Teamwork in concussion management

It is said it often takes a village to raise a child. Quite often, it seems like it takes several members of that village to treat a pediatric or adolescent athlete with a concussion. 

As the scholastic year winds down, I would like to discuss the members of the healthcare team who treat concussion and give some idea what the roles of these clinicians may be, so next year parents may have some idea what to expect if their child is treated for a concussion. This list is by no means complete but will discuss several of the primary players.

The Certified Athletic Trainer (ATC) is often the first responder to a concussion in the sports setting. These practitioners are responsible for the care and treatment of athletes on their team or at the venue in which they are the covering ATC. In the event of a significant concussive event, athletes are often transported to the Emergency Room where an ER physician and his/her team will care for the athlete.  Often, this team has a radiologist as a member who will read the CT or MRI of the brain performed in the ER setting.

Upon discharge, the athlete is generally referred back to their sports medicine or primary care physician or neurologist for coordination of care. This coordination of care involves treatment of the somatic, vestibular, ophthalmologic, cognitive, psychological, educational and sleep dysfunctions that have occurred as a result of the head injury.

Care that cannot be given by these physicians often results in referral to other specialists. Neurologists may also be consulted by other physicians to care for concussed patients with pre-morbid conditions such as migraine headache or Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD).  Neurosurgeons work with bleeding in the brain or skull fractures associated with the concussion. Ophthalmologists/optometrists work with visual issues. 

Psychologists/psychiatrists work with emotional and psychiatric issues. Ear-Nose-Throat specialists may work with continued ringing in the ears. Neuropsychologists work with diagnosing and treating cognitive issues. Often these issues across specialties are not new but made worse by the head injury.

Once a diagnosis has been made and the patient is determined to have a certain spectrum of symptoms, treatment with medications used to treat concussion symptoms and various therapies are often used. Physical and occupational therapy are used often. PT is often used for neck issues secondary to concussion, for example, while OT may be used for manual dexterity issues. Speech therapy may also be used. 

Vestibular Therapy is key in helping to rehabilitate the eyes, brain and body to work together as a unit again. Cognitive therapists help patients rehabilitate issues with learning and cognition. Finally, optometrists may work with patients on (Behavioral) Optometric Therapy for the eyes themselves.

Individuals at the athlete's school are critical for the successful treatment of the athlete. The best and most successful programs coordinate learning and academic accommodations between the Child Study Team, guidance department, school nurse, Certified Athletic Trainer, and teachers. Only by working as an integrated team can the complicated concussed patient be treated successfully.

Read more Sports Doc for Sports Medicine and Fitness.

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