concussion management guidelines

Concussions FAQs

Most of the common questions we receive are answered in these FAQ, organized by general topic. We are happy to answer additional questions by phone or in writing – reach out by telephone, email, or complete our Contact Form here.

If you have immediate access to an Athletic Trainer or sideline physician, see them NOW If not, consult with your Primary Care Provider (PCP) or on-call doctor or nurse, or visit Urgent Care or an Emergency Room (ER). See our Concussions page for signs suggesting that a more serious injury may have occurred and that warrants an ER visit. If you’re not sure, go anyway to be safe!

Nope! Most people diagnosed with a concussion do not “pass out” or “black out” (lose consciousness). One of the biggest problems in treating concussions is the absence of recognition and identification of the injury. Look here [link to my Concussions page] for a brief definition of what a concussion is, and common signs and symptoms.

Sometimes, the only symptom after a hard direct or indirect hit is that the person “just doesn’t feel right” – if unsure, allow evaluation by a trained professional before allowing return to sports with risk of contact to the head. Returning to sport prior to complete recovery can trigger more serious, and sometimes (albeit rarely) life-threatening brain injury.

Sports Neuropsychologists are doctoral level health care professionals – doctors – who have more specialized training in how the brain functions than any other kind of doctor. Not only can concussions affect physical functioning – the symptoms that your medical doctor or physical therapist will assess and may treat – concussions also affect all the aspects of functioning that sports neuropsychologists are trained to evaluate and manage – thinking (attention/memory), behaviors, emotions, and sleep.

Thus, sports neuropsychologists have unique skills to provide individualized care to help individuals recover from concussion quickly and safely and return to optimal performance.

Since concussions are a different kind of brain injury than a structural injury caused by a tumor, stroke, or penetrating object, not all neuropsychologists have the additional, specialized training needed for appropriate concussion evaluation and management, and especially within the context of sports-related injuries.

No, you’d still want to see a sports neuropsychologist – while knowledge of sports culture and common mechanisms of injury is invaluable for managing sports-related concussions, the mechanisms of injury and general injury-management principles are the same regardless of where or how the concussive injury occurred.
A concussion – a metabolic injury to the brain – affects our thinking, sleep, emotions, behaviors, and physical functioning. Since it affects functioning in so many different ways, there isn't any one doctor or specialist who has enough training to effectively treat all of those areas – it takes a team. Having a team member who has years of training in how the brain works – and how to manage brain injuries behaviorally – is key to recovery and especially when recovery is delayed or when individuals present with known risk factors associated with longer recoveries.
Sports neuropsychologists are experts in understanding brain-behavior relationships and how an injury to the brain – and its symptoms – affects functioning in all aspects of life. We don't need computerized tests to help us to understand, assess, and treat your injury because we have many other tools for that, and we also know that those tests are not always helpful, nor do they tell us all we need to know.

Yes you can – but it doesn’t mean that you should, and you certainly shouldn’t take them at home alone on your own time and in your own way! Without appropriate conditions, those test results may not be very reliable or valid. And, you want to be sure the person interpreting the testing has appropriate training.

Just as you wouldn’t ask a podiatrist to read a mammogram, you wouldn’t want someone without the appropriate degree and training giving and interpreting tests measuring brain functioning. A weekend workshop isn’t a substitute for 6-8 years of training, and there are no good shortcuts.

Neuropsychologists are often regarded as testing experts, and we have many tools to choose from. Common computerized concussion tests are just one tool for determining if you’re 100% back to your pre- injury functioning, but those tests also have drawbacks and there’s no such thing as a “passing score.” When needed, Dr. Shapiro can administer some tests via telehealth or in-person, assist your local Athletic
Trainer or physician with interpretation, or refer you to someone else. Working as a team is essential.

Neuropsychological testing for concussions is not nearly as extensive as “traditional” neuropsychological testing, since functioning is expected to change rapidly over time. Even in cases of chronic or persistent post-concussion symptoms, more than 1-2 hours of formal testing is rarely needed, with evaluations typically including extensive clinical interviewing and symptom assessment, with some oculomotor and/or
vestibular screening.

Yes…and no! Everyone recovers at their own rate, but recovery should take days or weeks, not months. Recovery should continue to progress quickly and when it doesn’t, Dr. Shapiro screens for barriers to recovery and known risk factors for prolonged recovery. A standard 20- or 40-minute medical exam is not going to allow enough time, or yield the information that is needed, to expedite recovery.

Dr. Shapiro provides individualized recommendations for supports in home, classroom, and workplace to help manage symptoms in a way that allows clients to return to life while facilitating recovery. When needed,
she refers to related providers in your area with the right training and specialized skills to help you, too.

In most cases, no more than a couple of days, tops. Many doctors will recommend a slower return to school or work because going back to the regular schedule can make people feel worse. They do the best they can, but many just don't have the time, or the training of a Sports Neuropsychologist, to develop the individualized Accommodations Plans and Care Plans that can help people return to (modified) normal activities without making symptoms worse.
Again, that’s one of the roles of the sports neuropsychologist – to work with you to develop an individualized Care Plan that allows a gradual resumption of daily routines, with short-term adjustments to minimize the symptom triggers that prolong recovery.
What does "rest" mean? And why would anyone tell you to stop using your cell phone or computer? Rather, we help clients understand what, exactly, a concussion is, and how to modify activities at home, work, and classroom, to minimize symptom triggers. We focus on what matters most to you and things you can DO instead of emphasizing what NOT to do, to help you get better faster. Rest doesn't mean doing nothing, and screen use doesn't have to derail recovery!

Everyone recovers at their own rate because of all the factors that can affect symptoms and recovery. Most healthy individuals recover fully in a few weeks. If recovery seems slow, is taking longer, or you have a history of anxiety, depression, learning or attention problems, poor sleep, prior concussions, dizziness,
migraine or other chronic pain, you want a sports neuropsychologist involved to help manage those risk factors associated with longer recoveries. Sooner vs. later never hurts, as we can usually help speed recovery at any age or stage but work with sports neuropsychology is not always needed for everyone.

Many doctors recommend that, but just as a medical doctor decides what kinds of tests – like blood tests or imaging, for example – is needed to evaluate an injury or illness, Dr. Shapiro decides what kind of testing or evaluation is needed for her clients. She uses many sources of information to evaluate functioning, but she does not always need hours and hours of the traditional neuropsychological testing that your doctor may be thinking of, either. It all starts with intake questionnaires and an initial 1-2 hour
initial evaluation – usually via telehealth. From there Dr. Shapiro will work with clients to determine the
best next steps.

International guidelines for management of sports-related concussions have not recommended widespread baseline testing for years, though many teams, schools, and parent groups think it's important, thanks to strong marketing efforts from for-profit test publishers, marketing strategists, and related healthcare providers who are sold on weekend workshops and given certificates of completion. That said, baseline testing is used routinely for NCAA and professional athletes. It can be useful for some people when it is administered correctly. Dr. Shapiro is happy to meet and discuss this with you, and to consult with your Athletic Trainer, Coach, Athletic Director, or team to help you decide if it may be helpful and, if so, what kind of testing would be useful. Here, too, you want to be sure that whatever tests are chosen are developed for this purpose, and with the target age range to whom it will be administered. There are also other kinds of tests that Athletic Trainers and Physical Therapists are well-trained to administer – other than computerized cognitive tests – that can also screen for pre-season risk factors like poor balance or oculomotor functioning that they can proactively address to minimize injury risk.
Current research indicates that active recoveries are best – that is, mild to moderate levels of physical activity that do not trigger a significant worsening of symptoms, as long as there is no risk of contact or reinjury. Sometimes this is challenging for schools in states in which students are prohibited from returning to sports until recovery is complete, but a well-trained sports neuropsychologist can work with school staff – nurses, coaches, and/or Athletic Trainer – to devise a reasonable and safe rehabilitation plan while recovery is ongoing.

No, it’s not. Continued headaches suggest that recovery is not complete.

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