Concussion Management

Concussion ManagementWhat is a concussion?

  • A complex pathophysiological process affecting the brain
  • Can be caused by a direct blow to the head, neck, or anywhere on the body forces are transmitted to the head. A concussion can occur even if you have not been “knocked out.”
  • Altered cellular metabolism causes decreased blood flow to the brain at a time the brain needs it the most. The resulting “mismatch” increases the vulnerability of the brain to further injury. This can affect cognitive functions, moods, physical attributes, and sleep patterns.

Concussion- So What?

Unlike other injuries, playing or practicing with concussive symptoms is dangerous and can lead to a longer recovery period. While your brain is still healing, you are much more likely to have a repeat concussion.

Repeat concussions increase the time it takes to recover and increases the likelihood of long term problems. In some cases, repeat concussions in young athletes can result in brain swelling or permanent damage to the brain. They can even be fatal.


ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was developed in the early 90’s as a tool used for clinical management of concussions for athletes.  It is a tool to help manage concussions on an individualized basis through baseline testing and/or post-injury neurocognitive testing.

This type of assessment can help evaluate a concussed athlete’s post-injury condition and track recovery for safe return to play. Some measurements that ImPACT evaluates include verbal and visual memory, speed and reaction time, attention span, and problem solving.

Why do a baseline computer test (ImPACT)?

  • Neurocognitive tests, such as ImPACT, are helpful in providing objective information about how the brain is responding to injury.  ImPACT has two components:  a pre and post concussion test.  The pre-test is very valuable as the scoring represents one’s baseline (normal) brain function.ImPACT is then repeated post concussion.  Results of the pre and post concussion tests are compared and care plans are then developed.
  • If a pre-test was not completed prior to a concussion, an ImPACT post concussion test can still be a reliable tool in the assessment of brain function (comparing concussed athletes to “norms” in their age group).It is recommended that ImPACT be completed every one to two years due to natural maturing of the brain which can lead to scoring changes over time.

Signs and Symptoms

A concussion can present with a wide array of symptoms that may or may not include:

  • Headache
  • Dizziness/lightheadedness
  • Balance problems
  • Blurry vision/light sensitivity
  • Vacant stare/“glassy” eyed
  • Noise sensitivity/“ringing” in ears
  • Nausea/Vomiting
  • Feeling “dazed” or “foggy”
  • Inability to focus/easily distracted
  • Slurred speech
  • Memory problems/unable to answer questions he/she would normally know
  • Poor learning/reading comprehension
  • Poor mental stamina
  • Irritability
  • Anxiety
  • Mood swings
  • Easily overwhelmed
  • Emotional/behavioral outburst
  • Lack of motivation
  • Sleep disturbance

When am I safe to return to activity?

An athlete with a concussion should be free of all symptoms and have returned to their normal sleeping and eating patterns, as well as typical concentration levels at school and work before resuming high levels of activity.

Once those requirements are met, he/she is ready to try more demanding activities that increase heart rate levels.Through direction of your concussion management team, lead by Dr. McDonough, activities will increase as long as symptoms do not return. Step by step return to participation allows the opportunity to assess brain healing so accurate return to play assessments can be made.

Under no circumstances should anyone return to activity while experiencing concussion signs or symptoms.

What can I expect from St. Croix Regional Sports Medicine?

  • Evidence based concussion management with return to play recommendations
  • Facilitation of baseline ImPACT testing
  • Post-concussion ImPACT testing
  • Referral to appropriate healthcare providers, if needed.