Expert Health Articles

Concussion Update

Over the last several years, there has been a lot of research performed concerning concussions and this is resulted in many changes in the evaluation and management of concussions. One of the more important discoveries is that concussions are extremely variable in their presentation because of the presence of a number of different concussion subtypes. At least seven different subtypes have been identified, and often patients may have multiple subtypes at the same time. Examples of the subtypes are vestibular or balance dysfunction, eye-brain communication abnormalities, cognitive impairment, exercise intolerance, posttraumatic migraines, cervical injury, sleep disturbance and mood abnormalities.

It is important to identify which of these subtypes are present, because each subtype requires different treatment strategies. For instance, headaches from a concussion can be caused by eye-brain communication abnormalities, cognitive fatigue, excessive activity, posttraumatic migraines and cervical injury. Each of these need to be treated very differently.

The existence of these subtypes highlights the importance of a detailed and comprehensive evaluation for concussions that assesses all of these various subtypes.

In addition to identifying subtypes of concussions and treating them appropriately, there have been other major changes in our concussion management. In the past, we would primarily treat concussions with rest.

Today, we are treating concussions more similar to other sports injuries and taking a more active approach. For instance, if you sprained your ankle, you might be recommended to be on crutches for a few days. Still, typically, we try to wean you off the crutches as soon as possible and start a gradual increase in activity, beginning with walking, and advancing to jogging, running, sprinting, pivoting and jumping. While we are progressively stressing the ankle, we are cautious not to stress the ankle too much that would cause the recovery to take a step backward.

Concussions are treated in much the same way. We are allowing athletes to start with light physical activity and progressing as tolerated, even while they are still symptomatic, instead of waiting until all their symptoms have resolved. We often will recommend returning to school as soon as possible. Still, patients may only attend a few periods a day and have limitations on the amount of homework and studying they are allowed to do. We are also more likely to prescribe physical and occupational therapy at an earlier time in the recovery. Physical therapy may include treatment of neck injuries, inner ear training, and exercises to help the eyes and the brain to reestablish communication.

Occupational therapy may include cognitive rehabilitation to help with memory, cognition, attention and focus, and problem-solving.

It is important to remember that every concussion is unique and needs individualized assessment and treatment for a safe and efficient return to all activities, including school, sports and/or work.

Michael Stump, MD

Sports Medicine

Blanchard Valley Orthopedics & Sports Medicine