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Concussion Resources for Healthcare Professionals
NOTE: Always practice within your professional competencies. The following information is provided as supplementary information. It is recommended to seek professional consultation with medical providers like the Sports Concussion Institute which are specially trained in concussion evaluation, treatment, and management.

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Recognition and Evaluation of the Injury

Recognizing when a concussion or other mild traumatic brain injury (mTBI) has occurred can be difficult, especially if the injured person did not lose consciousness and/or does not report amnesia. Sideline recognition becomes particularly difficult for the team physician or athletic trainer when the concussion symptoms are subtle in the first few hours after the impact, and this can be further complicated because concussions are characterized by random onset and spontaneous recovery of symptoms. Despite all these challenges, an early, accurate recognition of the injury is vital to the path of recovery.

The evaluation process should include a complete history, a physical examination, and a cognitive examination. In the acute phases of the concussion, it is important to first rule out intracranial bleeding and head/neck injuries. Gathering a complete history of the person allows for rapport building, identification of any symptoms and their severity levels, and the documentation of the mechanism of injury. A physical examination that includes orthopedic and neurological assessments is also suggested. These steps are often a part of emergency department procedures, and should occur as soon as possible after the impact. Assessing the person's symptoms, behavioral changes, and sleep disturbances is also recommended within a day of the injury.



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Cognitive Testing

It is considered best practice to utilize neurocognitive testing in the evaluation and management of concussions (McCrory et al, 2008). On the sideline, the SCAT2 {link: SCAT2.pdf} is a widely-used assessment tool to determine the level of cognitive functioning shortly after the impact. Additionally, the NFL has also issued a sideline assessment card {link: ACSM (2011) Consensus Statement Team Physician and Concussion.pdf} designed for use by team physicians.

While sideline assessments have been validated, computerized neurocognitive tests, in conjunction with vestibular screening, are considered to be the gold standard for concussion diagnosis and evaluation. Computerized concussion assessments typically measure verbal and visual memory, reaction time, visual-motor speed, and impulse control. Specialists (e.g., neuropsychologists, neurologists) trained in the administration and interpretation of these highly sensitive computerized assessments are best suited to manage the concussion and provide the medical clearance for return to play that is required by many states in the USA.


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Short- and Long-Term Effects of Concussion

Multiple studies have demonstrated the cumulative effect of concussions. It has been shown that athletes who sustain a concussion are at greater risk for a second concussion that includes loss of consciousness (8x), anterograde amnesia (5.5x), and confusion (5.1x) (Collins, Iverson, et al., 2003). If a subsequent concussion occurs during a time of recovery, the person risks a longer recovery period, potentially more symptoms, increases in symptom severity, and possibly second-impact syndrome. Post-Concussion Syndrome (PCS) can also result from the prolonged presence of concussive symptoms, which can have a debilitative effect on the person for weeks, months, or even years after the injury. In addition, the concussed person can experience a variety of psychological symptoms that can have a negative effect on daily functioning if they go unmanaged.

Long-term effects of concussion include depressive disorders, problems with anxiety, psychosocial problems, and physical and cognitive disturbances. Recent research has also linked sports concussions with Chronic Traumatic Encephalopathy (CTE), a disorder that results from repeated concussions. CTE is typically identified post-mortem, and has been determined to be the cause of death for multiple athletes under the age of 50.

Psychological Issues Related to Injury in Athletes and the Team Physician


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Concussion Management

Managing concussions requires more than just monitoring symptoms because some athletes may underreport or not report symptoms so that they can continue to play. The state-of-the-art in concussion management integrates acute care, neuropsychological testing, symptom monitoring, and evaluation of balance abilities. At the Sports Concussion Institute, the trained staff is dedicated to the safe management of concussions. We offer educational seminars, baseline concussion testing, comprehensive clinical care, and medical clearance for return to play and return to school activities. SCI utilizes a multi-disciplinary team approach to concussion management, and we invite you to seek consultation with our specialty clinic.


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