January 30, 2018
A growing number of physicians and athletic trainers are re-evaluating how they diagnose and treat head injuries suffered during scholastic sports practices and games. The biggest changes involve different evaluations for children and adolescents, and new approaches to exercise and concussion recovery.
New guidelines suggest the importance of separating patients into two age groups (ages 5-12 and 13 and older) using the Sports Concussion Assessment Tool (SCAT-5) and Child SCAT-5 to better determine concussion risk.
The Sport Concussion Assessment Tool 5 is a standardized sideline concussion screening tool for use by medical professionals. The SCAT-5 can be used to assess athletes ages 13 and older for a variety of mental and physical changes following a head injury. Athletes ages 12 and younger should be assessed using the Child SCAT-5. The SCAT-5 can be given as a baseline for use post-injury, or as a standalone test.
The comprehensive, easy-to-use SCAT-5 tools are effective because of the wide variety of symptoms a concussion may present – from a persistent or severe headache to poor balance, nausea and/or disorientation – and the difficulty in determining whether an athlete truly suffered a concussion.
Too Much Rest May Not Always Be A Good Thing
Concussion treatment is also changing. Research now suggests shifting away from complete rest, to incorporating moderate exercise into recovery. While the current treatment plan recommends both cognitive and physical rest – taking a break from schoolwork and getting lots of sleep, for example – that may not always work for everyone. Teens in particular are more susceptible to mood disorders and depression, and lack of exercise can contribute to this. We’re starting to think that maybe too much rest is not a good thing.
What’s a Recovering Teen To Do?
Growing research shows that low-intensity, low-impact exercise is safe within 48 hours after most concussions, and in some cases, is likely to be beneficial to recovery. Exercise on a stationary bike, for example, can provide cardiovascular exercise without risking head movements that may exacerbate the concussion, and without jeopardizing a patient’s balance, which is typically sensitive after a concussion.
All exercise should be conducted after being evaluated by a physician, and while under the supervision of an adult, such as a parent or athletic trainer. Rest remains important for concussion recovery, but combining it with exercise can make a difference in recovery for some patients. The scope of that exercise, however, remains limited.
The first level of treatment for a patient with concussion is always to remove the athlete from sports participation. In the past, players were allowed to play if their symptoms cleared, but this is no longer the case.
Prevention Is Still The Key
Although diagnosis and treatment are important components of concussion care, reducing the risk of sustaining a concussion at all is paramount. Most players undergo a physical exam to be eligible to participate in a sport. Including questions about previous concussions as well as migraines, mood disorders, ADD or even dyslexia can help determine a player’s risk.
Using a computer-based neuropsychological test as a baseline before participation in contact or collision sports can be beneficial. The athlete can take an ImPACT baseline test, and then, if he or she sustains a concussion during the season, the test can be used as a comparison diagnostic tool with tests done after the concussion.
An Evolving Field
Concussion study is always evolving, and research is ongoing on everything from reducing risk to treatment plans. And because of this continued research, and in an effort to protect athletes against concussions, athletic leagues are beginning to take precautionary measures in play.
While these precautions are reducing concussion rates and opportunities for concussions to occur in play, there are still a lot of unknowns in this area of research. Among them are the long-term consequences of concussions, as well developing more definitive diagnostic tools.
And, there is no one-size-fits-all treatment for concussions. Every concussion is unique. Treatment must be tailored based on the symptoms and the individual.