Inova recently sponsored a day-long conference on concussions earlier this summer at Lansdowne Resort, drawing practitioners from across the country.
Dr. Jill McCabe, medical director for Inova Loudoun’s pediatric emergency and pediatric inpatient departments, worked with clinic program coordinator and vestibular physical therapist Anne Blackstone, Inova Loudoun’s Concussion Clinic and Inova Neurosciences to put on the July 21 conference.
It’s a topic not well understood by the general public. When you say the word “concussion,” most people have a vague idea it’s something that happens when you hit your head hard.
But from the medical perspective, that’s not all it is.
According to McCabe and Blackstone, a person doesn’t have to hit his head to get a concussion; it’s more like a whiplash, or rotational forces, that cause the brain to bump up against the inside of the skull.
The symptoms that often follow a concussion include headache, blurred vision, vomiting and dizziness. Less obvious symptoms can be emotional ups and down and trouble sleeping.
“You’re just not your normal,” Blackstone said.
There are some key cognitive signs of concussion—you can’t remember, you can’t concentrate, you can’t process, you feel a bit foggy and slow.
The clinic proceeds gently with treatment, using a three-day rest and recover protocol for both cognitive and physical recovery. After that, clinicians move into active recovery work to get back to normal, using a graduated process.
“On the fourth day it’s very important to get back to normal—to be normal and do normal things,” Blackstone said, adding the key is to do it gradually. That phase involves physical activity, such as walking, maybe a bit of light exercise, always assessing the patient’s tolerance. Ninety percent of patients get back to normal within three to four weeks, although some can take years, she said.
Clinicians also look to see whether the diagnosis is for a vestibular dysfunction disorder, which can come from a concussion. This occurs deep in the inner ear, affecting one’s balance. Symptoms are similar—headaches, dizziness, cognitive slowing, imbalance and motion sensitivity, and anxiety.
McCabe heads the pediatric side of the multidisciplinary team along with a medical director for adults. Staff also includes doctors, nurse practitioners, physical therapists (orthopedic, vestibular and Neuro trained) and cognitive rehab trained speech language pathologists. Together they identify different needs to make sure they have the right treatment. “We ask, ‘what are we missing,’” Blackstone said.
McCabe said her staff is always on the lookout for signs of a concussion when patients turn up in the ER, both for adults and children. McCabe was a primary mover behind the county’s 2007 law requiring children aged 15 and under to wear a helmet when riding a bike or motorized scooter. Concern for young athletes in field sports is ongoing, with some advocating the wearing of helmets with sensors that could detect force to the head, or the movement of the head.
“That’s still in the process of being understood through research,” McCabe said, noting parents understandably want to protect their children, but the idea has been met with some opposition from athletic and school officials. “It’s still experimental, the science is not there yet,” she said, noting schools also don’t have the budget.
Acknowledging it can be a touchy subject. McCabe said that during the assessment testing she and her medical colleagues note that athletes make up half of the patients they see. “They’re at higher risk.”
The comprehensive assessment tests for a variety of symptoms. To figure out if it is concussion or something else McCabe says, “We analyze the data so we can come up with a plan. We need to understand [symptoms] better—why some are more prone to the injury, to the rotational forces likely to cause concussion.”
Inova Loudoun’s Concussion Clinic opened in June 2011, after doctors started to see more and more concussions. “We got together and consulted Commonwealth Emergency physicians, including Dr. Ron Waldrop, an ex-athlete who’d suffered injuries. We started partnering with him,” Blackstone said, leading to the formation of the concussion clinic.