Evie talks with Donna Sanderson-Hull about treatment of concussion and how physiotherapists can work to provide standardised care for all concussion patients.
A concussion is a form of brain injury causing a temporary disturbance of brain function. Concussions can occur not only with bumps, hits or blows to the head, but elsewhere on the body, which causes the brain to move back and forth in the skull. There are 22 different signs of concussion and it is an old misconception is that someone generally has to be knocked out to be diagnosed with a concussion. Thankfully, there is a lot more education now in sport on how to recognised a concussion and campaigns to remove people from the field of play should a concussion be suspected. The “if in doubt, sit them out” campaign by Peter Robinson, who’s son Ben died on a rugby pitch after a concussive episode has done much to highlight the need for better recognition of suspected concussion.
However, concussion can occur in many other landscapes, such as workplace accidents or motor accidents. Often a patient will have brushed off an incident as a ‘knock’. They may not notice they even have symptoms until they try normal everyday activities. Most people feel “back to normal” (i.e., symptoms go away) within 10 to 14 days after injury and make a full recovery within 3 to 4 weeks. But children as well as people with a history of concussions or mental health problems, such as anxiety or depression, may take longer to recover. In fact, it is thought that 30% of concussions will have on-going symptoms or post concussion syndrome.
Although there has been an explosion of research on concussion and the links to dementia, concussion awareness and immediate pitchside management, there is still no standardised care pathway for those who have experienced a concussion. The UK is far behind countries such a Canada and the US, who have standardised, evidenced based clinics providing concussion management for those with acute concussions and those suffering with prolonged symptoms. With earlier management and rehabilitation, it has been demonstrated that PCS could be reduced to 5%.
Participants in sport in Canada have access to baseline testing, often only provided to professional sports people here. The recent research suggests there is more validity in multimodal testing and as such, following the CCMI model, we do a raft of tests including visual/ocular motor, physical as well as neuro-cognitive (via imPACT). Baseline testing in this environment is often driven by the parent or sportsman in a way to provide more objective data for which to compare with post-injury data and improve safety for return to play.
Having trained with CCMI, and now as a certified clinic using the CCMI model, we can provide multiple aspects of care for acute and sub-acute presentations of concussion through to those suffering with PCS using comprehensive rehabilitation strategies for those that require it (with or without baseline data). This may involve physical exertion testing to assess heart rate on symptoms, visual ocular motor, vestibular and cervicogenic (due to the associated whiplash) treatments and special testing for those involved in higher levels of sport.
The free CCMI App has been very helpful too, that coaches, players and parents can all use it. The players all have a unique account number and the app allows either parent or coach to record an injury to that player. Side lines tests such as the SCAT 5 and other tests can then be uploaded directly into the app. This immediately reports the injury at pitch side and generates the correct immediate management advice to player, parents and coaches. This also gives advice to seek medical help if required. If there is a CCMI practitioner involved (usually as a result of previous baseline testing), they will also be in the loop. This also prevents kids being injured at club level on the weekend and managing to get away with playing the following week for school, as all stake holders have access to the account of the player. This also gives more transparency and clarity when protecting those involved in higher risk sports and will go someway to protect against litigation claims and reduce expensive care bills in the future,
My aim would be to build a network of CCMI certified clinics across our country to provide the same evidenced based standardised care for all concussion patients. ! I also believe this concussion rehabilitation lies at the heart of what we Physio’s do best.
Check out the free app :New Concussion Tracker App Supports Full Recovery and Safer Return-to-Play Decisions for Athletes
Here is the sideliners course as an intro: https://courses.completeconcussions.com/concussion-sideline-course-coaches-trainers-school-teachers/
The Promo code is: BlueSky