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Ebook Sports-Related concussion diagnosis and management (2/E): Part 2

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Part 2 book “Sports-Related concussion diagnosis and management” has contents: Neuroimaging in concussion, return to activity following concussion, promising advances in concussion diagnosis and treatment, the advent of subconcussion and chronic traumatic encephalopathy, and other contents. | CHAPTER 6 Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needs With Elizabeth M. Pieroth, Psy.D. Introduction The complex pathophysiology of injury and recovery of the nervous system emulates the diverse presentation, symptomatology, and challenges to diagnosis of concussion. As science continues to unfold the nature of the critical window period of recovery following injury, it is imperative that accurate tools to evaluate the injured athlete during this period are developed and researched. Only through proper assessment, including monitoring of the patient’s subjective symptoms and use of validated objective measures, can clinicians attempt to determine when the brain is recovered from injury without concerns of exacerbating symptoms or perpetuating longterm harm. Similarly to the multimodal nature in the acute assessment of concussion diagnosis (symptom checklists, neurocognitive assessment, balance/­coordination/ocular testing), observation and quantification of recovery employs a similar approach.1 This multimodal approach is comprised of continual clinical history and exams, neurocognitive testing (in the form of sideline assessment tools), symptom checklists (as discussed in Chapter 3), psychiatric evaluation (as discussed in Chapter 5), and most importantly, neuropsychological testing and other complimentary modalities like oculomotor, vestibular, gait/ balance, and electrophysiological evaluations.2 A survey, completed by 610 NCAA athletic trainers in 2014, stated that a total of 71.2%, 79.2%, and 66.9% athletic trainers employed at least three techniques to: obtain an athletes’ baseline neurological status, acutely assess postconcussion, and to determine appropriate return to play.3 The likelihood of receiving multimodal techniques for assessment is highly influenced by the available resources at that institution. Therefore, these techniques may differ versus those used at a high school setting a Division I .