The critically acclaimed film Concussion has brought the subject of concussion into a new light for athletes across the United States. In the public health exposé, Will Smith portrays forensic pathologist Bennet Omalu’s fight with the National Football League’s efforts to bury research on the brain damage suffered by its players. Attention increased two weeks ago when the NFL’s Jeff Miller, a health and safety policy executive, agreed at a congressional round table discussion that there was a link between football and degenerative brain disorders like chronic traumatic encephalopathy. The bottom line is that we have a lot more to learn about concussions as they are an issue in everyday life, sports and even for the military. There are more visits to the emergency room for kids with concussions related to play ground equipment and bicycle riding versus organized sports. The US military is devoting significant resources the developing the definition of a concussion to help better address blast injury concussions.
Now that concussion awareness is in the limelight, it’s up to athletes, coaches and parents to recognize the injury’s signs and symptoms and immediately pursue an accurate diagnosis and an appropriate treatment plan. The problem is the definition of concussion – a transient disruption in neurological function after head trauma. The issue is figuring out which signs or symptoms existed before versus after the head trauma. Clearly the prudent thing is to be cautious and when there is any doubt to institute return to activity protocols.
“Baseline” testing can be helpful to sort out what was present before versus after the concussion. I am not referring to any of the computerized “neurocognitive” tests. Standard lists of symptoms and graded symptoms scales along with simple standard neurological clinical testing of balance and memory have been developed and are supported by the evidence and expert consensus panels. Experiencing any of the symptoms or any abnormal test results meets the definition of a concussion unless known to be present before the head trauma. Many of the symptoms are common among the general population, not everyone has good balance and many people do poorly on memory tests.
I recommend the SCAT3 for athletes 13 years old or older and the Child SCAT3 for athletes at least 5 and up to 12 years. The test form is available free and any online search for either test will get you to a version you can print. The test can be administered by your primary care provider or any physical therapist or athletic trainer. It utilizes standard concussion symptom check lists, graded concussion symptoms scales, standard clinical balance and memory tests. This provides a general baseline status and allows for a comparison if a concussion is suspected. You can keep a copy of your SCAT3 baseline tests and take it to assist with evaluation by specialists if a concussion is suspected. There is nothing wrong with baseline testing that involves computer generated neurocognitive tests. We are considering offering one in our office. They arguably provided objective information on baseline status of specific dimensions of neurological or cognitive function. If you choose to add computerized testing to your baseline test I recommend also completing the age appropriate SCAT3 evaluation because of the portability among providers and the evaluation of more dimensions of neurological and cognitive function.
If you do sustain a concussion the good news is that 80% to 90% resolve in 7-10 days. There is a standard 7-10 day return to participation protocols that can be supervised by your primary care provider, physical therapist or athletic trainer. After a day of rest without symptoms these protocols gradually return you to normal daily activities followed by exercise and finally back to your sport. Evidence supports appropriate activity versus excessive rest provides the best recovery from a concussion.
(image reference: By Patrick J. Lynch, medical illustrator - Modified version of Image:Skull and brain normal human.svg by Patrick J. Lynch, medical illustrator, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=3489276) ______________________________________________________________________________ Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee.