Concussion Treatment: Returning to play

By Robert Senior

On Monday, we discussed the process by which football players are evaluated for concussion symptoms on the sideline during a game. But what about returning to play the following game, or weeks later? What steps must be taken and what goals must a player meet before returning to the huddle?

“When I get a referral, the first thing I’ll do is their ImPACT test,” says Robert Franks, D.O. at the Rothman Institute. “So if it’s a high school player who gets hurt on a Friday night, it’ll probably be Monday morning when I do the test.”

ImPACT assesses any changes in brain function while evaluating an individual’s current condition and tracking recovery.

Dr. Franks says that overall, he looks at concussions in five domains:

  • Somatic Symptoms—“These are the symptoms I’m told the person has.”
  • Cognition—“These are the results of their ImPACT test—how good or bad does it look?”
  • Vestibular/Balance Testing—“This is the BESS (Balance Error Scoring System) test, like the one we did on the sideline. In the office, we can be more thorough and do the full test.
  • Sleep Issues—“Usually, they’re going to be tired—we’re looking for disruptions or differences in their sleep patterns, such as difficulty falling asleep, or whether they’ve been sleeping all day.”
  • Emotional—Dr. Franks says that specialists will keep an eye out for increased anxiety or signs of depression—but acknowledges that such signs are very unlikely to be present during an initial evaluation.

As mentioned on Monday, Eagles quarterback Michael Vick sustained his second concussion in as many years on Sunday. Dr. Franks says that evaluating concussion history is critical. “How many concussion has the person had in the past? What kind of symptoms did they have, and how long did they last? You need to establish treatment patterns from the past. Did they lose consciousness, or have retrograde or post-traumatic amnesia?”

Dr. Franks puts his student-athletes on what he calls complete mental and physical rest. “No video games, no texting, no cell phones—we allow nothing that can stimulate the brain. Then we assess whether we need to alter their academic setting, in terms of reducing homework or other factors.”

The decision to return to play requires a symptom-free athlete who is no longer on any medications. ImPACT testing needs to return to baseline or average, and a full return to activities must be made for 24-48 hours. “That’s when we’ll start a return-to-play program,” concludes Dr. Franks.