Concussions

In order to ensure the best quality of care we can provide for you child, we ask that all concussion patients arrive 15 minutes prior to their appointment. Each visit you or your child will need to fill out some paperwork before we can begin the appointment.

Before your first appointment please print and fill out the Concussion New Patient Form, Graded Symptom Scale and Patient Health Questionnaire. 

For all follow up appointments please fill out ONLY the Graded Symptom Scale and Patient Health Questionnaire.

Concussion New Patient Form

Graded Symptom Scale and Patient Health Questionnaire for Children 12 and Under

Graded Symptom Scale and Patient Health Questionnaire for Children 13 and Over

If your child or teen displays any of the following symptoms, seek immediate medical care at an emergency department near you:

• Unconsciousness for any length of time
• Changes in alertness
• Convulsions or seizures
• Muscle weakness on one or both sides
• Persistent confusion
• Repeated vomiting
• Unequal pupils
• Unusual eye movements
• Walking problems

A concussion is a type of traumatic brain injury that can be caused by a direct blow to the head or body, or by a whip-lash type motion. Concussions result from the brain moving rapidly and hitting the inside of the skull causing damage to the brain cells and chemical changes within the brain. Concussions can affect sleep patterns, cognition, energy levels, eye function, balance and mood. To help the brain heal activities, both mental and physical, that aggravate or bring on symptoms should be mitigated and/or avoided.

There are many symptoms that can affect a student’s ability to learn. Modifications are suggested to specifically treat each individual student’s needs. A student will typically fall into one or more of the categories briefly described below:

Cognitive/Fatigue

• Decreased concentration, increased distractibility, difficulty learning and retaining new information, decreased multi-tasking, and marked fatigue by the end of the day.
• These symptoms will make it difficult for a student to keep up with school work and curriculum resulting in lower testing scores.

Post Traumatic Migraine

• Headaches, nausea, sensitivity to light and sound
• These symptoms may make it difficult for a student to sit in a noisy classroom, or look at a computer, tablet or projector.

Ocular Dysfunctions

• Movement of the eyes together is affected resulting in difficulty in bringing eye together to focus on and track an object. 
• This can affect a student’s ability to read and take notes.

Vestibular

• Impairments in balance centers of your brain affect the ability to interpret motion, coordinate head and eye movements, or stabilize vision upon head movement.
• The student is more likely to become car sick from bus rides or long car rides.

Anxiety/mood

• Difficulty with turning off worrisome thoughts, being particularly ruminative, thoughts of sadness, depression or change in mood.

Cervicogenic Headache

• Headache generated from injury to muscles of the neck. 

Concussion symptoms vary widely from one student to another. Even though they may look fine on the outside these symptoms affect functioning throughout the body. Decreased energy demands in the brain are required to make a full recovery, and often a full school day or work load will prolong the recovery and worsen symptoms. It is vital in the days and weeks following a concussion, as part of the treatment process, that modifications and sometimes adjustments to a student’s curriculum and work load are made if necessary.

Concussion management is a team approach which requires the combined efforts of the student, parents, teachers, healthcare providers and school administrators. The team approach aims to aide and improve the progression of recovery for the student in order to reduce the amount of class time and class work missed.

After cognitive rest, although concussion symptoms may go away, the brain may not be fully healed. The purpose of the return to play protocol is to increase your child’s physical activity level and heart rate to ensure concussion symptoms do not return and the brain is fully healed. Physical activity can increase the intra cranial pressure and make symptoms worse. Letting a concussed child return to physical activity before they are ready increases the risk for further or re-injury and prolonged concussion symptoms. The return to play protocol is designed to safely return a child to their normal activities on the playground, at home and in sports.

Visual Processing Systems

Central or Focal Visual Process

• Identification and detail

Peripheral or Ambient Visual Process

• Spatial awareness

Visual Disorders Following Concussion

Visual Acuity

• Static - ability to clearly see non-moving objects
• Dynamic - ability to focus on an object during head movement

Oculomotor – Eye Tracking

• Fixation
• Pursuits - smoothly follow moving targets/objects
• Saccades - quickly and accurately shift from one object to another

Binocularity – Eye Teaming

• Convergence - the movement of both eye inward to focus on and object
• Divergence - the movement of both eye outward to focus on and object

Accommodation – Eye Focusing

• Insufficiency - reduced level of focus stamina required for accurate near binocular vision
• Infacility – inability to change the accommodation of the eye with enough speed and accuracy to achieve normal function

Photosensitivity – sensitivity to light

Visual Spatial Dysfunction – difficulty organizing visual information into meaningful patterns and understanding how they might change as they rotate and move through space

Visual-Vestibular Integration Problem - neural combination of visual signals and vestibular signals regarding head movement

Visual Information Processing Problem - hindered ability to make sense of information taken through the eyes

Concussions are a traumatic brain injury which causes a significant disturbance in brain function. Proper treatment after a concussion is vital in the immediate days and weeks following the injury, and a crucial part of that treatment is adjustments to the students curriculum and work load. Decreased energy demands in the brain are requires to make a full recovery, and often a full school day/ work load will prolong the recovery and worsen symptoms. The recommendations for school attendance will be decided by the physician after each appointment based the student’s tolerance for cognitive activity.

Recommendations for School Attendance:

1. No School. The first 24-48 hours are often needed to let the brain rest. This is best achieved by “turning off” the brain.
2. Gradual return to school once able to tolerate 30-45 minutes if light brain activity (easy homework, light reading, etc.) at home. Students may return to school with scheduled 10-15 minute breaks in a quiet area.
3. Increase continuous hours of school until no breaks are needed. Modify homework (prorate work load extend due dates) and gradually add class participation. Allow the student to take breaks if needed in a quiet place ( i.e. nurses office)
4. Full day school attendance. Gradual removal of accommodations. May take 1 test per day and begin make up work.
5. Full day of school attendance with no accommodations

Why do we need a Return to Play Protocol?

After cognitive rest although concussion symptoms may go away the brain may not be fully healed. The purpose of the return to play protocol is to increase your child’s physical activity level and heart rate to ensure concussion symptoms do not return and the brain is fully healed. Physical activity can increase the intra cranial pressure, decrease glucose availability for the brain, or cause the brain to move violently in the skull, any of these can make symptoms worse when the brain is still healing. Letting a concussed child return to physical activity before they are ready increases the risk for further or re-injury which can result in prolonged concussion symptoms.

All physical activity should be stopped at the time of a concussion until instructed by a physician. Once the brain is able to handle full day of school without breaks and complete all daily assignments and homework, along with physician approval, then a return to play protocol can be implemented. The return to play protocols are designed to safely return a child to their normal activities on the playground, at home and in sports. Return to play guidelines are specific to an individual’s regular activities or sport. These guidelines should be performed under the direct supervision of a healthcare professional, such as your school athletic trainer.

As a general pediatrician managing concussions, Dr. McNulty may refer patients to specialists if their concussion symptoms are not resolving significantly within 2-3 weeks after their initial visit. Providing a comprehensive approach to concussion care creates the best possible treatment. There are several doctors and specialists we work with to provide care for specific deficits associated with concussions.

Neurology

• CHOC Concussion Clinic: 888-770-2462

Vestibular (Balance) Physical Therapy

• Dr. Nirav Patel and team @ Complete Balance Solutions: 949-340-6927
• CHOC PT: 888-770-2462

Neuro-Optometrist

• Dr. Eric Ikeda: 562-925-6591
• Dr. Vincent Cano: 949-799-3663

Neuropsychology

• Dr. Patricia Gisbert: 714-558-0303
• Dr. Johnathan Romaine @ CHOC: 888-770-2462

Psychology

• Dr. Casey Cooper: 949-306-3603
• Dr. Patricia Gisbert: 714-558-0303
• Dr. Chris Min @ CHOC: 888-770-2462

Physical Therapy

• ACIC Physical Therapy: 949-754-1344

Return to Play 

• Chris Phillips, ATC, CSCS @ Compete Sports Performance and Rehab: 949-690-1277

Speech/Language Therapy

• CHOC Speech Department: 888-770-2462

A Study for Concussion Detection and Monitoring with Ultrasound

Can Transcranial Doppler ultrasound be used to evaluate concussions?

Neural Analytics is creating products and services to measure, diagnose, and track brain health. We apply leading edge data science with established medical technology in eff­ort to improve the ability for first responders and clinicians to accurately assess traumatic brain injury.

Our devices will be portable, reliable, and produce precise and objective physiological measurements.

Neural Analytics is studying ways to improve concussion management.

Many concussion evaluations are based on self-reported symptoms and subjective tests. These may be inaccurate because patients may not fully report their symptoms, admit they feel injured, or have unrecognized injuries.

A reliable, objective concussion evaluation is needed.

Our study combines advanced data science with transcranial Doppler (TCD) ultrasound. This safe, non-invasive method is used to detect physiological changes that occur after a concussion. This technology would enable quick and accurate concussion detection and monitoring. It would allow doctors and medical professionals to improve their concussion care.

Become a part of this life-changing research.

Speak to your physician, athletic trainer, or contact our research coordinator at:

(877) 638-7251

info@neuralanalytics.com

Study Details

A safe, FDA approved TCD ultrasound headset will be fitted on your head, with one probe positioned at each temple. This will allow brain blood flow measurements to be collected. Next, you will perform simple breathing challenges to stimulate changes in blood flow. TCD measurements of these changes will be used to assess concussion.

Each study visit will be about 30 minutes. Several study visits may be requested to understand the recovery process. This will depend on your availability and symptoms.

The study can take place at several convenient locations:

Doctor’s office, School, Home, Our Mobile Research Unit

Eligibility

• Ages 9 to 85 years old

• Diagnosed with concussion

• Some health conditions may be excluded

Healthy individuals may also participate for control measurements

Side Effects

There are no known side effects associated with this study.

Compensation

Participants will be compensated up to $50 per measurement.

For more information about concussions, visit our website at www.neuralanalytics.com