Football season is fast-approaching and with it begins more discussion about concussions. What we have learned in the past 5 years in the assessment and treatment of concussion has grown and evolved into a systematic approach beginning with baseline neurological testing. Baseline testing is the most important aspect of concussion management. Without it, there is no way to determine the effects of a concussion and more importantly when the athlete is able to return to sport.
One of the most popular baseline tests is the ImPact test. Athletes go on a computer and take the test prior to the school year. The test takes about 20 minutes and measures verbal memory, visual memory, visual motor speed, reaction time and impulse control. The athlete’s score in each category is registered and stored. If an athlete suffers a head injury, the preliminary test serves as a baseline score. The athlete is tested again, and if he or she doesn’t meet the preliminary score, they are held out of competition until they complete the test.
What athletes and parents need to know is that a concussion is a functional injury to the brain, and seldom a structural injury. This means that images of the brain with CT scan, MRI, and X-ray fail to detect any structural abnormalities. Periods of physical and mental rest are required to heal an injury to the brain, as well as appropriate sleep and nutrition. When the athlete is ready to actively rehab after a concussion is going to depend on a few factors, like: what sport the athlete is returning to, the severity and findings of each patient.
Physical therapists play a lead role in the return to play protocol, as they can administer the ImPact testing, and exertional testing to determine if the athlete is ready to return to sport, as well as rehabilitation for visual motor skills, balance, proprioception, and stabilization of the neck.
Return to Play Protocol: Including ImPact testing scores- and symptoms during exertional testing.
· Phase 1: 30-40% of max HR; 10-15 min cardio in low stimulus environment (balance/proprioception and neck strengthening may also be done in Phase 1 and 2)
· Phase 2: 40-60% of max HR; 20- 30 min cardio in gym areas, light strength training
· Phase 3: 60- 80% of max HR; any environment, 80% max strength training, plyometrics
· Phase 4: 80-90% of max HR; aggressive strength training, sport specific training
· Phase 5: Full exertion; sport specific training; contact activities as appropriate for sport
There is no time table to move from one phase to the next. In order to move to the next phase, the athlete must pass each test without symptoms.
For coaches and parents it is important to recognize the signs and symptoms of concussion. Some classic examples are the athlete:
· Appears to be dazed or stunned
· Is confused about assignment
· Forgets plays
· Is unsure of game, score, or opponent
· Moves clumsily
· Answers questions slowly
· Loses consciousness
· Shows behavior or personality change
· Forgets events prior to play (retrograde)
· Forgets events after hit (post-traumatic)
Concussion is not just an injury pertaining only to football, but can also be suffered in any sporting activity. What football has done is raised the awareness about concussion in all of sport, and you can be proactive in rehabilitating a concussion with the help of a physical therapist.
ImPact Testing is available at Form and Function Physical Therapy!