Monday Medical: The concussion conundrum, Part II |

Monday Medical: The concussion conundrum, Part II

Lisa A. Bankard/For the Steamboat Today

Editor's note: This is the second article in a two-part series. The first article was published Dec. 7 and can be found online at, by searching for "concussion."

A concussion or mild traumatic brain injury occurs when a person receives a bump or blow to the head that causes the brain to shake inside the skull.

This force disrupts the way the brain typically functions and can cause a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess.

"A concussion is often a misunderstood injury because its symptoms are not always straightforward," said Michael "Mickey" Collins, Ph.D., a neuropsychologist and assistant director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program.

"I see daily in my clinic that no two concussions are alike, and the injury's effects and recovery period are different in each individual," he said.

Collins, who presents a program in Steamboat Springs tonight, said research has shown that allowing enough healing and recovery time for the brain after a concussion is crucial in preventing further damage.

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"Nationwide, we are seeing that concussions are too often under-diagnosed and poorly managed," he said. "We are concerned about that because if a brain injury like a concussion is not diagnosed and given time to heal properly, it could lead to further injury and more serious long-term problems."

Relying on an athlete's self-report of symptoms is inadequate. Athletes often will hold back information when describing their symptoms in an attempt to get back to the playing field.

Athletes who return to play too soon, before their brains have healed, are likely to suffer further brain injury, including post-concussion syndrome. If another concussion occurs soon after the initial injury, this "second-impact syndrome" can have catastrophic results.

Research at the University of Pittsburgh concussion program shows that even athletes who report being symptom-free may continue to exhibit neurocognitive deficits that they are either unaware of or are failing to report.

Because of these and other findings, Collins and Mark Lovell, Ph.D., — the current director of the University of Pittsburgh's concussion program — have led the current re-examination of traditional return-to-play standards that were primarily symptom-based.

Traditional neurological and radiologic procedures, such as CT and MRI scans and electroencephalograms, provide important information in identifying serious concerns, including skull fracture, hematoma and confusion. However, they are not useful in identifying the effects of concussion.

In proper concussion management, it is important to have baseline neurocognitive testing as well as post-injury testing. Such evaluation can help ob­­jectively assess the athlete's post-injury condition and track recovery for safe return to play.

In 1999, Immediate Post-Concussion and Cognitive Testing was developed by Lovell and Joseph Maroon, M.D. It is the first and most widely used computerized sports concussion evaluation system, designed after almost 10 years of university-based, grant-supported research.

The 20-minute ImPACT test measures brain processing, speed, memory and visual motor skills. It helps to quantify the ability of the athlete's brain to function at a normal level, pre- or post-injury. This brings objectivity to managing a difficult injury.

Even what seems to be a very mild concussion needs to be taken very seriously since deficits on ImPACT can be seen several days, or even weeks, after an injury. Younger athletes are more vulnerable to further brain injury post-concussion and require longer recovery time than older athletes.

More than 900 schools, 250 colleges and universities, 125 professional sports teams, and 250 sports medicine clinics nationwide are now using the neurocognitive testing with ImPACT.

Locally, this testing will be available at SportsMed at Yampa Valley Medical Center; in Steamboat, Hayden, North Park and Soroco schools; and through the Steamboat Springs Winter Sports Club.

The hope is that our community of athletes, coaches, athletic trainers, physical therapists and physicians will incorporate the same diagnosis, evaluation and management of concussion injuries.

Lisa A. Bankard is director of Yampa Valley Medical Center's wellness and community education programs. She can be reached at

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Yampa Valley Medical Center presents its monthly free family health program today at 7 p.m., in conference rooms 2 and 3 at the hospital. Michael “Mickey” Collins, Ph.D., from the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program, will discuss how to diagnose, evaluate and manage a sports-related concussion.

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