Every four years a panel of concussion experts and researchers meet from around the world to present and summarize recent research regarding concussion in sport. The group also provides recommendations to help guide clinical practice regarding all aspects of concussions, including treatment, return to play protocol and prevention that can be used by all health care professionals treating injured athletes. The most recent consensus statement was released this month and it supports everything Sheddon Physiotherapy and Complete Concussion Management have been doing for years. Below you will find the major highlights from the recent consensus and how it fits in with everything we have already been doing at SPSC.
Assessment of Concussion
The initial examination should consist of a thorough history, evaluation of mental status, cognition, oculomotor function, gross sensorimotor, coordination, gait, vestibular function and balance.
The therapists at SPSC have been treating concussion patients for years and have noticed that no two people will experience a concussion in the same way. As such, we use a multi-faceted approach when assessing concussions, including:
- detailed neurological exam;
- cognitive function;
- oculomotor function;
- vestibular function;
- cervical spine biomechanical assessment;
- coordination, balance and gait evaluation
In the past, athletes were encouraged to completely rest (dark room, no physical or cognitive activities) until symptom free. However, there is insufficient evidence that complete rest promotes recovery. The current recommendation is an acute period of rest (2-3 days) followed by gradually becoming more active, both cognitively and physically (not by returning to sport, but rather by doing activities such as cycling, walking, etc.) , all while making sure to stay below symptom aggravation.
The therapists at SPSC assess cognitive and physical symptom-exacerbation thresholds early on in treatment. Patients are then strongly encouraged to progressively become more active, yet staying within the pre-determined thresholds. Patients are monitored closely and progressed according to their symptoms, eventually resulting in a full return to school, work and eventually sport.
Treatment should be individualized and target specific dysfunctions identified on assessment. Evidence supports the use of:
- An active rehabilitation program involving sub-symptom-threshold aerobic exercise;
- A targeted physical therapy programme for patients with cervical spine and vestibular dysfunction.
At SPSC, concussed patients are thoroughly assessed in order to determine which systems are causing the concussion symptoms. From the assessment, patients will be given a treatment approach and exercise program tailored to their individual needs. Treatment involves interventions supported by research, such as cervical, visual or vestibular rehabilitation. Furthermore, athletes are assessed early on to determine symptom aggravation during aerobic exercise. From this assessment, an individualized exercise program will be given that stays below symptom exacerbation.
Research has shown that symptom resolution generally occurs prior to cognitive recovery. As such, symptom resolution CANNOT be used as the sole basis for a return to play decision. A range of different assessment tools must be used.
At SPSC we are vigilant with our return to play decision-making, given the high risk associated with returning to sport too quickly. All athletes are assessed thoroughly for full recovery of the brain, as well as different systems that can be injured with a concussion (cervical, vestibular, visual, etc.). Athletes are also put through a final exercise test to ensure they are fully ready to return to full contact symptom free.
Completing comprehensive baseline tests prior to the start of the season offers health care professionals valuable and objective information to help them make difficult return to play decisions. It also provides an additional educative opportunity to teach athletes about concussions.
At Sheddon Physiotherapy and Sports Clinic we offer the most comprehensive concussion baseline testing of any sports medicine clinic in the Mississauga and Oakville area. Most clinics will tell you that they provide concussion baseline testing, but that doesn’t mean they do it properly. Traditional baseline programs focus solely on computerized neuropsychological tests, such as the ImPACT test. Although vital for assessing neurocognitive function, research has shown that neuropsychological tests should not be used in isolation, since they only address one aspect of concussion. In order to properly manage concussions, a baseline test must be multidimensional, assessing the full spectrum of concussion outcomes (i.e., balance, reaction time, visual processing, physical capacity). These different test results will be compared to post-injury values in order to know when an athlete has returned to their normal pre-concussion baseline values. As such, the best way to ensure that you return to sport safely following a concussion is to get baseline tested before a concussion even occurs.
All of the therapists at Sheddon Physiotherapy and Sports Clinic have undergone extensive training with the Complete Concussion Management program in order to be educated with the most recent research-proven concussion management strategies. In addition, we have successfully treated hundreds of sports-related concussions and have an extensive network of specialists, including a sports medicine physician, vestibular physiotherapists, chiropractors and athletic therapists. We offer the highest quality of concussion testing and management in the Mississauga and Oakville area. If you are interested in learning more, please contact us at 905-849-4576