Clinics in sports medicine
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The pathophysiology of concussion may lead to a variety of both short- and long-term effects, which may lead to a decision to retire from contact sports. These effects follow a recognizable progression and may cause an athlete to opt out of play at any point along this progression. To elucidate the effect of concussion or mild traumatic brain injury and weigh in on a decision to retire, the treating physician needs to take into account the history, neurologic examination, brain imaging, and neuropsychological testing. In addition, myriad social factors surrounding play must be taken into consideration.
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Sport-related concussion is a common injury that occurs in a variety of sports. In recent years, more attention has been focused on the importance of this injury as well as the long-term complications of unrecognized, repetitive, and/or severe injury. The acute presentation of concussion as well as the diagnosis of concussion is often straightforward and obvious, but it can also be subtle and difficult to discern. ⋯ This article discusses the on-field presentation, diagnosis, and management of sport-related concussion. It is important to have a concussion protocol for high-risk sports, including a preseason and postinjury assessment, and an individualized yet comprehensive approach that includes evaluating symptoms, and a neurologic examination that includes cognitive function and balance testing. A multifaceted approach to the evaluation and diagnosis of concussion is endorsed for the optimal management of this injury.
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Although neuropsychological testing has proven to be a valuable tool in concussion management, it is most useful when administered as part of a comprehensive assessment battery that includes grading of symptoms and clinical balance tests. A thorough sideline and clinical examination by the certified athletic trainer and team physician is considered an important first step in the management of concussion. ⋯ The evaluation should include obtaining a history for specific details about the injury (eg, mechanism, symptomatology, concussion history), followed by assessing neurocognitive function and balance, which is the focus of this article. The objective measures from balance testing can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation.
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Assessment of concussion can be challenging for medical practitioners given the different factors associated with each individual injury. The use of neuropsychological testing provides an objective method in the evaluation and management of concussion. ⋯ Neuropsychological assessment has also proven to be effective in the detection of differences based on several individual factors, including age, gender, and history of prior concussion. Despite its documented value, neuropsychological assessment should be one of several tools used as part of the concussion assessment/management process.
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Concussions and head injuries may never be completely eliminated from sports. However, with better data comes an improved understanding of the types of actions and activities that typically result in concussions. With this knowledge can come improved techniques and rule changes to minimize the rate and severity of concussions in sports. This article identifies the factors that affect concussion rate.