Training & Conditioning

August/September 2019

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20 T&C AUGUST/SEPTEMBER 2019 TR AINING - CONDITIONING .COM TREATING THE ATHLETE M any athletes assume that a blow to the head is just part of the game. As they may have done many times before, they "shake it off" and resume play. Nobody wants to let down the team. The last decade has seen a 60% rise in sports- related head injuries (SRC) in emergency rooms across the country. The steep rise may be attributed to better awareness of deficits, but also to improved accessibility to technology. The first indication of a possible concussion, and, therefore, the need for intervention and management, is the suspicion of injury, symptoms and symptom provocation. There is no MRI, CT scan or blood test, that as of yet, can diagnose a concussion. In many cases, the hit can be something that initially seems ordinary or unremarkable. The intent is not to discourage play but rather to enable student-athletes to engage in sport and recreational activity with better knowledge to keep them playing longer, smarter and safer. It's from this initial injury that student-athletes display symptoms that can take minutes, hours or even days to emerge. Those symptoms can be stimulated by poor sleep or loud noises. Suspicion of injury, followed by symptoms and symptom provocation, has been the avenue for diagnosing a concussion. Symptoms can go largely unnoticed, and the significance may be hidden for hours or longer. It's for this reason that, in our practice, we make our office available to examine these individuals immediately to capture initial signs and indicators. Establishing baselines Establishing the baseline of function is critical in developing a complete assessment, points of improvement and future treatments. The five critical baselines that we address are: 1. Vision. Determining acuity, blind spots, blurring, double • vision, oculomotor — fixation, pursuits and saccades, • near point of convergence (NPC) — using eye-tracking software like RightEye. 2. Vestibular. Any reports of dizziness, stumbling, falls, • nystagmus (eye movements) or vertigo. Also, vestibular- • ocular reflex (VOR) assessment and vision motion • sensitivity (VMS) assessment using RightEye. 3. Balance. Addressing changes in gait or the ability to perform activities — climbing stairs, stepping over objects or walking on uneven surfaces. Conduct a BESS test with eyes open/closed, shoulder-width and in tandem stance. 4. Cognition. Including memory, orientation to current events, and problem solving utilizing web-based products • such as ImPACT testing. Also, CNS vital signs and CBS • health assessment. 5. Reaction time. Can be done with or without technology, utilizing Senaptec or DynaVision D2 technology. We designed our assessment and treatment approach with a multidisciplinary best practice approach. In assessing the effects of concussions and potential consequences, both long and short term, we utilize a team approach. Our professionals include a physical therapist, occupational, athletic trainer and a neuro-optometrist. We find this to be extremely beneficial in testing and interpreting results. As a group, we're able to create a picture of how the person is functioning and any conditions or effects that may be of concern. In the beginning evaluation, we establish the system conditions that present at that point in time, a snapshot of the conditions in that moment. By documenting the neurological status, we determine an important baseline. With this information, we can then monitor changes that may occur in the future. Examining symptoms Many individuals assume that the initial common symptoms of nausea and headache are the only concerning factors, or proof, of a concussion. It's important, therefore, to make our initial evaluation and ongoing monitoring a more in-depth explanation of the interwoven brain function that may seem slight and unrelated. The person may report blurred vision, double vision or sensitivity to light. They may explain feelings of dizziness and vision similar to stepping off a roller coaster. Balance problems may be minor, yet connected to a concussion and brain injury. They may notice that they cannot stand on one leg and kick a ball as easily, or that they fall more in gymnastics or skateboarding. Advanced motor skills such as climbing stairs or hiking may seem more difficult. These are frequently missed as symptoms of a previous concussion. Students can complain of difficulties remembering school lectures and assignments. Individuals may notice moments of confusion that are unusual, like not knowing when or where their next class is scheduled. Fatigue and difficulty sleeping, or sleeping too much, also are subtle symptoms that are often contributed to other causes. Post-traumatic stress can be another puzzling and underreported pathology. The athlete may appear easily frightened, anxious and withdrawn. Depression and anxiety can be attributed to the injury, particularly if they are new to the person. Migraines, as well as neck and back pain, can appear and may be indicative of serious, possibly advancing conditions. Linking them to the incident can help in the diagnosis and treatment of these cases. Why the eyes • 70% of our brain is dedicated to vision in some fashion. • 80% of all sensory goes through the eyes. • 90% of individuals that have a concussion will demonstrate one or more ocular difficulties. If not • • addressed, it can result in delayed recovery. DR. DEANN FITZGERALD A comprehensive approach to concussions

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