Who should be responsible for sports concussion management and evaluation? 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 only their individual, unique perspective. One, for example, may feel only the tusks. Another the tail. Another the trunk-like legs. Etc.
The role of medical sports specialists in concussion management
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.
The starting line vs. the end zone
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 providers 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. School-based Athletic Trainers are essential members of the student-athlete’s Care Team, often collaborating with academic staff and overseeing post-injury rehabilitation.
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.
But where’s the brain specialist in concussion management?
Of all of those team players listed above, none have the extensive training in the functioning of the brain that is the focus of Sports Neuropsychology training. We aren’t always needed, either, 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.
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 the management of sports-related concussions. It’s not a matter of turf or ego. Our brains control all aspects of functioning, and sports neuropsychologists simply have the extensive training and knowledge that other specialties above don’t have. Our appointment scheduling and billing processes are also structured differently, such that we can spend more time with clients than most other kinds of providers. 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.
Concussions are treatable!
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. Some helpful resources can be found on our Resources page here.
More about my concussion-related background
My long-standing interest in concussions grew out of my early career work at Yale evaluating young adults with reading and attention-related concerns. I attended my first sports-related concussion at the University of Pittsburgh Medical Center in the early 2000’s, taking a much deeper dive into applied research and clinical concussion work at one of the first pediatric concussion clinics in the country at Children’s National Medical Center in Washington DC starting in 2006.
I was a founding member of the Sports Neuropsychology Society – of which I am now a Fellow – and attended International Meetings on Concussion in Sport in St. Moritz in 2008, Zurich in 2012, and Berlin in 2016. I have served as an Independent Consulting Neuropsychologist for men’s and women’s professional teams across a variety of sports that have included ice hockey (AHL/NHL), soccer (WPS/MLS), lacrosse, baseball, and now rugby. I have also worked with schools and colleges to develop, consult, or oversee baseline testing programs and post-injury evaluation and to provide continuing education to teachers, school nurses, athletic trainers, and coaches.
I continue to present formally to local, national, and international professional groups about concussion-related issues, and very much enjoy informal presentations and conversations with local youth rec teams, parents, players, schools, and community organizations.
Our shared vision for the DrMomCast podcast series was not only to provide a vehicle for women supporting women in science, but primarily to help educate the public and address some of the sensationalized headlines and hysteria around concussions. I take concussions and brain health very, very seriously, but I also value the benefits of team sports – including contact sports. Failures to recognize concussive injuries and to manage them appropriately often create a bigger health crisis and individual risk than the injury itself, and regardless of whether or not the injury was sustained through sports, car accidents, or routine trips and falls.
In case you’re wondering, here are the neuropsychology services that I offer in Charlotte, North Carolina:
Neuropsychological Testing and Evaluation
Concussion Recovery and Care
Behavioral Sleep Medicine
Neuropsychology Consultations
