Concussion Testing: Early Diagnosis Is Critical. Yet Often Missed
Concussion remains a growing medical problem in the US. The occurrence of traumatic brain injury in boxers and football players and its similarity to the brain injury pattern seen in US Armed Forces servicemen returning from tours of duty in Afghanistan shed more light on the underlying pathology.
Not only the symptoms were similar, their Head CT Scans and Head MRI’s esp. functional MRI’s of the head showed similar areas of damage that had been missed in the time immediately after the concussive injury. The Dept. of Defense funded several studies and protocols and as it stands today, all US Defense Forces have access to these EEG Based Concussion Testing as a means to risk stratify and identify functional brain trauma.
In the general community however, in spite of research and new modalities for early concussion diagnosis & concussion testing after head injury or head trauma, the majority of brain injuries remain un-diagnosed. Part of the challenge is the habit of going to an ER. Pediatricians do it for kids after soccer or basketball injuries, general practitioners refer patients after a motor vehicular accident or a fall at home or a head injury at work.
And it is standard practice in almost all ER’s to order a CT Head as the immediate next diagnostic test. The purpose of the CT head in cases of head trauma after a fall or a car accident or a head injury during sports or at work is simply to identify patients that need admission to the hospital for observation on a neurosurgical ICU or immediate surgery to remove the blood that is accumulating inside the skull (either outside the brain tissue compressing the brain or inside the brain tissue) causing damage from pressure to neighboring brain tissue. A CT Head is never testing for functional brain injury and it is the disruption in electrical circuits that is the best predictor of long term effects from such brain injury.
It has become amply clear that there is more to head injury than just the presence or absence of bleeding inside the skull. The CT Scan of the head can only identify structural changes. The brain however is an electrical tissue with circuits that can get stunned and take time to recover. Only EEG based concussion testing protocols can pick these up. Standard EEG tests do not.
It remains standard ER procedure to send home all patients with a normal Head CT or Head MRI. This is a missed opportunity for several reasons.
1. An EEG based concussion testing in patients aged 18-85 years old; within 72 hours of injury; would detect patients with specific areas of the brain that have concussive injury. These patients need to follow a different protocol before their brains can recover fully. If not done, these patients will develop long term brain injury called Chronic Traumatic Encephalopathy (CTE) or Traumatic Brain Injury (TBI). If identified early and managed properly, they would go on to full recovery instead of having memory issues and dementia in later life.
2. Statcare’s specialized EEG testing for concussion helps risk stratify patients for ALL levels. This means that patients with head injury who undergo EEG concussion Testing can be separated into several groups – those that need a CT Head for evidence of structural damage on EEG (Blood in the brain affects electrical activity even in small amounts) and those that do not need CT Head or MRI. This can be done with an extremely high degree of confidence. It is the third group, however that majority of the patients fall into which is picked up by EEG Concussion Testing. This group is one that does not have a need for CT Head but has enough evidence of EEG detected electrical disturbance in brain circuits that need to be managed carefully. These are exactly the patients that would be sent home from the ER today; and still suffer symptoms of concussion and eventually have CTE or TBI or neurological symptoms such as memory issues decades later. Currently these patients are sent home without monitoring, without re-testing for recovery and without any instructions on how to protect their brain from more stress. Sending such patients back to their work or school or having them use their brains for stress activities only progresses the damage and prolongs recovery.
3. Unnecessary ER visits can be avoided and unnecessary exposure to radiation from CT Scan can be avoided as well.
4. Early diagnosis of electrical injury and management of the brain trauma, prevents long-term CTE and TBI.
Sending people back to work or back to school without detecting underlying brain injury from head trauma or risk stratifying high risk patients for Chronic Traumatic Encephalopathy (CTE) is a missed opportunity. This care plan misses a critical point where a proper evaluation and testing of brain function in every patient with head injury through EEG diagnosed electrical injury patterns had to be performed and risk stratification of the patient done. An appropriate intervention based on the seriousness of the initial brain injury pattern on concussion testing as well as its evolution over time while the brain is actively being protected from further stresses (like TV, Home work etc.) has to been undertaken.
How you evaluate concussive injury with EEG concussion tests in this period can make the difference.
Performing a CT or an MRI Scan of the Brain only seeks to look for physical and structural damage to the brain after head trauma. The functional damage to electrical circuits in the brain, however, remain un-diagnosed as these testing modalities cannot detect functional issues. EEG based concussion testing does. These cases can be high risk for developing Traumatic Brain Injury (TBI) and CTE and can be identified by computer assisted cutting edge EEG concussion diagnostic tests performed at Statcare.
Why is it important to diagnose the electrical trauma to the brain with specific EEG concussion tests?
There are many reasons to do so. Most importantly, a brain already suffering from an functional trauma (as can be seen in the injury pattern recorded through EEG concussion testing done at Statcare) has to be protected from further stress such as watching TV or playing video games or having to learn new information in the school. Too often, Pediatricians, ER Physicians and many other medical professional release children “back to school” without quantifying the injury through appropriate concussion tests or making an adequate recovery plan from a concussion related brain injury. Read on to see how Statcare can help. Remember, your Concussion Screening Tests at Statcare are covered by most Insurance plans. These concussion tests have been validated by research and are extremely good at predicting brain injury.
Don't wait! Call us at (855) 9 FOR DOC to get your child the concussion testing he or she deserves!
CONCUSSION SYMPTOMS AND SIGNS
One challenge in concussion management is the misconcept that it is a concussive injury only if there is an impairment or loss of consciousness associated with the external trauma. Nothing can be farther from the truth as data has proved mild brain injury can happen without a loss of consciousness and lead to far reaching effects on mood, behavior, poor academic performance and eventual permanent long term cognitive deficits. CTE (Chronic Traumatic Encephalopathy) awareness has only highlighted what was previously our blind spot in identifying a progressive and fatal illness that looks and behaves quite like Alzheimer’s Disease but has actually resulted from repeated, recurrent concussive head injury that was not tested for or diagnosed or addressed initially, esp. in contact sports like football.
Another misconcept is that symptoms from concussive injury occur right away. While that may be true as well, most patients actually suffer from symptoms from concussion days or months after the head injury, or until the person resumes their everyday life. Sometimes, people do not recognize or admit that they are having problems. Others may not understand their problems and how the concussion symptoms they are experiencing impact their daily activities.
If you have recently experienced a bump, blow or jolt to the head or body and are experiencing any of the following concussion signs or symptoms, see one of our Statcare providers for a Brain Physical to determine if you have a concussion and help you manage your recovery
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Statcare serves the Long Island residents of Nassau County, Suffolk County, Queens, and Brooklyn, as well as the Bronx in NYC. If you have any questions about any conditions we treat or services we offer, call (855) 9 FOR DOC today.
We recommend using the free Concussion Test and Tracker app to help evaluate your symptoms, and how to go about getting treated for it accordingly. The Symptom Checklist Evaluation will help you determine the best course of action, and tell you where to go if further medical treatment for concussion is suggested. After being evaluated for your head injury, SportGait will allow you and your medical provider test and track your recovery and keep you educated on your brain health from diagnosis to return to activity.
Danger signs of concussion
In rare cases, a person with a concussion may form a dangerous blood clot that crowds the brain against the skull. Head to the emergency department right away if you experience these danger signs after a bump, blow, or jolt to your head or body
Danger Concussion Symptoms in Adults
- Headache that gets worse and does not go away.
- Weakness, numbness or decreased coordination.
- Repeated vomiting or nausea.
- Slurred speech.
- Look very drowsy or cannot wake up.
- Have one pupil (the black part in the middle of the eye) larger than the other.
- Have convulsions or seizures.
- Cannot recognize people or places.
- Are getting more and more confused, restless, or agitated.
- Have unusual behavior.
- Lose consciousness.
Danger Concussion Symptoms in Children
Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:
- Have any of the danger signs for adults listed above.
- Will not stop crying and are inconsolable.
- Will not nurse or eat.
What will Statcare do to help me recover from a concussion
“How do I recover from my concussion?”
The Concussion Test and Tracker app, along with the Brain Physical, is developed to ensure that you get the best possible treatment, with step by step guidelines that help determine when you can return to activity and recover. Our system allows you track every step of your recovery including what activities you can participate in over time, and giving you informative health tips to ensure you fully recover and prevent further damage.
We use SportGait for concussion recovery management – here’s why:
SportGait examines the relationship between the physical and mental performance of individuals to detect concussion using balance, gait, and neuropsychological testing in combination with special sensor technology. SportGait’s Concussion Management System (CMP) enables the us to work with patients and referral partners in a data-driven collaboration to identify, track and monitor at-risk individuals.
The Concussion Management Platform (CMP)
The Physician App for the CMP gives urgent care facilities objective data from five validated, reliable concussion assessments and alerts physicians when a patient’s results deviate from what is expected. It works regardless of whether a patient has had a recent baseline exam or their first medical assessment was post-concussion, meets all the guidelines set by the CDC (Centers for Disease Control and Prevention) and NIH (National Institutes of Health), and complies with all State Laws regarding concussion management and evaluation.
The result is an improved Safe-to-SafeTMContinuum of Care as physicians assist the patient through incident and treatment, and at the appropriate time, clear them for a safe return to school, work or play.
For Athletes And Their Parents
There is a free SportGait app which can be used on its own or in combination with Statcare’s system, though the true power of the CMP comes from the decision to integrate the two. When a patient enables this feature for Statcare locations, the patient’s medical history is automatically updated with information stored in the log, providing physicians with a fuller picture of the situation and improving their ability to make an accurate assessment.
BASELINE AND CONCUSSION TESTS ONLY TAKE 30 MINUTES TO COMPLETE, YET THEY PROVIDE INVALUABLE DATA TO PHYSICIANS.
With SportGait’s help, we aim to raise awareness and educate the community on concussion and recovery safety, which can help prevent further injury. Check out their website or Facebook page to learn more about the signs, symptoms and causes of concussion, research on new and upcoming mTBI detection technology, what you can do to recover faster without hurting your brain further, and more.
Common Questions about the SportGait Brain Physical
Our system helps ensure medical providers give you comprehensive, step by step care during recovery, so you can prevent further damaging conditions like second impact concussion and post-concussion syndrome.
Yes! SportGait uses an array of validated tests that have normative data; if you do not have a baseline test on record, a medical practitioner can look to see if your test results stray from the national averages established for your age. However, we do highly suggest baseline testing so physicians have a record of what normal looks like for you specifically.
For personalized concussion treatment. Each of the tests administered during a baseline assessment will be administered again if you believe you’ve sustained a concussion. The baseline results give medical practitioners a record of objective data to compare new results to, supporting diagnoses and treatment decisions.
The app is free. A baseline physical is an out of pocket expense, though in cases of a suspected concussion, the tests and recovery plan should be covered by most insurance companies – the only thing you pay is the co-pay!
Budget about 30 minutes for a baseline each year. You can even have your Brain Physical baseline during your annual physical for school, sports or work!
No. When you download the SportGait app, you are given a unique ID number that syncs your records between all participating providers. When you’re out of town, use the app’s built-in locator to find a participating clinic near you.