Neurological

Concussions

What is a concussion?

Concussion, also known as mild traumatic brain injury (MTBI), is an injury of the brain. It is frequently associated with headache, nausea, and difficulty with balance and concentration. Some descriptors such as having “your bell rung” and others have been used to describe symptoms of concussion. A concussion may or may not have loss-of-consciousness. A person does not have to be “knocked-out” to have a concussion. Coaches, parents, trainers and other personnel around sports should have an understanding of concussion, and understand the importance of rapid medical evaluation to prevent to harmful effects of repeated head injury.

How is a concussion diagnosed?

The most important step in concussion recognition is the reporting of symptoms by the affected student-athlete. Several educational campaigns have been sponsored by organizations including the Centers for Disease Control (CDC) in an attempt to bring to light the symptoms of concussion and importance of athlete reporting and recognition by coaches, trainers and parents of concussed student-athletes. Obviously, in the setting of an unconscious student-athlete, the diagnosis is easier to make. The student-athlete with symptoms of confusion, headache, nausea, etc. is then evaluated by trainers or medical staff on site, sent to an emergency room if symptoms are severe, or diagnosed at a later time in a physician’s office.

Testing such as CT (computerized tomography) scans, or MRI (magnetic resonance imaging) do not show a concussion. These tests may be helpful in ruling-out other serious conditions, but it is important to understand that the changes that occur in the brain are not visible on these tests. CT and MRI can be normal even in the setting of very serious brain injury. Specialized testing to evaluate concentration, memory and judgment can be helpful in diagnosing concussion.

How are concussions treated?

After appropriate evaluation, the most important part of treatment is rest. At the time of concussion and until cleared by a physician competent in the evaluation and treatment of this condition, student-athletes should not engage in any vigorous physical activity. There should also be allowances for make-up class and homework. Testing should be deferred until the student-athlete is asymptomatic. Avoidance of stimulation may help speed recovery in giving the brain the rest it needs to heal.

What potential complications exist if a concussion is undiagnosed or mistreated?

The most serious reported complication of concussion is second impact syndrome. This is a situation where, if the brain is re-injured in the time prior to healing of an initial concussion, coma or death can occur. This can happen even if the initial concussion was not severe. This is why it is so important to rest the brain and ensure that all the symptoms of concussion are resolved before return-to-play. This includes the symptoms that may not be felt, such as slowed reaction time and impaired memory or concentration. Your doctor may recommend specialized testing to help in this process. Also, post-concussion syndrome is a situation where a person can have headaches, mental fogginess, and difficulty in school for weeks or months after concussion is a risk. This is more common with repeated concussions.

What is computerized neurocognitive testing/ImPACT?

This is a computerized test that helps the physician evaluating the concussion to better understand the extent of injury. Because concussion affects the overall function of the brain, ImPACT gives a standardized way to score these brain functions. The test looks at different kinds of memory, concentration and reaction time. Even when student-athletes report no symptoms at all the test can help to identify and track the progress of concussion. This helps prevent missed diagnosis and also ensures complete recovery prior to participation.

How are we using ImPACT to help the diagnosis and treatment of brain injury?

Regional Orthopedics is proud to sponsor Tottenville High School in being the first school in the New York City PSAL offering ImPACT testing for concussion assessment and management. As part of the overall approach to managing concussion/mild traumatic brain injury (MTBI), ImPACT offers an objective look at the function of the brain before and after injury.  Dr. Montalbano has extensive experience with the diagnosis and treatment of concussion and is trained in the use of the ImPACT program. High risk student-athletes will be pre-tested at the beginning of their athletic season. In the event of a suspected concussion, student-athletes will have a physician evaluation and coordination of retesting. The test is a computer-based program that takes approximately 20 minutes to complete. The results of the test are then printed and interpreted by Dr. Montalbano at his office.