Concussion Management: It Takes a Village

Reports of concussions continue to rise in the U.S., yet concussion management is still considered to be in its infancy. The complex nature of concussion injuries make traditional medical care models ineffective in properly diagnosing and rehabilitating the brain…and the whole person.


The Problem: So Many and So Complex

1.6 -3.6 million sport-related concussions occur each year in the U.S.. This is overshadowed by the fact that more than half of all concussions are caused by non-sport activities.

There are 43 working concussion definitions, and no internationally agreed definition. Yet a current definition of concussion is “Any bolt, jolt, blow to the head or body causing a symptom.”

Immediate symptoms following a concussion can include foggy head, dizziness, headaches, neck pain, visual changes, nausea, fatigue, changes in vision, ringing in the ears, and slurred speech.

Additional or delayed symptoms may include difficulty with concentration or memory, irritability or personality changes, sensitivity to light and noise, sleep disturbances, anxiety, depression, and changes in taste and smell.

Concussions are increasingly suspected of contributing to long term disfunctions including Chronic Traumatic Encephalopathy (CTE), Dementia, Depression, and more.

Traditional Solutions: Fragmented Care

Schools, Athletic Trainers, Primary Providers, ER attendees and specialists have traditionally managed concussions in isolation to one another. Concussion diagnosis was usually based on the presence of loss of consciousness after an injury, making for radically low detection rates of concussion injuries by doctors and sideline officials. Concussion management was limited to a “wait and see” approach, which relied on the physiological decrease in symptoms over time.

Interprofessional Collaborative Solutions: Collective Care

Advances in concussion research and interprofessional communication have led to the emergence of new collaborative models of concussion care. Currently, 7 “Trajectories” have been identified in Concussion Injury and Management including: Vestibular Injury, Cognitive Injury, Anxiety/Mood Disregulation, Cervical Injury, Post-trauma Headache/Migraine, Oculomotor Injury, and Metabolic/Autonomic Injury. These injuries cross all traditional and non-traditional disciplines requiring new models of collaborating around a client’s unique needs.

New models of understanding concussion injury are borrowed from engineering and computer science including “Root Cause Analysis” and “Complex Systems Management.” Rather than label a diagnosis based on a list of symptoms, these models work to understand the brain and body as a complex system with interrelated parts. Solving the unique needs of each injury requires understanding how the different parts have been affected, and how they are affecting other interconnected parts.

One example is understanding how neck injuries nearly always accompany concussions, and how many symptoms, including headaches, vestibular disfunction, brain fog, and fatigue can be coming from the neck rather than the brain. Injury to the autonomic system, which is responsible for the ability for the “energy systems” in the brain to function can also further lead to fatigue and brain fog. It is important to understand which areas are injured, and which may be contributing to the actual symptoms.

New subspecialties are emerging to better address complex areas of injury. These include neuropsychology, vestibular therapy, occupational therapy, craniocervical chiropractic, neurooptometry, functional neurology, sports psychology, and functional medicine. These experts are often more up-to-date in concussion research and best practices than primary providers, pediatricians, and even neurologists.

New Hope

Pasadena is one of countless professional communities across the U.S. where diverse health professionals are working together to knowledge-share, collaborate, and co-manage concussion cases in a patient-centered approach. It is exciting to see patients and clients returning to pre-injury status after even protracted concussion injuries. The care and expertise of so many talented professionals make this community a model of compassion and innovation in the U.S.