Outline of Concussion Management
#TeamEPP has experience in preventing concussions, responding on-site, assessing on-site and in clinic, treating, and returning athletes to training and competition.
Why do we assess comprehensive baseline metrics?
Physiological recovery may outlast
the time for clinical / symptom resolution
Concussion can involve any singular or combined dysfunction:
Pain
Cognition / Thinking
Reaction Time
Behaviour
Vision
Balance / Vestibular
Cardiovascular
Strength / Conditioning
Sleep / Fatigue
Regular, objective, multimodal testing provides a confident target to
assist return to training / competition decisions
What do we measure?
Symptoms - Pain, Health, Physical Function, Emotional Well-Being, Social Function, Energy / Fatigue, Sleep
Physical Testing - Balance / Proprioception, Cardiovascular, Strength, Reaction Time
Neurocognitive Testing - ImPact, SCAT 5, King Devick
Dual Task Complexity - Combined Physical and Neurocognitive Testing
How Do You Manage a New Concussion?
Experience is required to appropriately triage appropriate care, as Emergency Care may be indicated by subtle clinical assessment.
When away from our Athletic events, #TeamEPP recognizes that many Athletes first report to us after a period of time. Nevertheless, each first consult begins with a thorough medical history and comprehensive physical exam to rule out the rare need for Urgent or Emergency care. Fortunately, these steps also help us learn details about each individual head injury that will assist in the recovery. We are able to best determine advice to help you take control of your injury, and to prepare you for the next steps in recovery. Healing has already begun, and we are here to keep you on track.
Management will include:
Education - downside to “rest” as advice; pathophysiology; course of healing; what to expect; who / where to access resources; sleep hygiene; concussion specific dietary advice
Activity Recommendations - school / work / driving / exercise as recovery
Physiological - Treadmill test to evaluate exercise tolerance; Continue safe Strength & Conditioning, Chicago Blackhawk Test to evaluate full return
Visual + Vestibular - Eyes and balance have a complex relationship
Neck / Cervical - Neck influences headaches, vision, and balance to add another layer in the complexity; Research absolutely proves concussion is always accompanied by whiplash, the symptoms of which can mimic concussion symptoms
Baseline Comparison - Symptom; Physical; Neurocognitive
When is it Safe to Return to Sport?
Criterion based assessment and graded progression considering the multiple systems affected by a head injury. Our goal is to return you to sport only when you and your brain are safely ready to return. We will include in our discussions:
Current comparison to baseline metrics, including risk analysis for another concussion or musculoskeletal injury
Identifying and managing dysfunction related to whiplash, to clarify the conversation around concussion
Concussion history
Aggregate of information from you, your family, your medical staff, your team staff, etc.
Persistent Symptom Management
Athletes experiencing ongoing dysfunction after 6 weeks require a comprehensive analysis from experienced clinicians that investigate the integration of multiple, interrelated components:
Cardiovascular / Autonomic Nervous System
Vision and Balance / Proprioception
Cervicogenic / Whiplash Associated Disorders
Post-Traumatic Stress and Anxiety - Psychologists
Sleep
Diet
Experience also encourages us to access the skill sets in our preferred network:
Medical - Sport Physicians / Physiatrists, Neurologists, ENTs, GPs
Visual - Opthamologists, Neuro-Optometrists
Diet - Dietitians, Naturopathic Physicians