Expert Evaluation and Intense Treatment Concussion Management

Kyle Klitsch, DO

News about the danger of concussions seems to be everywhere, filling the pages of medical journals and swirling through cyberspace. Even ESPN and the sports page are packed with concussion-related news. As a specialist treating concussion, I believe such coverage is warranted. After all, concussions are the most prevalent form of traumatic brain injury.

Primary care physicians know the best treatment is cognitive rest. Limiting mental activity, which may require truncated school or workdays, allows the brain to heal faster. When rest alone does not alleviate symptoms, Good Shepherd Rehabilitation’s Concussion Management Program can provide advanced evaluation and treatment services.

The best time to determine whether a patient needs more intensive concussion treatment is during the initial evaluation. At this time, the physician should ascertain whether the patient is experiencing:

  • Amnesia, either since or minutes before the accident
  • Persistent headaches or pressure in the head
  • Sensitivity to light or noise
  • Persistent vomiting
  • Confusion, lack of focus or distractibility
  • Difficulty processing language, either verbalization or comprehension (Does the patient have dysarthria?)
  • Personality changes, such as irritability
  • Drowsiness that persists more than an hour after waking
  • Vestibular difficulties, such as loss of balance, problems walking or clumsiness
  • Vision difficulty, such as ametropia or diplopia

Depending on the number and intensity of symptoms, the physician might wait two weeks to see if the patient improves, or if symptoms are severe, refer the patient immediately to the Concussion Management Program. Here, a team of physical medicine and rehabilitation physicians, clinical neuropsychologists and the area’s largest number of brain-injury certified physical, occupational and speech therapists perform comprehensive assessments.

Most evaluations begin with a computerized test called ImPACT, which measures verbal and visual short-term memory, visual motor speed and reaction time. Used to establish a cognitive baseline and evaluate post concussive symptoms, it is repeated throughout treatment to measure the patient’s improvement.

Good Shepherd therapists also perform vision testing to evaluate eye muscle function, the ability of the eyes to work together, field of vision, reading difficulty and visual recall. Concussions can also affect the inner ear, which regulates balance. The Concussion Management Program uses technology such as the Bertec Balance Advantage system to evaluate and treat balance and posture issues. Using biofeedback, the device provides objective assessment and retraining of balance – both sensory and voluntary motor control.

Armed with the evaluation findings, the team develops a customized treatment plan to address the problems identified. This may involve physical, occupational and speech therapy, as well as evidence-based headache management protocols to reduce pain.

All the professionals involved view the patient from a different perspective. By sharing perceptions, the team creates a complete picture of the whole patient. This enables the Good Shepherd Team to deliver coordinated, comprehensive care.