After an acute concussion, an individual should be evaluated by an appropriately trained medical professional. Although rare after a concussion, any life-threatening complications (such as a hemorrhage) should be ruled-out. If the patient is experiencing worsening of symptoms, repetitive vomiting or any evidence of seizure activity or had loss of consciousness more than 30 seconds, they should be examined in an emergency room.
An evaluation by a healthcare provider with expertise in concussion is the best next step. The concussion specialist will complete a thorough assessment of the injury and resulting symptoms and provide education on concussion, recommendations to aid the recovery process, and individualized work or school accommodations. The concussion specialist will closely monitor the patient’s recovery from their concussion.
Most patients recover without additional intervention within days or weeks of their injury. These individuals can safely return to their pre-injury activities under the supervision of their healthcare providers. For athletes, this may include the assistance of an athletic trainer or physical therapist to monitor their return-to-play exercise progression.
Unfortunately, some patients will have persistent symptoms that warrant further evaluation and treatment. There can be a number of underlying conditions that contribute to these symptoms. The concussion specialist is best trained to determine what additional treatments are most appropriate.
This may include:
- A referral to physical therapy for treatment of the cervical spine (neck) or jaw.
- PM&R physicians provide comprehensive assessment of the cervical spine and other orthopedic injuries after a fall or other trauma to the head.
- Specially trained physical therapist also complete vestibular rehabilitation for complaints of dizziness, imbalance and visual symptoms.
- Other patients may require specialized optometry/ophthalmology evaluations due to concussion-related visual disturbance.
- Many patients have cognitive complaints after a concussion and will be referred to a neuropsychologist for an assessment of their cognitive and emotional functioning.
- A referral to a psychologist and/or psychiatrist is often helpful to address pre-existing or post-injury symptoms of depression or anxiety.
- A neurologist may be recommended for consideration of medications for persistent headaches.
- Sleep specialists may assess an individual with persistent post-concussive sleep disturbance