Concussion management

Liberty Hospital Sports Medicine consults with CIC Kyle Schneweis, MD, a sports medicine physician at The Liberty Clinic. Dr. Schneweis helps with the diagnosis, treatment and management of concussion patients. LHSM also can work with a patient’s primary care physician during the treatment and management of a concussion.

Our physical therapists will utilize both aerobic and strengthening based exercises to help with rehabilitation of a patient’s vestibular system.

The purpose of vestibular therapy is to address symptoms and issues that patients may experience that are associated with dizziness, balance problems and difficulty focusing.

Speech therapy is essential with certain patients to help assist with the cognitive remediation of speech.

Neurocognitive testing is an assessment tool that is used to help with the treatment and management of concussions. ImPACT is a computer-based test that is performed as a pre-injury assessment (baseline tests typically done before start of sport season) and then can be performed following a concussion or a suspected concussion. ImPACT neurocognitive testing is a tool that can help trained medical professionals with possible treatment options as well as assist in the decision when an athlete is safe to begin a return-to-play protocol.

BITS is a rehabilitation therapy tool designed to evaluate and improve abilities in individuals with disabilities resulting from traumatic injuries and movement disorders. BITS has many uses and applications that are beneficial to the management of concussions, including: cognitive training and memory/processing, vestibular training, motor reaction and planning, and hand-object-eye coordination activities.

For patients involved with athletics, Liberty Hospital Sports Medicine offers a structured Return-to-Play Program that allows athletes the ability to safely progress their level of activity following a concussion. The gradual-step program is overseen by a certified athletic trainer who has an expertise in concussion management and has ITAT training.

What is a supervised Return-to-Play Protocol?

A Return-to-Play Protocol is a four-step activity plan that gradually increases in length and intensity. Each workout gets progressively more difficult to ensure the athlete is 100% ready to return fully to sports. A Return-to-Play Protocol should only be started once all of the athlete's symptoms have been resolved.

Athletes can complete their Return-to-Play Protocol under the direction of an ImPACT Trained Athletic Trainer (ITAT). The ITAT is there to monitor symptoms, encourage the athlete and take the guesswork out of the process for the patient and/or parents. This is a fee-for-service program that is not billed to insurance. Cost for Step 1 is $15; Step 2-4 is $25 each.

*Step 4 can be completed by athletes in non-contact sports and/or athletes out of season. Step 4 involves the athlete’s participation in a full practice with their team that includes full-contact activities under observation of a coach or athletic trainer. The ability to assess the integration of contact-related sport activities cannot be accommodated within the clinical setting.

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the most-widely used and most scientifically validated computerized concussion evaluation system. ImPACT provides trained clinicians with neurocognitive assessment tools and is used as part of a comprehensive clinical evaluation to help with determining safe return-to-play and return-to-learn decisions.

A baseline ImPACT test is a pre-injury test that takes approximately 30 to 45 minutes to complete. It will establish a benchmark of an athlete's neurocognitive levels, such as brain processing speed, memory, problem solving and visual motor skills. The baseline provides a benchmark score when an athlete is in their normal or non-concussed state. In the event an athlete is injured, the ImPACT test is retaken to compare the athletes post-injury cognitive level to their pre-injury level. Prior to an athlete returning to sports, they should be close to their pre-injury or normal cognitive level.

The baseline test does not evaluate the subject for a concussion, identify past concussion(s), prevent future concussions or determine if someone is predisposed to a concussion.

Typically a post injury ImPACT is administered 24 to 72 hours after the injury to see where the athlete is compared to their baseline test. Depending on the results and the athlete's symptoms, your healthcare provider may ask for additional tests to be completed at a later time.

Any athlete 11 years or older can take a baseline ImPACT test. In the event an athlete is injured but does not have a baseline ImPACT test, they can still take a post-injury test, and their results will be compared to the national average for their age.

The ImPACT test is administered by athletic trainers, school nurses, athletic directors, team doctors and psychologists. Before testing, individuals should try to get plenty of sleep and take all of their regular medications. If the test taker wears prescription glasses or contacts, they should be worn if needed for computer work. During the testing, no electronic devices such as cell phones or tablets are allowed in the testing area. Also, no food or drinks are allowed. During the testing, if an individual has a question, the test administrator will be accessible for questions.

The cost per test is $25, for both baseline and post-injury testing. Discounted rates are available for teams or groups; please contact us for pricing. Larger team or group testing will be administered at Liberty Hospital. Individual testing and post-injury testing will take place at Liberty Hospital Sports Medicine. After the test, you will receive a copy of the results. Please keep a copy for your records, and then share the information with your physician(s). To schedule a test or for more information, please call 816.407.2322.

Anyone can sustain a concussion. The program is available for any patient who may have sustained a concussion; this includes athletes in school-related sports, recreational athletes, patients who were in a motor vehicle accident or any other type of accident.

Concussions are a type of traumatic brain injury (TBI) caused by a blow or jolt to the head or body that causes a temporary disturbance of brain function. A concussion is a functional injury to the brain, so structurally, the brain will appear normal on all imaging, including CT scans and MRIs. A concussion occurs when an impulse is sent to the brain, causing a complex metabolic change of events. During a concussion, the brain demands more energy than it is receiving. Due to the metabolic chain of events, blood flow—and therefore glucose (the body's main source of energy)—decreases in the brain. With most injuries, the body wants to have more glucose to an injured area. So, with the decreased blood and an overall increased need, the brain has a gap of supply and demand for blood. Therefore, it can lead to symptoms such as disorientation, memory loss, concentration and slowness in thinking.

Anyone who has experienced a bump, blow or jolt to the head or body and reports one or more of the following symptoms may have a concussion:

• Headache or pressure in the head.
• Dizziness.
• Nausea or vomiting.
• Neck pain.
• Sensitivity to light.
• Sensitivity to sound/noise.
• Blurred vision and/or double vision.
• Difficulty concentrating.
• Difficulty remembering/loss of memory.
• Ringing in the ears
• Feeling slowed down or feel in a fog.
• Confusion.
• Drowsiness.
• Trouble falling asleep.
• Irritability.
• More emotional/sadness.

What might a coach or parent observe when someone may have a concussion?

• Loss of consciousness.
• Sleepiness, grogginess.
• Balance problems.
• Slurred speech.
• Slowness in responding.
• Out-of-it behavior.
• Difficulty remembering.

When should I seek immediate care?

• If one pupil is larger than the other.
• Drowsiness or difficulty awakening.
• Headache that worsens.
• Slurred speech, weakness or numbness in limbs, or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures.
• Unusual behavior or increased confusion.

The diagnosis of a concussion is determined through clinical examination. By definition, all imaging tests such as a CT scan and MRI will appear normal.

When someone sustains a concussion, the primary objective is to keep the exertion level to the brain to a minimum. This includes no physical exertion, no extreme visual stimulus (such as texting, video games, or computer work), and limiting cognitive stress (taking exams in school). The prognosis for most concussions is good with proper rest and monitoring. However, if a concussion is not managed properly, the athlete or patient may experience lingering symptoms and side effects for a prolonged time.

Anyone with a suspected concussion should be removed from sports and physical activities until they can be assessed by a medical professional such as a physician or athletic trainer. There is no such thing as a minor head injury. Symptoms may become worse with exertion or possibly rest. Athletes should not return to play until cleared by a medical professional.

If someone has sustained a possible concussion, he or she should be removed from play or physical activity and allowed to rest. Cease doing any activity that causes the symptoms of the concussion to increase.

Brain rest involves the need to reduce both physical and mental activities. Concussion symptoms may increase with the following:

• Talking on a phone or texting.
• Watching television.
• Playing video games.
• Listening to music.
• Physical activity.
• School work.