Concussion Management: The 3-Pronged ApproachWritten by Laura Miller | February 11, 2011
Team physicians for professional and youth athletic teams have been focusing more on concussion awareness and prevention over this past year than in previous years. Team physicians should take a three-pronged approach to concussion management, which means assessing neurocognition, balance and symptoms. After sustaining a concussion, it's important to keep players out of play until the concussion has fully healed, says Jon Peters, PhD, vice president and general manager of NeuroCom, so they don't incur more damage from a second concussion on top of the first. There are several different traditional and modern testing methods team physicians should employ to ensure players have fully recovered from concussions. Mr. Peters discusses the different protocol for checking athletes with suspected concussions.
The three-pronged approach
The Balance Error Scoring System, developed by researchers at the University of North Carolina, Chapel Hill, tests the athlete's balance to ensure it has sufficiently returned after sustaining a concussion. The BESS system quantifies athletes' ability to balance while standing in a double-leg stance, single-leg stance and tandem stances, requiring them to stand in each position for 20 seconds with less than 10 errors before pronouncing the balance at a "firm stance." An alternative to the BESS testing is to take an observational approach, says Mr. Peters. "Ask the athlete to take different stances and see how many errors he or she makes in balance control," he says. "From BESS, move to a more objective domain to technology."
New developments in neurocognitive testing allow physicians to assess the athlete's baseline functions before sustaining a concussion so they have a baseline for return-to-play after a concussion occurs. However, the physicians and players shouldn't assume that once the neurocognitive testing is back to baseline that their balance has fully returned as well. "Some studies show patients who recover neurocognitive functions first while others show players recovering their balance first," says Mr. Peters. "This means the return to baseline of neurocognitive function and balance is player-dependent. That's why I stress the role of the clinician in that process."
Finally, make sure all symptoms are healed before returning the player to the game. Symptoms can include dizziness and difficulty concentrating.
Playing while concussed can lead to other injuries
Concussions aren't preventable, but physicians can prevent the players from sustaining a second concussion before the first has fully healed. Playing while concussed can place the athlete at a higher risk of incurring a second concussion or further injuries. "If the player's balance control isn't back, you can have an ACL injury or ankle sprain because the player doesn't have their motor skills back," says Mr. Peters. "Independent of concussions, there is significant literature to show that if you take players who suffer ankle sprains and incorporate balance into rehab, you can prevent future injuries related to balance."
Read other coverage on concussions:
- 5 Things to Know About Concussion Management and Prevention
- American Academy of Neurosurgery: 5 Recommendations About Concussions
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