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Chapter 4: Current Prevention Tools, Diagnostic Tests, and Treatment for Concussions

Chapter 4.1 Diagnosis

Concussions are a very hard injury to diagnose, as no two concussions are the same. Some may
experience all sorts of symptoms while another will only experience a single symptom. Someone may
experience symptoms right away and some may experience symptoms days to even months from the
original concussion. This is a reason why we need to understand the severity of concussions and the
possible symptoms that could follow from it.

The warning signs of a sustained concussion is not always obvious, but here are the most common
symptoms:

● Headache or migraine ● Cognitive trouble (fogginess, attention

● Dizziness problems, memory problems)
● Nausea ● Changes in mood
● Fatigue ● Sleeping problems
● Glassy eyes ● Grey tinge to the face

A doctor trained in diagnosing and managing concussions will need to perform a detailed exam and
cognitive test. This will help him or her tell the grade and severity of the concussion.

During the concussion exam, your doctor will check your:

● Hearing ● Balance and coordination

● Vision ● Memory
● Reflexes ● Attention span

When you are initially seen by the doctor they may run you through a test called the Glasgow Coma
Scale, to assist in ruling out serious brain illnesses. Those suffering from just a concussion should receive
a score or 14-15 and a normal individual should receive a score of 15. Here is the grading system.
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Feature Criteria Points

Motor Response The patient obeys commands 6

The patient responds to a painful stimulus by moving toward the 5

site of the stimulus

The patient moves away from a painful stimulus 4

The patient flexes his or her joints in response to a painful stimuli 3

The patient extends his or her joints in response to a painful 2

stimuli

The patient has no response to a painful stimuli 1

Verbal Reponse The patient is able to respond appropriately to questions regarding 5

who he or she is and where he or she is

The patient responds to questions, but is confused 4

The patient responds to questioning using inappropriate words. 3

There is no conversation

The patient makes incomprehensible sounds, but no actual words 2

No response to questioning 1

Eye Opening The patient spontaneously opens his or her eyes 4

The patient opens his or her eyes to speech 3

The patient opens his or her eyes to painful stimulus 2

The patient does not open his or her eyes, despite painful 1
stimulus

Total Possible Score 15

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("Glasgow Coma Scale Used In Evaluating Level of Consciousness, Not Concussion Severity |
MomsTeam", 2019)

Cognitive tests such as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) are key
tools we use to diagnose signs of a concussion.

The ImPACT test looks at your:

● Verbal and visual memory.

● Brain processing speed.
● Reaction time.

Some questions that doctors may ask are the following:

● What is your name?

● How old are you?
● How has your day been so far?
● What were you doing 20 minutes ago?
● What did you eat for breakfast/lunch?

Cognitive tests alone can diagnose concussions

You may also have a neurovestibular exam as part of the first evaluation. This exam looks for vestibular,
balance, and vision problems that often occur with a concussion.

Your doctor may order imaging tests — such as MRI or CT scans — to make sure there's no bruising or
bleeding in your brain. ​Which is only in very severe cases

Chapter 4.2 Treatment

There are several ways concussions are treated, some of which will sometimes be combined to help the
patient recover.
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“Rest is the most appropriate way to allow your brain to recover from a concussion. Your doctor
will recommend that you physically and mentally rest to recover from a concussion with only 10 minutes
of anaerobic activity a day to start.

This means avoiding activities that increase any of your symptoms, such as general physical
exertion, sports or any vigorous movements, until these activities no longer provoke your symptoms.

This rest also includes limiting activities that require thinking and mental concentration, such as
playing video games, watching TV, schoolwork, reading, texting or using a computer, if these activities
trigger your symptoms or worsen them.

Your doctor may recommend that you have shortened school days or workdays, take breaks
during the day, or have reduced school workloads or work assignments as you recover from a concussion.

As your symptoms improve, you may gradually add more activities that involve thinking, such as
doing more schoolwork or work assignments, or increasing your time spent at school or work. Increasing
the number of classes and/or increasing ½ day awake.

Your doctor will tell you when it's safe for you to resume light physical activity. Sometimes,
you're allowed to do light physical activity — such as riding a stationary bike or light jogging for 20
minutes — before your symptoms are completely gone, so long as it doesn't worsen symptoms.

Eventually, once all signs and symptoms of concussion have resolved, you and your doctor can
discuss the steps you'll need to take to safely play sports again. Resuming sports too soon increases the
risk of a second concussion and potentially fatal brain injury.

For headaches, try taking a pain reliever such as acetaminophen (Tylenol, others). Avoid other
pain relievers such as ibuprofen (Advil, Motrin IB, others) and aspirin, as these medications may increase
the risk of bleeding.”("Concussion Signs, Diagnosis, and Treatment | UPMC", 2019)

Getting to know your limits may be difficult, that is why neuro specialists and physicians have
come together to create a unified and universal system which essentially plans your day and is normally
termed the activity diet. It is called the Parkwood Point System.
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Patients learn to adapt their days to satisfy the point system. Some days may seem boring because
of the little things you do but by following the system you are helping your body stay in what we call the
safe zone, the zone in which do not seem to feel any symptoms. This zone varies for everyone so the
patient MUST realize that pushing through their symptoms are only going to make everything worse.
Time in the danger zone needs to be minimized so the recovery time is shortened overall. Here is an
illustration of 3 zones:("Protection and Prevention Strategies", 2019)
Here is the Activity Diet for the Parkwood Point System:
In order to curb your activity “appetite” we are going to try an Activity Diet. We will do this in a similar
way that Weight Watchers helps curb appetite in order to achieve weight loss—using ​points​! These are
the following tasks that you participate in, and how many points each is worth. You are limited to a
certain amount of points per day, decided by your doctor, it is generally around 10! So choose your
activities wisely, because if you run out of points, you aren’t supposed to do anything else (yes, that
includes watching TV, using the computer, or reading!). You may also get symptoms if you go over your
point maximum, and that’s what we’re trying to avoid.

ADLs (bathing, Grocery shopping 5 Dining out alone 3-5

dressing, 0.5-1 (or shopping in general
grooming) per hour)

Meal Prep: Having friends over (2) 3 Dining out with one 4
breakfast 0.5-1 per hour guest (per hour)

Meal Prep: lunch Each additional friend +1 Each additional guest +1

0.5-1 (or increased
noise/stimulation at
venue)

Meal Prep: simple Attending therapy: PT 3 Driving as a passenger 1

supper 1-2 (short distance vs. long)
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Meal Prep: Attending therapy: OT 2 Driving as a driver 0.5-2

complex supper 2-3 (short distance vs. long)

Cleaning: 1 per Attending therapy: SW 2 Attending a doctor’s 3-4

Vacuuming, task appointment/dental
dusting, appointment
bathrooms

Talking on the Attending therapy: SLP 2 Watching TV 0.5

phone 2 (per 30 minutes)
(per 15 minutes)

Using the Therapy homework 1 Working 3-5

computer 2 (per 30 minutes) (per half day)
(per 30 minutes)

Caring for small 1 Reading Large family gatherings 4-5

children (per hour) 1-2 (per 4 hrs)
(per hour)

Wedding/Funeral/ 3-5 Attending Church 5 Yardwork/Gardening/S 2-3

Baptism service now shoveling (per 30
(for each piece: minutes)
ceremony, dinner,
reception)

Haircut 1 Dishes 0.5 Laundry (per load) 1

Phone (per 15 0.5 General business 1-2 Phone for business 1

min) (per 15 minutes)

Hockey Game 5
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Chapter 4.3: Prevention

There are several ways concussions are prevented today, from protective equipment to proper
training. Concussion prevention is a priority for many.
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“Helmets are designed to mitigate the likelihood of head injuries from an impact to the head by
dissipating and distributing the energy of impact and protecting the head from penetration. Early helmets
were designed to prevent such injuries as skull fractures as well as moderate to severe brain injuries such
as focal contusions and hemorrhages. The typical helmet has a comfort liner, an impact energy attenuating
liner, a restraint system, and a shell. Some helmets, such as those used in motor sport, bicycling, and
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alpine skiing, are designed to attenuate a single impact. Once one of these single-impact helmets has
sustained an impact, it must be replaced. Other helmets, such as those used in ice hockey, football, and
lacrosse, are designed to withstand multiple impacts over a season of games and practices. Part of the
difference between single-impact helmets and multiple-impact helmets lies in the materials used. For
example, multiple-impact helmets, such as those for hockey and football, use materials that do not
permanently deform but rather compress and return to their original dimensions. Inner shells can be made
of vinyl nitrile or expanded polypropylene, and outer shells use lightweight plastics and composites for
durability and protection. Single-impact helmets contain materials that are frangible and deform or
fracture permanently upon impact as part of their energy management strategy.”("Protection and
Prevention Strategies", 2019)

“Helmet design involves a series of trade-offs between optimal safety and parameters such as the
thickness and other characteristics of the attenuation material, the size and mass of the helmet, comfort,
and acceptability. A primary goal of the attenuation layer is to decrease the peak deceleration and to
increase the time duration over which the deceleration occurs; this can be achieved by a thicker or more
compliant layer of material which improves the energy management by reducing the peak linear
deceleration upon impact. However, better energy management via an increased thickness results in a
large helmet that may be unacceptable from a style, agility, or visibility standpoint. A helmet with
increased mass would have reduced linear head acceleration for a given force; however, it may actually
increase the rotational acceleration generated from an impact because there would be an increased radius
over which the forces are acting.”("Protection and Prevention Strategies", 2019)

Chapter 4.4: Companies Taking Advantage

“There are concerns that the makers of sports protective equipment have taken advantage of
growing concussion awareness by making unsubstantiated claims that certain products can reduce
concussion risk. For example, as discussed at a 2011 hearing on concussions and the marketing of sports
equipment before the U.S. Senate Committee on Commerce, Science, and Transportation, packaging and
online advertising for particular devices (e.g., mouthguards and soccer headbands) designed specifically
for youth athletes have included language that may be construed to mean that the product reduces
concussion risk or else they have made explicit claims of reduced concussion risk with use of the product
(U.S. Senate Committee on Commerce, Science, and Transportation, 2011). In order to avoid a false sense
of security, it is important that athletes, parents, and coaches be aware of—and that marketers of sports
equipment accurately convey—the limitations of protective equipment as it relates to concussions. Until a
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universally accepted injury risk curve for concussions is established, as well as associated variants with
age and perhaps direction, claims of reduced concussion risk with protective devices will not be based on
fundamentally sound science.”("Protection and Prevention Strategies", 2019)