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Washington Health System Offers Multifaceted Approach to Concussion Care
By Daniel Casciato

Any child who plays a sport, whether it is contact or non-contact, is at risk for a concussion. Concussions can result from a direct blow to the head or blow to the body that causes the head to move rapidly back and forth. They can occur without loss of consciousness while symptoms can occur upon impact or several days following the injury. As a parent or a coach, don’t ignore the signs or symptoms—otherwise you can put your child’s long- and short-term health at risk.

“Some of the most common symptoms would be headache, dizziness/nausea, confusion, blurred vision, difficulty concentrating and sensitivity to light or noise,” says Matt Guarino, DPT, Sports Medicine Program Coordinator at Washington Health System (WHS).

For a detailed list of common signs/symptoms, visit http://whs.org/sportsmed"whs.org/sportsmed.

Concussion management begins with the initial assessment. First, the athlete who was injured should be removed from play and examined for signs and symptoms of a concussion. With a growing, nationwide emphasis and increased awareness about concussions, protocols have been developed for all age groups in sports leagues today. Most leagues have a good on-the-field assessment by athletic trainers or other trained healthcare professionals who can identify concussions, notes Roger Marino, MPT, Manager of Outpatient Rehab Services at Washington Health System.

“We rely heavily on these athletic trainers or healthcare professionals on their assessment,” says Marino. “If it’s determined to be a concussion, they would refer that athlete to a specialized physician or ER following the injury.”

Since signs and symptoms may not appear for a couple days, Guarino stresses that parents should keep a close eye on their child. “If your child experiences any signs or symptoms, seek medical advice immediately, whether it's an ER visit or contacting your primary care provider or pediatrician. All concussions are serious and require prompt medical attention by a trained professional.”

Once an athlete is diagnosed with a concussion, a treatment plan will be implemented to promote recovery and safe return to play. Plans will vary depending on the severity of symptoms and may include: school modifications, decreased screen time (cell phones, computers, video games, TV), concussion rehab/physical therapy and ImPACT testing (Immediate Post-Concussion Assessment and Cognitive Testing). ImPACT is the first, most-widely used, and most scientifically validated computerized concussion evaluation system. This test can help to objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play.

The test takes approximately 20-30 minutes to complete. It measures multiple aspects of cognitive functioning in athletes, including:

  • Attention span
  • Working memory
  • Sustained and selective attention time
  • Response variability
  • Non-verbal problem solving
  • Reaction time

Every athlete in western Pennsylvania who plays sports should complete a baseline ImPACT test prior to the start of the season. In the event that athlete sustains a concussion, they can repeat the test and the post-injury scores will be compared to baseline scores. If an athlete has already sustained an injury without getting baseline tested, ImPACT testing can still be given and the scores compared with normal age-matched peers. WHS currently offers baseline and post-injury testing for ages 12-59.

Washington Health System now offers a comprehensive Concussion Clinic that includes sports medicine specialist Dr. Patricia Bornhorst, DO as well as physical therapists specially trained in concussion rehab. Dr. Bornhorst’s office is conveniently located in the same building as Outpatient Rehabilitation Services where post-concussion rehab and ImPACT testing are offered.

Whether an athlete needs to see a concussion specialist, such as Dr. Bornhorst, a physical therapist or take the ImPACT test, Guarino says all of their needs can be taken care of through Washington Health System. Primary care physicians or pediatricians who are managing an athlete’s post-concussion care can also refer patients to WHS Outpatient Rehabilitation for concussion rehab and ImPACT testing.

“We streamline the entire process,” he says. “We offer prompt appointments because we understand that concussion management is time sensitive. There should be no delay. We also remain in constant communication with the athlete’s athletic trainer and physician throughout the entire process. We discuss and ensure that an established return-to-play protocol is in place.”

Marino agrees.

“We try to make it easy on an athlete to receive concussion care through our health system,” he says. “Instead of having to travel all the way into Pittsburgh for an evaluation, and then back out here to see another physician or another facility for rehabilitation, we try to make it very easy for the kids, and more importantly, for the parents.”

For more information, visit whs.org/sportsmed

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