By Ryan D. Fairchild, MS, PT, MBA, Vestibular Rehabilitation Certified, IPMR
Do you know when it’s safe to return to play after a concussion?
Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. They result in 144,000 ER visits per year; however, it was estimated in one recent review that up to 3.8 million recreation and sports-related concussions occur annually in the U.S. Concussions represent 9 percent of all high school athletic injuries; however, data are significantly lacking about concussions in grade school and middle school athletes. Football results in the highest rate of concussion for the high school male, while soccer and basketball have the highest rates for the high school female. Rugby, ice hockey, and lacrosse also account for higher rates but data is limited as these are often club sports.
What is a concussion?
A concussion is a short-lived brain injury caused by a bump, blow, or jolt to the head. Most concussions appear without loss of consciousness. The American Academy of Pediatrics recommends any child or adolescent who sustains a concussion be evaluated by a physician before returning to play and that physical activity be restricted from 7 to 10 days, or longer.
Signs and Symptoms of a Concussion
Symptoms of a concussion can occur immediately or hours after the blow or fall. Signs and symptoms can vary over time, depending on activity level, making them difficult to recognize. If the athlete experiences any of the following signs or symptoms, get them to a health care provider for an evaluation.
Evaluation and Management
If you suspect your athlete has sustained a concussion you should immediately alert the coaches, take the athlete out of the game and seek medical treatment from a health care provider who is experienced in evaluating concussions.
Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. The athlete should not return to play until he/she is asymptomatic with activity and “cleared” by a health care professional to return to play. A concussion is a brain injury, and like all other injuries, needs time to heal.
Treatment
Post-concussion treatment typically includes limiting mental and physical exertion, prescribed medication as needed, and vestibular rehabilitation. There are rehabilitation programs available using specially trained therapists to conduct a comprehensive evaluation. In reviewing rehabilitation programs, make sure they incorporate several options for evaluation; such as the use of Frenzel glasses for testing peripheral vs. central vision problems. Or, a program may also use the NeuroCom SmartBalanceMaster® to check for functional deficits with sensory, motor and/or central balance issues, and or ImPACT® Neurocognitive testing to evaluate cognitive efficiency.
The therapist will develop a patient-specific treatment plan using the results of this evaluation. The treatment may include exceptional therapy to improve tolerance to activity, vestibular exercise to address the number of vestibular issues caused by concussions, or compensatory strategies to overcome deficits. There are many symptoms that accompany a concussion and can vary drastically from one athlete to another. The multidisciplinary team at IPMR is specially trained and well equipped to address this very complex issue.
At IPMR our goal is to improve function and quality of life. We work with the athlete’s doctor to get the athlete back in the game as quickly and safely as possible and to minimize post concussion symptoms using the IPMR Vestibular Rehabilitation program. For more information on concussion management, or to schedule a presentation on safe return to play, call Linda Beckman at 309-621-4164. Visit: impr.org.
Sources upon request.
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