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Who should evaluate and manage sports concussions? Like blind men and elephants...



I realize that my subtitle may not be worded in the most appropriate manner, but I used it anyway because it’s an apt analogy, that of multiple persons who cannot see, standing around an elephant and trying to figure out what it is based on their individual, unique perspective. One, for example, may feel only the tusks. Another the tail. Another the trunk-like legs. Etc.


Sports-related concussions are sustained while playing sports - thus, athletic trainers and other sports medicine professionals may be the first to evaluate, which isn’t necessarily a bad thing. They understand the world of sports, have particular expertise in musculoskeletal injuries, and are particularly familiar with the kinds of injuries often sustained in sports, including but not limited to sports-concussions.


But, just as we don’t have teachers treat the broken wrist sustained from a playground accident, the injury setting alone shouldn’t determine who’s best to evaluate, manage, and treat all aspects of an injury!


For example, emergency physicians are also trained to diagnose acute (urgent) injuries that include but are not limited to concussions - they can, for example, determine if an individual's symptoms might suggest a more severe brain injury like a bruise or a bleed, rather than a concussion.


Other professionals can effectively evaluate and treat from their own perspective too. Primary care physicians - family medicine and pediatricians - are becoming increasingly familiar with the diagnosis and treatment of concussions, along with the many other illnesses and injuries and conditions they may diagnose and treat, and all within the unfortunately restrictive 20- or 40-minute appointment slots that are increasingly the norm in our 21st century world of managed care.


Other key professionals include physical therapists with specialty training in treating the persistent dizziness or fogginess, or the musculoskeletal strain or whiplash injury that can sometimes co-occur with concussions. For K-12 and college students, related academic personnel from teachers to nurses, disabilities services staff, and more also play critical roles in facilitating the return-to-learn without sabotaging recovery.


These are all essential players on the concussion recovery team. Each has their own perspective and area of expertise, with no one specialty or provider who can manage this injury most effectively on their own.


ALSO:


Of all of those team players listed above, none have the extensive training in the functioning of the brain that is the focus of a Sports Neuropsychologist’s training. We aren’t always needed, which I think is a good thing. Nor can we treat in a silo and entirely on our own. But, we can almost always expedite the return to sports, the classroom, or workplace more quickly and efficiently, and especially when there are risk factors for prolonged recoveries. .


Concussions are treatable. Recovery should take days or weeks, not months.


There are known risk factors - “red flags” - for longer recoveries for which referral to a Sports Neuropsychologist - is recommended by national and international practice standards for management of sports-related concussions. We can also screen for those off-the-bat most effectively, too.


It’s not a matter of turf or ego - we simply have the extensive training and knowledge that other specialties don’t have, and the brain controls all aspects of functioning. For every slow-to-recover child, adolescent, or adult that I see for “chronic” symptoms at 2 months, 6 months, 10 months, or longer post-injury, I invariably wish that I just could have seen them sooner.


While there is still much we do not know about concussions, there is quite a bit that we do know, and the science and related practice continue to evolve. All providers really do strive to do what’s best for their patients, in an ever evolving and competitive marketplace in which they are asked to do more (and know more) with less, and within the constraints allowed by medical insurance.


The best advice I can give anyone is to be an informed consumer - there is no one test or treatment or professional that is THE answer. Computerized testing is not always needed pre- or post-injury, and treatments should not cost thousands and thousands of dollars either.


Seek trusted resources from providers you know. Look for professional guidelines written by multidisciplinary teams, like the Concussion in Sport Group vs. those produced by any one medical specialty group.


Good multidisciplinary resources:


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