In Sunday’s paper the New York Times included an article by Seth Berkman on the front page of its sports section entitled, "Women's Hockey Grows Bigger, Faster, and Dire". The Times laid out their take on the buzz worthy topic of concussions within the realm of women’s ice hockey, a sport that has been a statistical leader in concussion prevalence over the years despite having no body checking.
I spent several hours with Berkman in early September discussing this subject, not long after I launched my blog. Berkman had a keen interest in concussions and was determined to bring some of its most pressing issues into the limelight. I am grateful he used the Times’ platform to discuss this topic and feel fortunate he included my story to highlight the many complexities and struggles of concussion recovery.
He ended the article with a quote from me about concussion awareness that read, “You see left and right in doctors’ offices and wherever, your quick little synopsis of what a concussion is, what are symptoms. Everyone knows those; it’s textbook. But when you get beyond the typical couple of weeks’ recovery, it’s like, then what happens? That was the challenge I faced.”
“There wasn’t a clear-cut path for me or guidance as to what that next step should be. You can’t be running around like a chicken with its head cut off trying to get help. There’s a lot of room for improvement in terms of concussion awareness and what that actually means.”
I feel it is both appropriate and timely to take the opportunity to expand on this quote in an effort to redefine the phrase “concussion awareness”. This expression must begin to include meaningful information about concussion recovery that extends beyond the typical 7-10 day healing protocol.
With this in mind, I want to discuss tangible changes that can be made within the medical community to better evaluate and treat this injury. I think the easiest way to do this is to showcase Dr. Jeffrey Kutcher’s Sports Neurology Clinic as a model for what could and should be implemented to expedite concussion recovery.
As I alluded to in my post last week, the Sports Neurology Clinic incorporates a comprehensive team-based approach to concussion care. The program, founded by Dr. Kutcher with the sole aim of improving the neurological care of athletes, is based on the understanding that there are no one-size-fits-all prognoses for concussions.
The Centerpiece - Sports Neurology
The core of the program is sports neurology. Dr. Kutcher is a sports neurologist with a special focus on concussions and migraine headaches. He is one of the leading concussion experts in the United States and serves as the Director of the NBA’s concussion program as well as the Team Physician for the US Ski and Snowboarding team.
His extensive background allows him to effectively evaluate concussions and determine which combination of specialty doctors will best serve his patients. He spends several hours getting to know all the details of each patients’ concussion history and symptoms. From there, he refers his patients to one or more specialty doctors who then provide their own expertise and, thereby, help determine the major drivers of symptoms. They then collaborate and create a unique treatment plan for each patient moving forward.
The Sports Neurology Clinic doctors treat a variety of concussion symptoms attributed to many different causes, which I have broken down below:
Cerviogenic / Structural Damage
I have said this several times on this blog but I can’t say it enough – far too often the biomechanical and structural injuries (i.e. neck trauma) associated with concussions are overlooked. This happened to me time and time again throughout my quest to find help.
Thankfully, Dr. Kutcher recognizes the tremendous importance of addressing this element of concussions. In fact, one of the first things he told me during my visit was that individuals who suffer from migraines very often complain of neck pain as well. He has studied migraines and concussions enough to know that neck pathology can play a role in a patients’ symptomology.
This is why he will often refer patients to Dr. Miles Colwell, a Physical Medicine and Rehabilitation doctor. Dr. Colwell evaluates this piece of the puzzle, and with both a medical degree (MD) and degree in Osteopathic medicine (DO), he is more than qualified to do so.
As I mentioned in a previous post, structural damage outside of the brain can continue to perpetuate concussion-like symptoms long after the actual concussion has healed. This kind of damage keeps the nervous system in a hyperactive state and can contribute to a variety of physical and cognitive symptoms. In my case, my neck injury was the biggest driver of all of my pain and discomfort. This is why I feel it's so important patients suffering from Post-Concussion Syndrome find a qualified doctor who can evaluate any role their neck might be playing in their symptomology.
Vestibular (Balance and Coordination) Dysfunction
Structural damage in the neck isn't the only thing that can prolong recovery. Common concussion complaints include difficulties with balance, coordination, vertigo, dizziness, blurred vision and visual tracking issues. If a patient complains of one or all of these symptoms, Dr. Kutcher would likely issue a referral to the team’s Vestibular specialist.
The vestibular system includes the parts of the inner ear and brain that process sensory information involved with controlling balance and eye movements. A vestibular doctor would evaluate any abnormalities within this system and issue a variety of eye exercises to help return their brain to normal function.
Physical Complaints and Limitations
Concussion patients also often suffer from a variety of physical symptoms, most notably headaches. If headaches don’t resolve from other forms of treatment, Dr. Kutcher might refer his patient to a neurologist specializing in headaches to evaluate any unaddressed concerns. Other less common physical complaints might merit the opinion of a neurosurgeon to address inside the skull pathologies such as skull fractures, or a Movement Disorder Specialist for things like abnormal body tics or tremors.
As far as physical limitations go, it is very common for concussion patients to experience a significant increase in symptoms with physical activity. This has been the biggest trigger of my symptoms for the last two years. However, Dr. Kutcher advocates a proactive approach for concussion recovery, and he implements a progressive return to physical activity as a method of alleviating Post-Concussion Syndrome. The nervous system behaves differently when it is under stress (i.e. exercising), and Dr. Kutcher believes it is important to monitor this while undergoing a neurological evaluation. Athletic trainers play a major role in assisting with this part of the program.
Cognition – fogginess, memory issues, difficulty concentrating or focusing – is also frequently affected after a person suffers a blow to the head. Dr. Kutcher has neuropsychologists on staff to assess these types of brain functions. He has described the IMPACT test, which is the test to determine the “severity” of a concussion, as the tinker toy version of neuropsychology. He also works closely with a Cognitive Disorders Neurologist when dealing with more severe cases when any sort of dementing illness might be suspected.
If a patient is suffering from anxiety, depression or some form of mood disorder, the Sports Neurology Clinic has a variety of doctors who address these needs as well. Psychiatrists and psychologists are utilized to help patients with both pre-existing mood disorders and any psychological issues that stemmed as a result of the concussion.
Anyone who has suffered long-term concussion issues can attest to the toll this injury can take on their mental health, which makes access to these types of doctors particularly important.
The Sports Neurology Clinic is a one-stop shop to concussion care. It eliminates the need to search frantically for answers and run around seeing doctors with conflicting treatments and diagnoses. It removes the stress that comes from doctors selling you on their approach because these doctors all work together. They utilize their respective expertise, draw conclusions as a team and support their patients every step of the way throughout recovery.
There is really no better way to handle a complex, nuanced injury that is becoming a growing and pressing concern in our country. This comprehensive, team-based model should be the norm rather than the exception for concussion care. With continued growth and national recognition, a program like this will begin to redefine the meaning of both concussion awareness and recovery.