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Concussion Management is Key To Full Recovery

From professional athletes to weekend warriors, concussions are common injuries. In the United States, an estimated 300,000 sports-related concussions occur each year. However, thousands more may suffer concussions as a result of playground injuries, falls, car accidents and other causes.

A concussion is a brain injury, most often caused by a blow to the head. While they may range in severity, all concussions temporarily affect brain function to some degree. Concussions can impair speech, balance, coordination, memory and cognitive thinking.

Immediate symptoms of concussion may include difficulty thinking clearly, quickly forgetting new information, headache, slurred speech, unusual behavior, and repeated nausea or vomiting. Concussion may cause balance problems, slowed movement, and sleeping more or less than usual.

Most people who suffer a concussion do not lose consciousness. Often, they try to resume their usual levels of activity because they believe their injuries are not serious. However, there are potentially serious impairments. Patients with suspected concussions should be evaluated immediately by a physician, and should not resume play without medical clearance.

In most cases, the physician will ask questions about the injury and check strength, balance, coordination and cognitive functioning such as memory and communication. A CT scan is usually ordered if the person lost consciousness or has lingering symptoms. In addition, a CT scan is recommended if there is a suspected fracture of the skull or bleeding in the brain; symptoms may include bruising of both eyes, or bruising behind the ear can indicate a skull fracture.

Most concussions resolve on their own within a few days or sometimes weeks. The physician will want to know about any new symptoms or changes in behavior. Pain medications may be recommended to relieve headache. Depending on the severity of the concussion, additional testing may be needed including MRI scanning and seeing a neurologist in consultation.

Sometimes a second concussion may occur before the first one has fully healed. These “second impact” concussions can cause additional trauma to the brain, including brain swelling and widespread damage. They carry a higher risk of long-term cognitive dysfunction and may even be fatal. The consequences of repetitive concussions may include memory dysfunction, motor dysfunction and Parkinson’s-like movement disorder, such as balance and gait disturbances, rigidity, tremor and slowed movement.

Even seemingly mild injuries often require professional care and management to ensure optimal recovery. Once available only to elite athletes, concussion management has evolved into a well-defined clinical service that helps prevent second impact concussions through education, relieve pain and symptoms, and help patients make appropriate decisions about returning to work, school or sports.

Baseline testing and/or post-injury neurocognitive testing can help to objectively evaluate the patient’s post-injury condition and track recovery for safe return to activities. Such evaluation, known as ImPACT testing, has proved to be an integral part of proper concussion management.

Many people choose to participate in ImPACT testing before sports activity, to establish a standard for their cognitive abilities. Testing takes about 20 minutes and measures various areas, including verbal and visual memory, attention span and nonverbal problem solving.

Michael Lobatz, M.D., is a board-certified neurologist with Scripps Health.

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