Neuropsychological Consultation: Concussion Management

“No player should return to play on the same day he was injured, and no player should return to play without an individualized return-to-play care plan supervised by a brain injury specialist”

Michael Sefton, Ph.D.

It is now well known that rest is the key to recovery following a sports-related concussion. Massachusetts now requires parents, athletes, and coaches to have education about the impact of concussion.  School nurses tend to be the front line advocates for these programs in the public schools.  They do it all including the counseling and supervision of post-injury testing.  Post-injury testing and concussion support is available at the Concussion Assessment and Management Program that may bring to light subtle neurocognitive signs of lingering concussion.  Athletes should be symptom free for 7-10 days prior to beginning a return-to-play plan.  Contact Dr. Sefton for assistance with managing return to play, return to school and return to work when recovering from concussion.

A call for baseline testing: Gaining ground on concussion management

The Concussion Assessment and Management Program (CAMP) in central Massachusetts provides consultation with schools and teams using innovative and scientifically proven methods for measuring cognitive baseline in athletes. With greater awareness of the potential long-term impact of concussion it is more important than ever to recognize the signs and symptoms.

Preseason cognitive testing is being conducted across the country on athletes who are beginning their high school and college careers. This is an important first step in the management of students who are afflicted with the signs and symptoms of brain injury. “Fortunately, baseline cognitive testing has increasingly become the norm for players as young as grade school, since it can help detect concussion-related changes and guide a physician’s decision to clear a concussed young player to return to play. Over time, researchers are certain to use that data to track players’ cognitive well-being as a function of playing time and blows to the head.” LA Times Science 8-31-13

Ostensibly, post-injury testing offers physicians and parents alike with up to the minute measurement of neurocognitive indices that are predictive of the readiness for return to play. When available these results will be compared with the athlete’s baseline and used as a barometer of healing.

“A concussion is…

“A concussion is an academic injury, in the sense that it affects the capacity for learning,” said pediatric neuropsychologist Gerard Gioia at the Children’s National Medical Center in Washington.

A return to school care plan is essential for student experiencing the cognitive impact of concussion. According to Michael Sefton, Ph.D., school-based modifications may be added at any time after a student athlete is injured. “Just as you would allow an athlete suffering with an orthopedic injury
to use an elevator, school administrators are permitting a host of accommodations for athletes with concussion in order to allow them to heal and succeed in the academic setting.” Concussion is considered an invisible injury but arguably it is not invisible to those responsible for teaching school curriculum to afflicted students according to Sefton.

Concussion thought of as invisible injury

“CT scans can’t detect the brain’s massive metabolic disturbance in the wake of trauma. Nor can they measure the shearing of fat-covered axons — the “white matter” that carries electrical impulses across the hemispheres of the brain and from region to region. And yet research suggests both of those processes may be key to concussion’s most damaging cognitive consequences.” LA Times 8-31-13

Concussion is described as an invisible injury ostensibly because there are no outward signs of deformity, bruising, or bones that are broken.  Athletes who are “resting” as part of the step by step return-to-play protocol often feel marginalized by their teammates.  Coaches strive to keep injured players in the mix by including them at practice and insisting they ride the team bus to games.  This isn’t always possible when a student recovers from concussion.  Many experience symptoms of light and sound sensistivity so riding the bus can be a painful endeavor.  Other signs of concussion include poor concentration, lack of focus, decreased short term memory, decreased cognitive efficiency, and sometimes depression.