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With all the hype pertaining to Sports Concussions it is hard to know how to handle or manage it correctly in order to get the student athlete back to life, education, and eventually sport. Our treatment approach at NSW meets the needs of both the athlete and the parent at each phase of recovery. Depending on the severity of the concussion, NSW has various services that can assist in the recovery process.
Dr. Dunkle is a Certified Consultant with ImPACT© Computerized Testing, which is a program used by professional, college, and high school sport programs to monitor cognitive functions before and after a concussion is sustained (see below). In addition, Dr. Dunkle continues to service many school districts in Westchester County and was on the New York State Public High School Athletic Association Concussion Committee, which was responsible for educating and implementing many of the concussion guidelines used in New York State. While in graduate school, Dr. Dunkle coached men’s ice hockey and lacrosse at the collegiate level, and was also a player at both the high school and college levels.
Concussion symptoms observed- The athlete appears dazed, vacant facial expression, confusion about assignment, athlete forgets plays, disorientation to game, score, or opposing team, inappropriate emotional reaction (laughing, crying), incoordination or clumsiness, slowing in answering questions, loss of consciousness (even for seconds), and any change in typical behavior or personality.
Recovery from a Concussion – The recovery process can take days, weeks, or even months depending on the location and impact of the injury. Needed recovery time varies with each individual. Each concussed athlete should be evaluated individually rather than with traditionally used general evaluation and return-to-play guidelines. As noted in research, high school student athletes take longer to recover than college and professional athletes and the decision to return to play is a critical one, possibly having long term implications.
The use of ImPACT©
Each athlete is administered a base-line, pre-season test using ImPACT© (Immediate Post-Concussion Assessment and Cognitive Testing – www.impacttest.com) which is a well researched computerized measure to assess one’s cognitive capabilities in such areas as verbal and visual memory, attention, speed of processing, and reaction time. This assessment is used as comparative data if the athlete later sustains a concussion during play.
IF an athlete is not administered ImPACT© and no baseline assessment has been conducted there are techniques to determine pre-injury level of functioning and safe and effective return to play decisions can be made.
NSW Concussion Evaluation with ImPACT© and Return-to-Play Decision
Assessment includes Clinical Interview and ImPACT©
Cognitive testing should occur within 24-72 hours of injury.
Follow-up evaluations can occur approximately every 5 days in order to monitor symptoms and to track the athlete’s recovery and to assist parents and school personnel (i.e., teachers and professors) in making accurate decisions.
The best and safest measures to use in determining whether an athlete should return to play are that the symptoms have fully cleared and that an athlete’s cognitive capabilities have returned to baseline (or estimated pre-injury level of functioning) based upon symptom and cognitive data.
Once the symptoms and cognitive data are returned to baseline, the athlete is put under physical exertion to assess if any symptoms return. This provides the best assurance to the coaches and medical staff, as well as parents and athletes, that he or she is ready to return to full athletic competition without risk of further injury.
This testing and followed up care is performed by a credentialed Clinical Neuropsychologist who works closely with coaches, trainers, and physicians.
If Symptoms Persist
If symptoms of a concussion persist for longer than 3 to 4 weeks, the athlete may be suffering from what is known as Post Concussion Syndrome. Treatment for this condition may include the athlete undergoing a Neuropsychological Evaluation in order to fully delineate the degree of injury as well as determine the individual’s strengths and weaknesses. Following this extensive evaluation, an athlete may be advised to enter into cognitive rehabilitation as well as other treatment modalities in order to assist him or her in returning to their highest level of functioning.
Decisions in whether to return to competitive athletics or retire for an extended period of time requires careful consideration and can only be made after the extent of one’s recovery is fully analyzed.
If Used Correctly, ImPACT© can…
Help determine severity of the concussion
Provide valuable information to the athlete, parents, athletic trainers, and physicians
Provide information on academic deficits associated with concussion and assist the school administration in making academic decisions
Promote safe return to play
Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012- www.bjsm.bmj.com/content/47/5/250
NYSED Guidelines for Concussion Management – www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/ConcussionManageGuidelines.pdf
Summary Concussion Management and Awareness Act- www.vvsschools.org/domain/61
Student Parent Concussion Information Sheet- www.cdc.gov/headsup/pdfs/…/headsupconcussion_parent_athlete_info.pdfCached
CDC “Heads Up, Concussion in Youth Sports” Course for Physical Education Teachers and Coaches- www.cdc.gov/headsup/youthsports/training/
CDC “Heads Up to Clinicians” Course for School Nurses and Certified Athletic Trainers- www.cdc.gov/concussion/headsup/clinicians/