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Weekend Doctor

By STEVE VOLPE, Ph.D.
Concussions and their medical management have garnered significant attention this past year – and for good reason. A number of former professional athletes have come forward with their stories of serious medical issues that have resulted from mismanagement of concussions.
The state of Ohio passed new laws on April 26, 2013, called the “returned to play” laws that provide clear requirements for school-based athletics regarding concussion management and prevention. A few highlights of the laws include:
• Coaches are required to undergo an online training program every three years regarding concussion symptom recognition,
• Once an athlete is removed from play due to suspicion of concussion they are not allowed to return to play until they have been assessed and cleared by a qualified health care profession,
• Schools are required to provide the Ohio Department of Health concussion/head trauma information sheet to parents/guardians.
A concussion is a clinical syndrome characterized by immediate and transient alteration in brain function. This includes alteration of mental status and level of consciousness, resulting from mechanical force or trauma. Loss of consciousness is not required for one to have experienced a concussion.
In the past, concussions were graded on three levels based upon symptoms. Current school of thought believes that any sign or symptom of a concussion is to be taken seriously. The athlete is to be removed from play until proper assessment and management has occurred. Some common signs/symptoms of a concussion after a blow or jolt to the body include confusion, nausea, dizziness, blurred vision, headache, clumsiness, amnesia, loss of consciousness, light sensitivity and concentration problems.
Proper management of concussions starts with prevention and preparation.
Proper protective equipment should be worn at all times. Proper technique, especially in full contact sports, needs to be taught. Athletic programs should have every athlete undergo baseline cognitive/coordination testing, such as the SCAT2, prior to the start of the season so pre-injury cognition/coordination levels are established. This allows comparison analysis when a concussion is suspected.
Once a concussion is determined the athlete is to be removed from play immediately and not allowed to return until proper management and clearance is administered by qualified health care professionals. Diagnostic imaging of the brain should be considered to rule out any trauma that may require immediate evasive medical attention.
Once the concussion symptoms resolve, the athlete should begin, at minimum, a five day stressed progression return to play protocol administered by a qualified health care professional, such as a physical therapist or athletic trainer. Concussion symptoms are assessed after each step using the baseline cognitive/coordination tool. If no symptoms are present, the next level is administered the following day.
The stages of progressions are as follows:
1. Rest until asymptomatic,
2. Light aerobic exercise,
3. More intense aerobic exercise,
4. Non-contact sport specific training drills and light resistance training,
5. Full contact sport specific training drills i.e. regular practice. Written medical clearance is required by a physician before ‘full contact’/practice (step 5) can occur. If no symptoms occur after step 5, then return to full-go competition is allowed.
Volpe is a physical therapist at the Independence House Outpatient Therapy Center in Fostoria. Questions for Blanchard Valley Health System experts may be sent to Weekend Doctor, The Courier, P.O. Box 609, Findlay, OH 45839.

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