Pro-Action Sports Injury Clinic (PASIC) is a proud to have joined the Shift Concussion Management Program and R2P concussion management to bring you research driven, comprehensive concussion management. This program is unlike anything of its kind to date. Using a network of healthcare professionals including chiropractors, Osteopathic doctors, physicians, neurologists and neuropsychologists, and backed by the latest research, Pro-Action Sports Injury Clinic provides baseline testing, concussion education, and assessment protocols that revolutionize the way concussions are managed compared to the rest, rest, rest instructions that are typical with concussions. We are excited to be able to offer this in the Ottawa area!
Pro-Action sports Injury Clinic is committed to offering the highest level of concussion care to athletes of all ages. As part of this commitment we have invested heavily in the development of cutting edge baseline concussion testing and research-based “Return-to-Learn” and Return-to-Play protocols. These programs are designed to work in conjunction with each athlete’s school, teachers, parents, trainers, coaches, and family doctors. This team cohesiveness is an integral part of our management program to ensure that the athlete is being managed properly each and every step of the way. This type of concussion management is only currently seen in professional sports organizations with no such programs available to children and adolescent athletes until now!
What Is a Concussion?
According to the most recent Zurich consensus statement, a concussion, or mild traumatic brain injury (mTBI) as it is sometimes called, is a complex process affecting the brain induced by biomechanical forces. The forces that they are referring to are acceleration or impulse forces delivered to the brain. Concussions cause a temporary dysfunction in the involved nerves, where they don’t work properly for a period of time and may cause any one, or more, of the following signs or symptoms:
- Pressure in the head
- Neck Pain
- Nausea Or Vomit
- Blurred Vision
- Balance Problems
- Sensitivity to light
- Sensitivity to noise
- Feeling Slowed Down
- Feeling of “Fogginess”
- Not feeling right or feeling off
- Difficulty concentrating
- Difficulty remembering
- Fatigue or low energy
- Trouble falling asleep
- More Emotional
- Nervous Or Anxious
Why Baseline Testing?
Concussions can produce a wide array of symptoms, which poses a challenge for coaches, trainers, parents, and health professionals involved in the care of an injured athlete. The time-course for recovery also varies widely from athlete to athlete, making it impossible to employ a one size fit all approach to concussion rehabilitation and return-to-learn and return-to-play timelines. Currently, there is no reliable diagnostic test or marker that can be used to identify a concussion when it’s occurred, or similarly, determine when a concussion has resolved.
For this reason, a growing emphasis has been placed on multiple tests that are objective baseline test protocols to increase data points to track and determine an athlete’s recovery and reliable measurements for the progression of return-to-play readiness. By recording an athlete’s “normal” level of functioning, we are better able to gauge the level of impairment that may exist post-injury by performing comparative testing. The Pro-Action Team believes this requires a multifaceted approach and that no single test should be used in isolation.
That is why the Pro-Action Concussion Management Program offers several testing components designed to assess:
- Neurocognitive Performance (ImPACT)
- Balance and Bess Balancing testing
- Visual Coordination
- King-Devick test
Pro-Action baseline testers also review and document previous concussive episodes and history of concussion-like symptoms to aid in individualized post-injury assessments should they be required.
Baseline values can vary widely from one athlete to the next, and in young developing athletes, these measures can change dramatically from year to year. It is therefore important to have record of each player’s baseline level of physical and neurocognitive functioning before the start of each season. Should an athlete sustain a concussion during the season, Pro-Action Practitioners have the ability to compare post-injury testing to baseline values. This allows for a more accurate and objective assessment an otherwise elusive injury, and provides important information when making return-to-play decisions.
Recent advancements in concussion management have resulted in the widespread use of computer-based neurocognitive testing protocols, and evidence now shows that concussed athletes demonstrate subtle cognitive deficits that may persist beyond symptom resolution – emphasizing the fact that return to play once “symptom-free” is no longer an accurate measure of readiness.
For this reason, PASIC employs computerized neurocognitive testing as part of all baseline and post-injury assessment protocols. This type of testing provides us with a snapshot of how an athlete’s brain is functioning both pre and post injury by measuring things like reaction time, processing speed, memory, and attention/concentration. These cognitive processes are often affected by concussive injury, and so this type of testing provides us with important information when managing an athlete’s recovery.
Note: computer-based neurocognitive tests that are designed for concussion assessment (eg. ImPACT) are valuable and valid tools that provide objective information on various aspects of neurocognitive performance; however, these tests are not meant to replace a full neuropsychological assessment that would be provided by a qualified Neuropsychologist. When more complex or comprehensive testing is required, specialist referral may be indicated.
It is well known that neurocognitive performance may be impacted following a concussion, but other aspects of physical performance may also be hindered: e.g. balance and visual coordination skills. This type of testing is often overlooked during traditional baseline evaluations, but all Pro-Action/Shift clinical sites offer these additional testing components to gain a more complete picture of our athletes.
What makes us different is not only do we do baseline testing, but we educate our parents, kids, players, teachers, trainers and coaches about concussions, diagnosis, management, baseline testing and treatment. At PASIC we provide a smooth and comprehensive and complete transition from baseline testing to concussion management and treatment to return patients to work/school and finally sport. It is this lack of full knowledge on how to transition from baseline testing to treatment that often lack.
Our referral sources with Iris (Dr. Corriveau in Barrhaven who is not just your regular optometrist) the binocular vision experts, Shift Concussion Management experts and Dr. Jacquie van Ierssel of R2P concussion management creates a complete team for our more complicated concussion cases. Getting you back to your life is our #1 goal.
What We Do To Help
The chiropractors at PASIC, in conjunction with Shift Concussion management and R2P concussion management, provide complete care for concussions, whether it was 10 minutes ago or 5 weeks ago, we will provide you with a program of care that is evidence based and continues to grow as more and more research and testing becomes available. Treatments provided for recovery include Active Release Techniques for muscle, nerve, ligament treatment, neurocognitive testing, chiropractic adjustments, vestibular training/rehab, visual training/rehab, exertion testing, sports specific testing.
There is a progression for all our treatments unique to every patient and we ensure that you are comfortable with all techniques and treatments we provide prior to engagement. We do not perform activities you are not comfortable with. We will give you exercises and training to do at home, and there is constant education from the first appointment and onward. We engage in communication on a regular basis by answering questions and understanding progressions and symptoms.
The first, and by far the most important, step in properly managing concussions actually comes before the injury even happens. Actually, before the season even starts!
Under the current medical guidelines for a concussion injury, return-to-play decisions are made using a “symptom-based” approach, however medical research has repeatedly shown that following a concussion, symptoms are actually the first thing to resolve despite continued deficits from baseline neurocognitive functioning, balance, reaction time, visual tracking etc. The research has also shown that even once the athlete is asymptomatic (no longer feeling any symptoms), this continued neurological dysfunction makes them still extremely vulnerable to suffering a more severe and potentially permanent, or even fatal, brain injury. Using symptoms alone to guide decisions is also a problem for another reason: Athletes frequently withhold information or are untruthful regarding their symptoms in an effort to accommodate the pressures of coaches and parents and allow them to return to, or continue to play, perhaps all involved are uneducated to the potential dangers that may come forth if another impact is experienced during this vulnerable state.
Professional sports organizations have been aware of this problem for years and have instituted baseline tests done each year, prior to beginning the season. There is currently no X-ray, MRI, or CAT scan that can detect the presence of a concussion. In the event of a potential injury, the athlete is examined and functional systems tested and the results are compared to their pre-injury results so that subtle deficiencies can be picked up and the diagnosis can be properly made. These baseline scores are also then used to accurately determine when the athlete has completely returned to their baseline levels and can therefore safely to return to their sport.
This quality of comprehensive concussion management has been only available to professional sports organizations, and university/college athletic programs, but is now being more available for athletes and students of all ages who have suffered a concussion.
Using medical research and input from prominent professional sports organizations like Pittsburgh University; our research team has developed the most comprehensive baseline testing and management program currently available for amateur athletes!
Many companies have been promoting online neurocognitive tests as “baseline concussion evaluations”, however when used as the only method of assessment, these tests have been shown to be very unreliable (See Below) and fall very short of testing all facets of concussion injuries. As part of a complete evaluation however, these tests have been shown to lend a valuable insight into neurocognitive functioning. Our comprehensive baseline testing includes tests of all facets of concussion injuries, including but not limited to:
- Visual Processing/Visual Movements
- Reaction Time
- Balance and Proprioception
- Motor Strength
- Neurocognitive Testing
Truth About Online-Testing
Baseline testing should be repeated at least once per year and should involve more than just online/computer-based neurocognitive testing. Medical research has repeatedly demonstrated online or computer-based testing to be unreliable alone. Several studies have shown, and several world-wide consensus statements have concluded, that by themselves online testing may over-estimate recovery and send players back in to harms way (click here)
Here are some quotes from recent research studies examining the usefulness of a concussion program that only uses online testing:
“Neuropsychological tests should only be used as a part of a comprehensive concussion management strategy and SHOULD NOT BE USED IN ISOLATION-American Medical Society position statement on concussion in sport” – Clinical Journal of Sports Medicine – 2013
“Computer-based concussion evaluations did not provide stable measures of cognitive functioning. Inconsistent performance on concussion assessments may lead clinicians to inaccurate determinations of cognitive function” -Broglio et al., 2007
“We conclude that the empirical evidence does not support the use of ImPACT testing (a popular computer-based concussion test) for determining the time of post-concussion return to play” -Mayers et al. Journal of Clinical and Experimental Neuropsychology, 2012
(see here and here for additional news stories highlighting the major limitations with only using online testing as your concussion management strategy).
Although these tests have shown unreliability as a stand-alone test, they are currently recommended as an adjunct to a complete and comprehensive program. Our program has been designed to be completely research-based, which is why we include online testing as only one small component of our comprehensive protocol.
If any of the below symptoms occur, seek immediate medical attention:
- One pupil larger than the other
- Person is drowsy or cannot be awakened
- A headache that is very severe or worsens
- Repeated vomiting or nausea
- Slurred speech
- Convulsions or seizures
- Person cannot recognize people or places
- Has difficulty recalling short term memory
- Person becomes increasingly confused, restless or agitated
- Person is unsteady on their feet
- Person was intoxicated with drugs or alcohol at the time of the injury
- Bruising behind the ears, black eyes, or very tender points on the face
- Fluid or blood from the ears, nose, mouth or eyes
- Decreasing level of consciousness or awareness
Disclaimer: This information is designed to provide education and awareness. This information does not take the place of a proper medical evaluation. PASIC does not take any responsibility of injury or death if you choose not to report to a medical professional.
Acute Concussion Rehab
In the immediate post-injury phase usually lasting 24-72 hours, there is a need for rest for the mind and body. The first stage of concussion recovery is complete rest! Concussion or mild traumatic brain injury, is essentially an energy deficit inside the brain, complete with metabolic imbalances and decrease in blood flow. Rest has two very important features when it comes to concussion. First, it keeps the athlete safe from a second impact, which could prolong recovery or have more devastating injuries. Secondly, rest allows the athlete to restore their energy levels and heal the neurophysiological damage that is occurring.
The general consensus within the research and medical community is that anything that could potentially waste energy, such as mental stimulation or concentration as well as physical exercise, will in-turn delay recovery at initial stages! Thus, COMPLETE PHYSICAL and COGNITIVE REST is prescribed during that 24-72 hour time window during initial recovery phase. This means: no school, no homework, no screens (texting, no computer/video games, no television) and no physical activity. Often athletes are encouraged to sit in a dark room especially if light stimulation is apparent. This is hopefully helpful to also encourage napping and sleeping since sleeping is essential for healing of the body especially at this period. Once again we are trying to build energy stores and heal the brain as rapidly as possible.
The use of medications should be reserved for extreme circumstances and should only be used if directly prescribed by a physician who is familiar with concussion injuries. Pain killing medications may mask the signs of a potentially worsening condition and may also increase the risk of intracranial hemorrhage (bleeding in the brain) in medications like asprin. (Do we need this) Many common pain medications for headaches can also lead to a phenomenon called “rebound headaches” if they are taken for an extended period of time and then stopped. This may confound things and make it difficult to determine if these are concussion symptoms or simply medication withdrawal symptoms. As such, athletes who are on medications for their concussion symptoms are not allowed to return to their sport.
“There is no scientific evidence that medication speeds recovery from concussion in humans”
– Leddy et al, 2012
Return to Learn
The next stages of rehabilitation from a concussion injury involve a gradual return first to cognitive activity and then a gradual increase in physical activity with each stage separated by a period of at least 24 hours and in younger adolescence 48 hours might be more appropriate.
Symptoms can have a significant impact on classroom learning and schoolwork. Physical symptoms may interfere with the student’s ability to focus and concentrate, while cognitive symptoms may impact the ability of the student to learn, memorize and process information, as well as keep track of assignments and tests. Struggles with school work may worsen the frustrations, nervousness and/or irritability that were originally caused by changes in brain chemistry. Lastly, disturbances in sleep patterns often result in fatigue and drowsiness during the day, factors, which may compound all the other problems the student, may experience. www.Nationwide childrens.org.
Most students will benefit from an initial period of rest with minor accommodations. Premature returns to the classroom may hinder a student’s academic progress, and worsen or prolong their symptoms. At PASIC we take slow progressive steps to ensure proper return to school where symptoms are kept to a minimum by academic accommodations while keeping them involved in a social atmosphere and in communication with their studies/school.
The athlete during must have NO SYMPTOMS at any one of the stages in order to be progressed to the next stage. If symptoms are encountered, this is indication of not being ready for the complexity of the task, and the athlete should drop back to the previous stage for a 24-hour period before attempting the next stage again.
Post-Concussion Syndrome Rehab
What is Post-Concussion Syndrome?
Risks for prolonged recovery and post-concussion syndrome:
- -History of concussions
- Multiple injuries in close time-proximity
- Pre-existing depression or anxiety
- Family or life stressors
- Younger children and adolescents are known to take longer to recover
- Improper management – not allowing proper recovery
PASIC along with R2P and Shift concussion management has implemented research-based rehabilitation program designed to use the best evidenced based research to help patients recover from their acute or long-standing concussion symptoms.
Please do not hesitate to contact us for your concussion needs as we are committed helping you find the fastest and best way to relieve your symptoms with us and our expert referral sources.
Our team of highly trained professionals uses the latest healing technologies to restore you to pain-free health, quickly and easily.
We thoroughly evaluate & treat all of the contributing root factors related to your issue.
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