At InFocus we provide a comprehensive, systematic and interdisciplinary approach when helping patients recover from a concussion. Over the last 10 years we have built an amazing team of professionals to whom we can refer. We work together to return patients to work, school and activity as quickly and as safely as possible. At InFocus we communicate frequently with employers, schools, coaches and physicians to ensure seamless transitions and successful return to function.
- Physiotherapy for associated orthopaedic injuries
- Vestibular Assessment & Rehabilitation
- Physical Exertion Testing and Physical Reconditioning
- Neurocognitive Testing
- Balance Testing
- Referrals to Vision Therapy as needed
- Academic Accommodation Forms
- Abilities Forms for employers as requested
Put simply, a concussion changes the way our brain functions – causes it to work less optimally. It may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head. A Concussion may or may not involve loss of consciousness (loss of consciousness is not a diagnostic requirement). In fact, less than 20% of concussions result in a loss of consciousness.
A direct or indirect blow to the head, face or jaw can cause the brain to accelerate then rapidly decelerate within the skull. This acceleration/deceleration motion can induce mechanical changes to the nerve fibres – causing them to stretch – and in turn, alter several important metabolic pathways.
Though injury is apparent given the spectrum of symptoms experienced by a concussed athlete, no structural damage is caused to the brain itself. That is, unlike other sports injuries (like a fractured wrist or dislocated shoulder) nothing appears “wrong” or abnormal on standard imaging studies like CT, or MRI. Instead, these imaging methods are used to rule out more severe trauma such as bleeding within the brain or skull or fractures of the skull or neck. We understand now, more than ever, that just because we can’t see the injury, it doesn’t mean that something’s not wrong.
Current evidence suggests that the rapid stretch of nerve fibres within the brain during a concussive trauma results in the release of various neurotransmitters (signalling molecules within the brain), which trigger the initiation of a complex neurometabolic pathway. Ultimately the brain is unable to produce the energy required to sustain its normal processes, creating a generalized metabolic depression. These changes take place within minutes of the injury and can last for hours or days before normalization occurs. It is thought to be this metabolic imbalance, along with other impaired physiological processes that contribute to the physical, cognitive, behavioural and emotional signs and symptoms typically seen in a concussed individual.
The majority (80-90%) of concussion-related symptoms are thought to resolve in a short (7-10 day) period; however in some, symptoms may persist beyond 10 days:
- Children & adolescents
- Players suffering from multiple concussions in a close timeframe
- Persistent headache (>60 hrs) or high symptom load
- Athletes with history of migraine, depression, ADHD, learning disabilities or sleep disorders
Why some athletes seem to recover quickly and others do not remains unclear. Even when symptoms resolve quickly it is advisable that a proper gradual return-to-play protocol be carried out. The whole recovery process therefore may take upwards of 3-4 weeks to prevent premature return to sport.
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 “cookie-cutter” approach to concussion rehabilitation 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 objective baseline testing protocols that can be used to track an athlete’s recovery and serve as a tangible measurement for return-to-play readiness. By measuring 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. This requires a multifaceted approach and InFocus believes that no single test should be used in isolation.
That is why InFocus offers a comprehensive baseline test designed to assess:
- Neurocognitive function (memory, reaction time, processing speed etc.)
- Balance and Postural Sway
- Screening of visual function
InFocus 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 before the start of the season to have record of each player’s baseline level of physical and neurocognitive functioning. Should the athlete sustain a concussion during the season, the rehab team has the ability to compare post-injury testing to baseline values. This allows for a more accurate and objective assessment of the severity of the 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, InFocus 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, Axon Sports CCAT) are valuable and valid tools that provide objective information on neurocognitive function; 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.
Evaluating Physical Performance
It is well known that neurocognitive performance may be impacted following a concussion, but various aspects of physical performance may also be hindered: e.g. balance, coordination, and visual function. This type of testing is often overlooked during baseline evaluations.
The physical component of Shift’s baseline testing aids in post-injury comparison should the need arise. Knowing each athlete’s baseline level of physical performance gives us important information when evaluating post-injury recovery. In addition, these values give us a reference point when measuring performance throughout the return-to-play protocol. When athletes spend an extended period away from sport due to injury, they may become deconditioned which puts them at risk of further injury. All physical performance values should be returned to baseline before considering return-to-sport.