Concussion Management Program

Any injury to the head is a serious issue. Getting an early diagnosis and receiving the proper treatment are essential to resuming a normal life. The reality is anyone — not only athletes —can sustain a concussion. 

Liberty Hospital Sports Medicine believes the best approach to manage and rehabilitate a concussion is through an individualized treatment plan based on the patient’s specific needs and goals. Our team approach to the management and treatment of a concussion allows the patient/athlete a safe and efficient return to activities and/or sport.

Our Approach to Concussion Management

Credential ImPACT Consultant access - Here at Liberty Hospital Sports Medicine we consult with Credentialed ImPACT Consultant (CIC) Kyle Schneweis, M.D., a Sports Medicine physician at The Liberty Clinic.  Dr. Schneweis helps with the diagnosis, treatment, and management of concussion patients.  Liberty Hospital Sports Medicine also can work with a patient’s primary care physician during the treatment and management of a concussion.

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

Vestibular Physical Therapy/Treatment – 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.  Jennifer Mackie, P.T., specializes in vestibular therapy and also is an ImPACT-trained physical therapist (ITPT).

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

Neurocognitive Pre-Injury and Post-Injury Testing with ImPACT – Neurocognitive testing is an assessment tool that is used to help with the treatment and management of concussions.  ImPACT testing is 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 (Bioness Integrated Technology System) – 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. 

Sports Return-to-Play Program – 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.

ImPACT Testing

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 uses as part of a comprehensive clinical evaluation to help with determining safe return to play and return to learn decisions. Read more.

What is a concussion?

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 is demanding 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/or slowness in thinking. 

Signs and symptoms

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

How is it diagnosed?

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.  

Treatment

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 he or she 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.

After the concussion

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

Return-to-Play Protocol

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 percent 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.

Concussion facts

  • Symptoms can be subtle, such as a headache or even just feeling sluggish.
  • Symptoms may not affect a patient for 48 to 72 hours after the injury.
  • All concussions are different and the recovery time table for a person who sustains a concussion will vary.
  • Children and adolescents recover slower from concussions than adults, due to development of their brains.
  •  A concussion is a treatable injury.
  • You do not have to lose consciousness to sustain a concussion; studies show that less than 10% of concussions result in a loss of consciousness. 

     027 Schneweis Kyle Web              Hanson Jared 047

Kyle Schneweis, M.D., CIC   Jared Hanson, ATC/L, ITAT

Board-certified sports medicine physician Kyle Schneweis, M.D., CAQ-SM, who is a credentialed ImPACT Consultant physician is involved with the Concussion Management Program. The program offers physical therapy, vestibular therapy, speech therapy, baseline and post injury ImPACT testing, and for athletes, a return-to-play program supervised by an ImPACT Trained Athletic Trainer (ITAT). Dr. Schneweis' office is located at The Liberty Clinic, 2609 Glenn Hendren Drive, Liberty, MO 64068; 816-781-7730.

Jared Hanson, ATC/L, ITAT, oversees the Concussion Management Program. Jared is a Certified Athletic Trainer with more than 13 years of clinical experience, training in concussion management, and is an ImPACT Trained Athletic Trainer (ITAT). Jared will work in conjunction with Dr. Schneweis, a patient’s primary care physician and the remainder of the staff at Liberty Hospital Sports Medicine to help navigate the patient through his or her treatment and rehabilitation process.

© 2019 Liberty Hospital

Liberty Hospital | 2525 Glenn Hendren Drive | Liberty, MO 64068 | 816.781.7200