Concussion injuries can plague athletes for a lifetime. At the 66th meeting of the American Academy of Neurology in Philadelphia April 2014, physicians discussed current protocol for evaluating for this mild, but still traumatic, brain injury and now recommend a simple vision test to “capture” more of these head injuries. What follows is a guide to the symptoms, testing and updated protocol for concussions.
Definition and Symptoms
A concussion is a disturbance in brain function which can occur after a blow to the head, but also when intense force is applied to the environment surrounding the head. For example, a concussion can result from the sudden stopping, swerving or falling in a auto accident even if the skull was not directly impacted. This applies in sports as well when, for example, a ball player falls hard and fast but does not strike his head on the ground. In addition, physicians are more concerned about a concussion in a child or adolescent because the brain is still developing.
Symptoms of a concussion can, but not always, include:
- dizziness and./or loss of balance
- concentration or memory problems
- sluggishness in movement, speech or thought
- sensitivity to voice and light
- sleep problems
These symptoms warrant immediate evaluation by a health care professional. Young people, and especially athletes, can sometimes deny symptoms or think they can continue on without evaluation. This is where care from and consideration by parents, coaches, teachers and other people surrounding the affected individual are important.
Testing for possible concussions sustained by athletes begins with baseline testing (or testing under normal conditions in a routine physical exam). Simple balance and cognition (thought processes) are evaluated and noted, but what has not been part of a normal sports physical to date is vision testing.
Neurologists now propose using the King-Devick vision test in the pre-season. This test takes about a minute and involves a timed reading of numbers from an iPad or from index cards. If a suspected concussion occurs during a sporting event, the test is administered, along with the usual balance and cognition tests, at the sidelines. Deviation from the baseline results can be diagnostic for concussion. Imaging and other testing in a hospital may be necessary.
The athletic department at the University of Florida routinely uses the King-Devick vision test along with its other concussion evaluations. What physicians are finding is that the vision test alone shows 79 percent of concussions, while the cognition test picks up only 52 percent and the balance test 70 percent. All 3 testing modes, when used together, show concussions in 100 percent of the athletes suspected to have the injury. These findings are backed up by the National Institutes on Health.
Physicians at the University of Florida praise the combination of tests as being far more objective and accurate for finding concussions. They urge the use of the 3 evaluations to pinpoint as many of these potentially serious and far-reaching head injuries as possible.
Treatment of Concussions
- rest (limited physical activity) for 3 to 10 days
- no heavy physical contact
- no “brain strain” from watching TV, texting or playing video games
In addition, people with concussions need follow-up care with the 3 methods of testing to make sure results are returning to the pre-injury, baseline numbers.