There is insufficient discourse surrounding adequate concussion treatment, with minimal attention relegated to football enthusiasts. The prevalence of these occurrences remains underestimated, frequently eluding diagnosis, thereby underscoring the pervasiveness of Persistent Concussive Syndrome. This syndrome, characterized by protracted recovery periods extending over years, underscores the imperative for heightened awareness and understanding beyond the realm of sports discussions.
Background for Deficit in Concussion Awareness, Symptoms, and Treatment
A concussion is categorized as a mild brain injury despite lasting consequences. This classification has often resulted in neglect of requisite therapy and treatment. Research demonstrates how a concussion results in a temporary change of brain functions via an influx of metabolites, neurochemicals, and blood flow. Common causes of concussion are falls, motor vehicle collisions, unintentional head trauma, assaults, and most often from contact sports.
Between 1.7 and 3 million sports- and recreation-related concussions happen each year, half of which are unreported or undetected. These alarming numbers are rooted in a lack of sideline protocol, proper screening, and trained professionals on the field who can recognize, assess, and respond to the signs of a concussion. This deficit in comprehension and readiness was visibly exemplified in a severe incident during the U.S. National Football League 2022-2023 season involving the Miami Dolphins' quarterback, Tua Tagovailoa, who suffered two consecutive concussions resulting in a contracture on the field. This incident ultimately compelled the largest sports organization established to institute a comprehensive, contemporary, evidence-based concussion protocol for the effective management of athletes' health and the prevention of recurrence. The NFL released a statement in February 2023 acknowledging that regular-season concussions increased by 18% in 2022. Recognition by this institution of the gravity and prevalence of concussions indicates the necessity for implementing comprehensive enhanced concussion management, diagnostic assessments, and treatment protocols across organizations and health facilities.
The aforementioned statistics do not include concussive injuries that occur in schools, professional environments, or households. The prevailing lack of understanding regarding concussions and appropriate treatment modalities contributes to the problematic presumption that rest alone will resolve the injury. Furthermore, a common misconception is that a complete loss of consciousness ("blackout") is required to necessitate classification as a concussion. However, biologically proven signs and symptoms of a concussion include persistent headache, cognitive fogginess, visual impairments, and fatigue. Notably, individuals experiencing a "blackout," discernible balance and coordination deficits, or recurrent sensory disturbances ("zingers") should promptly seek medical attention, as these manifestations suggest a more severe form of concussion, constituting a traumatic brain injury.
Morbidity Risk and Significance of Proposed Treatment Enhancement
As a Doctor of Physical Therapy, my research and current endeavor centers on formulating evidence-based educational content and a comprehensive concussion protocol for adoption by educational institutions, sports clubs, professional leagues, and other organizations across the United States. The overarching objective is to disseminate awareness regarding concussions within the broader populace, encouraging proactive health management among young athletes and fostering an advocacy stance among individuals in their pursuit of treatment options.
Further impetus to expand research and treatment efforts in the domain of concussions stems from the recognition of concussions as a significant risk factor for various morbidities. Empirical studies have elucidated that a spectrum of post-traumatic morbidities may develop following the initial brain insult. These ramifications include diminished cognitive function, dementia, chronic traumatic encephalopathy (commonly referred to as CTE), Parkinson's disease, epilepsy, as well as psychiatric and metabolic dysfunctions. Particularly noteworthy is the observation of a markedly elevated risk of stroke in individuals who have experienced concussions, which are an independent risk factor for both ischemic and hemorrhagic events. Consequently, research studies advocate the implementation of preventative and monitoring strategies for stroke in individuals with a history of concussions. Head trauma ranks as the second most common coexisting diagnosis with ischemic stroke in the pediatric population.
In my capacity as a licensed physical therapist with specialized training and experience in both research and clinical practice, particularly in the rehabilitation of individuals experiencing functional deficits following a stroke, I possess a profound understanding of the extent of damage and impairments caused by a cerebral injury. Pediatric stroke affects survivors with lifelong disabilities in motor, cognitive, and behavioral function. Presently, there are no specific treatments for stroke. Therefore, prevention is exceedingly important. In the course of a comprehensive three-year research endeavor, my collaborators and I conducted a study involving randomized controlled trials. The study sought to juxtapose the reflex responses of two distinct cohorts: one comprising individuals post-stroke and another consisting of those with the absence of stroke history. This investigation aimed to establish a direct comparison, discerning the consequential significance of functional and mobility losses attributed to the cerebral damage induced by strokes. While medical professionals exert diligent efforts to incorporate the latest research findings and maximize the restoration of mobility and independence in individuals post-stroke, a critical imperative lies in the exhaustive consideration of preventive measures such as concussion awareness.
A notable concern regarding concussion pertains to the prevailing recommendation suggesting medical attention only after symptoms persist for a duration of 10-14 days. This presents a potential impediment to timely access to care and education regarding proper recovery protocol, including limiting phone use initially, resting in the first few days, and carefully reintroducing into regular activities. These crucial pieces of information are imperative for individuals promptly following a concussion, as they play a pivotal role in mitigating the risk of persistent concussive syndrome. Current recommendations to the general public online offer concise guidance centered around rest and a gradual return to activity. However, these guidelines lack comprehensive detail, failing to provide specific instructions on the optimal duration of rest, recommended activities, the pace and extent of reintegration into normal activities, and instrumental strategies for individuals to effectively modulate and gauge their progress or regression in the recovery process. The NCAA protocol encourages athletes to report their injuries but does not require professional coaches and trainers to be trained and certified in observing and recognizing signs and symptoms of a concussion.
While the NFL has begun to address the need for a concussion protocol across the league, lower-level athletes, including middle school, high school, and even collegiate athletes, do not have the same established concussion protocol. Schools, sports clubs, and first responding organizations do not have a concussion protocol in place, despite the fact that concussions are common within such organizations and their activities. It is critical to emphasize that brain injuries and concussions are no less worrisome in middle schools and high schools than those that happen in national athletic organizations like the NFL or NHL.
Two-Prong Approach for Nationwide Concussion Rehabilitation Protocol
Within the ambit of my research and physical therapy enterprise, two pivotal initiatives comprise my vision: the refinement of an enhanced concussion management protocol and the emergence as a leading provider in concussion and pediatric stroke rehabilitation. In my primary initiative, I address the deficiency in accurate information pertaining to concussions and concussion education. This involves the development of an easy-to-follow online course tailored for educators, trainers, coaches, and supervisors. Complimentary resources will be disseminated through our website, including school speaking engagements, webinars, and seminars, with the overarching aim of enhancing concussion awareness and education within these target constituencies.
The concussion protocol includes concrete education on signs and symptoms, typical recovery patterns, strategies for on-field response, evidence-based assessments, proper treatment options, referrals, and general rehabilitation roadmaps. It will be available to organizations across the United States after proper consultation from my company, which will develop and tailor protocols based on the nature of the client for optimal execution. My overarching vision entails the formulation of a rigorously evidence-based concussion protocol, adaptable for implementation by diverse entities, including schools, sports clubs, first-responding organizations, and K-12 educational institutions. Concurrently, my mission is to disseminate this knowledge to the broader public, fostering an expanded understanding of the nuances and implications associated with this injury, simplified protocols that support children during recovery, and appropriate timelines to seek medical attention.
The secondary objective aims to establish my company as the preeminent entity specializing in the rehabilitation of concussions and pediatric strokes. With 30% of all concussion cases manifesting into Persistent Concussive Syndrome (PCS), time-sensitive concussion treatment and recovery are essential. PCS may persist for a protracted period of 1-2 years with chronic head discomfort, balance and coordination deficits, visual impairments, and neck pain. This prolonged period is associated with heightened susceptibility to additional concussions, increased risk of physical injuries, diminished work or performance output, elevated absenteeism, escalated overall treatment costs, and a substantial compromise to one's overall quality of life.
Given the considerable import of these factors, my mission is centered on delivering contemporary, evidence-based, and superior-quality concussion recovery services. These services are administered under the guidance of proficient physical therapists who acknowledge the imperative of facilitating a return to pre-injury levels of function. Furthermore, in the context of pediatric patients recovering from strokes, our aim is to establish ourselves as a dependable provider capable of accommodating their needs expeditiously and alleviating the challenges associated with extended waiting lists. This is particularly pertinent as stroke rehabilitation is time-sensitive, with a substantial proportion of recovery efforts concentrated within the initial six months post-stroke.
Conclusion
Spreading educational values and fostering an in-depth understanding of concussions, brain injuries, and effective rehabilitation treatments for concussions and strokes are critical tasks for instituting quality healthcare to millions of citizens. This imperative arises from the necessity to attenuate the escalating prevalence of brain injuries, preempt potential long-term functional ramifications, enhance the overall health and well-being of the populace, and contribute to the alleviation of burdens on the healthcare system.
The Bureau of Labor Statistics underscores a projected 15% growth in the employment of physical therapists from 2022 to 2032—a rate notably surpassing the average for all occupations. The exigency for specialized physical therapists who possess sufficient education, profound expertise, a visionary perspective on the potential achievements in enhancing the well-being of the U.S. population, and a demonstrated history of engagement in high-quality neurological research pertaining to brain injuries is abundantly clear.
