Recovery Process with Concussion
While there continues to be much debate on the topic of chronic traumatic encephalopathy, there is no doubt that the immediate impact of concussions can be quite disruptive to athletes and their families. The Courier Journal provided a nice discussion of concussion and the new state guidelines that are attempting to protect Middle and High School students in the November 25th, 2012 Sunday Paper. It is a very positive sign to see that the steps that a player must go through to return to play have increased as awareness of the length of the recovery process from concussion has become a focus of research. My concern from reading this article is that it does not point out that if cognitive symptoms continue for an extended time frame that there is a need for more extensive neuro-cognitive evaluation before the player returns to play.
The screening instruments, like the IMPACT, that most programs will be using are indeed better than nothing, but they do not have the sophistication to provide a clear and comprehensive picture of cognitive functioning when there is ongoing cognitive sequela from a concussion. Presentations during the most recent American Academy of Clinical Neuropsychology discussed the value of screening measure and concluded that it was vitally important for coaches and athletic directors to recognize that further evaluation of cognitive deficits should be sought if athletes continue to show performance below baseline for more than a few days after a suspected concussion.
It is my hope that as awareness of concussion increases, the guidelines for return to play will improve to the level that we have seen with other sports related injuries. The brain needs time to recover and the extent of injury must be fully evaluated to make an informed decision on return to play.