Concussion Management Now and Then
November 17, 2013
It wasn’t but a short time ago that the widely held notions of what defined a concussion and how the medical community managed it differed dramatically from what we do today. The paradigm has completely changed. While all concussions are not equal we do not attempt to grade the severity or base management upon some scoring system, of which there were nineteen. The mechanisms that cause the symptoms and dysfunction in a concussion are understood better and the way we manage return to play from concussions is managed very differently than before. Prior to the paradigm change concussions were understandably undertreated as the signs and symptoms are not as obvious as standard external or musculoskeletal injuries.
Media coverage on the consequences of rare but potentially deadly Second Impact Syndrome as well as long term consequences suffered by NFL players has dramatically increased public awareness. Relative to the past there has been a seeming avalanche of information which beforehand was rarely discussed inside the main stream. Fortunately there have been centers of research that have been studying sports related concussions for more than a decade, including the special cases of adolescence, that have gone a very long way in improving concussion understanding and its management. Due to the increased awareness concussion legislation started passing nationwide in state legislators, here in Texas known as Natasha’s Law or H.B. 2038. This legislation requires each school district to form a committee composed of a multidisciplinary team of professionals to develop standards for removal of athletes from play and a process in which the athlete can safely return to play. In my opinion this law has been a very positive sea-change in the acceptance of modern concussion management by athletic trainers, the coaches they work with, parents and sometimes even the athletes themselves.