Friday, April 18, 2014
Inquirer Daily News

Concussion Treatment: Returning to play

Earlier this week, we discussed the process by which football players are evaluated for concussion symptoms on the sideline during a game. But what steps must be taken before returning to the huddle?

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.

About this blog
Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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