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September 2011

September 2011

Neuroscience News


Allegheny General Hospital Concussion Center

Concussion center at WPAHS

Concussions have reached epidemic proportions in the United States. The Centers for Disease Control and Prevention estimates that approximately 1.6 to 3.8 million concussions (mild traumatic brain injuries) occur each year and that approximately 20 percent of these injuries are sports-related.

While it is assumed that football has the highest concussion rates – football players suffer a minimum of 1.5 concussions every year – recent data indicate that per 10,000 participants, rates for concussed athletes presenting to an emergency department are 5.22 in basketball, 5.2 in football, 4.9 in ice hockey, and 3.1 in soccer. In addition, concussions do not occur in isolation. There is increasing evidence that repeated concussions may result in early dementia or other degenerative neurological conditions such as Lou Gehrig's disease (amyotrophic lateral sclerosis).

It is a general misunderstanding that a concussion involves a loss of consciousness. Most individuals who sustain a concussion may be momentarily dazed or "dinged" and not appear to have any problems continuing to function. However, such episodes are just as serious as those that do involve loss of consciousness.

With respect to sports concussion management, any athlete who appears to have sustained a concussion should immediately be removed from play. The athlete should not return to sports until all symptoms of concussion have resolved. The athlete should abstain from sports until an evaluation has been performed by a doctor who has training in sports concussion and has been given clearance to return to play. To ensure identification of individuals at risk, a certified trainer should be present at every sporting event. Educational efforts on concussion should be emphasized to improve coaches', players', and parents' understanding of the potentially dangerous risks associated with concussion.

Allegheny General Hospital has long been at the forefront of evaluation of patients with sports or non-sports-related concussion.

Given the increasing incidence of this problem, AGH announces an enhancement and expansion of its current Concussion Center.

The Concussion Center is a multidisciplinary collaborative effort among Sports Medicine (Dr. Edward Snell, Dr. Sam Akhavan), Neurology (Dr. Kevin Kelly), and Neurosurgery (Dr. Jack Wilberger).

The center focuses on:

Trainers and coaches are offered regular educational opportunities to identify on-the-field activities that may predispose an individual to a concussion. They are also made aware of the latest technology to minimize the incidents of concussion.

Trainers are taught the most up-to-date methods for sideline assessment of athletes for concussion and the guidelines for referral to the Concussion Center.

The Concussion Center currently uses the ImPACTTM evaluation system to assess the neuropsychological functioning of individuals with a concussion who have had a baseline ImPACTTM test. As the majority of symptoms expressed by concussed individuals may be subjective in nature - i.e., double vision, dizziness, nausea, headache - this type of testing may reveal deficits in brain function that indicate the presence of an injury.

In addition, there is a detailed neurological examination and, as appropriate, studies such as CT scans and MRI scans.

While the majority of treatment for postconcussive symptoms is focused on improvement of the individual’s symptoms, those with significant neuropsychological abnormalities on ImPACTTM testing may require cognitive treatment as well.

Return to Play/Activity Guidelines
Athletes are restricted from physical exertion while experiencing any postconcussion symptom. Following the resolution of all symptoms and the return of ImPACTTM test results to baseline, the athlete is allowed to gradually return to activity with increasing levels of non-contact physical exertion. If the athlete remains asymptomatic with such exertion, he or she is allowed to return to practice with limited contact. Once again, as long as the athlete remains symptom-free, they are allowed to progress to more active involvement in their sport.

The Concussion Center is actively seeking tests with greater sensitivity and specificity to identify the presence of a concussion as well as its severity. Currently, this involves a simpler and more easily interpreted set of neuropsychological tests administered in a video game-type environment. Additionally, subtle eye movement abnormalities have been identified in association with concussion and a sophisticated method of testing such eye movements is actively ongoing through the Concussion Center to determine if resolution of these abnormalities is associated with full brain recovery.

Individuals who have suffered a concussion and have ongoing concerns will be seen as soon as possible. The Concussion Center can be accessed 24 hours a day by calling                        1.412.DOCTORS (412.362.8677)  (362.8677)


IMPORTANT: The Concussion Center does not replace the Emergency Department for those who may be having significant immediate symptoms such as lethargy, memory loss, headache, vomiting or unsteadiness.