Dr. Marla Shapiro

Phone: (404) 937-3107
Email: info@ganeuropsych.com

by 2 Comments

Who is qualified to evaluate and treat concussions?

I am often asked who is qualified to evaluate and treat a concussion. My colleague, Dr. Rosemarie Moser, wrote a nice article about this topic for MomsTeam that you can access via MomsTeam – http://ow.ly/WoFdv. She makes excellent points, but I’ll review some of the highlights here.

A concussion is a brain injury, a metabolic response that is typically associated with a number of different physical, emotional and cognitive symptoms. Experts in each of these areas are needed in order to evaluate properly, and to ensure a well-developed, individualized treatment plan.

More specifically…

  • A certified athletic trainer, working under the supervision of a sports-medicine physician, may provide an immediate sideline assessment and refer to the ER or to a doctor for further evaluation;
  • An emergency room or urgent care physician can provide immediate assessment to rule out a more serious injury, or a team physician or primary care physician may provide that initial diagnosis and initial recommendations if a trip to the ER wasn’t necessary;red flag table
  • A neurologist can provide evaluation and medical management of persistent post-concussion headache or migraine;
  • A physical therapist with specialized training in vestibular therapy can evaluate dizziness and balance problems and decide if a home-exercise program is needed; and,
  • A neuropsychologist – with expertise and specialized training in brain-behavior relationships – will evaluate symptoms, including cognitive (thinking-related) and emotional symptoms, interpret neurocognitive testing like ImPACT or other measures, and develop an individualized concussion management plan that takes individual needs, symptoms, risk factors, and lifestyle into account.

As a neuropsychologist working with athletes with sports-related concussions, I like to see individuals as quickly as possible – and definitely after a week if progress has been slow – so that I can help to turn things around and expedite recovery. However, I can work with athletes at any stage of recovery to put together an appropriate plan of care to facilitate recovery at any point, whether it’s 1 day, 1 week, 1 month, or a year post-injury.

I often hear from patients, “but my doctor said these things take time.” Yes, they do, but up to a point –if properly managed, symptoms should not persist for months or years. Some individuals have risk factors that can be associated with longer recoveries – things like pre-injury attention, learning, or emotional disorders, significant anxiety, migraines and sleep problems, for example, that can be worsened by concussion and extend recovery for weeks or months. Younger athletes often require more time to recover, too, but in all cases, there’s much we can do to minimize disruption to schoolwork and life, and to speed recovery, rather than just waiting to “give it time.”

Be sure that your neuropsychologist has specialized training and experience in working with concussions, specifically, and not just brain injuries in general … that is, more than just a class, workshop, or a clinical rotation. For an experienced sports neuropsychologist in your area, see http://www.sportsneuropsychologysociety.com/ .

Comments

    • Great question. While I love the attention to this issue from the media, stories like this seem to only fuel confusion and hysteria. This story does highlight the risks and dangers of returning to play too soon, and before recovery is complete. Thus, it does not make sense to me at all that this player was returned to play while symptomatic. Most states have laws in place that address this, but clearly the message isn’t getting conveyed as clearly and pervasively as we’d hope.

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