members of the family, school and medical teams.
Lisa A. Bankard is director of wellness and community education at Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org or 970-871-2500.