Concussion

At Memorial Hermann, our goal is to provide convenient, high-quality concussion therapy to Houston residents through our suite of physical and occupational therapy services. This also includes initial testing following a concussion and fast, accurate assessments of head injuries using physical and cognitive examinations. 

Led by Summer Ott, PsyD as the director of the Memorial Hermann | Rockets Sports Medicine Institute Concussion Program, our goal is to provide convenient, high-quality concussion therapy to Houston residents through our suite of physical and occupational therapy services. This also includes initial testing following a concussion and fast, accurate assessments of head injuries using physical and cognitive examinations.

All athletes regardless of age, sport or ability require immediate care after a concussion. Patients treated through our concussion therapy program have experienced success by following its stepwise progression to return to physical activity under the careful supervision of a concussion-trained specialist.

What is a Concussion?

Concussions – injuries to the brain caused by a bump, blow, or jolt to the head or body that can cause the brain to abruptly move or twist within the skull – are the most common type of traumatic brain injury and can change the way your brain normally works. A concussion can also potentially cause serious long-term neurological damage, particularly for athletes participating in high-impact contact sports that involve repeated blows to the head.

The incidence of head injuries including concussion for which patients seek care in emergency departments in the United States doubled between 2001 and 2010. The largest increase during this period was in the birth-to-4 age group, where the incidence was 2,200 patients per 100,000 people.

Concussion FAQs

Any blow to the head is sufficient to cause a concussion. Any fall or trivial bump to the head, if accompanied by symptoms, may indicate a concussion. The impairment may be so mild as to be disregarded by the patient, a parent or other observers.

Signs and symptoms can be apparent soon after a head injury, although it may not be possible to know how serious the injury is for many hours or even days. Because of the potential for symptoms to appear more slowly, it is important to continue to check over time for signs of concussion, even more than a day after an injury. Anyone who has suffered a head injury and has worsening symptoms should be taken to an emergency room, and persistent subtle complaints or symptoms should be referred for medical evaluation.

Awareness of the signs and symptoms of concussion can help get the most effective treatment, and allow athletes or anyone who has suffered a blow to the head to return to activity in a healthy way.

Symptoms may include changes in behavior or eating habits, headache, nausea (with or without vomiting), avoidance of bright light, irritability, weakness in the arms or legs, and, most of all, a general observation that the subject is not behaving in their typical manner.

Observable Signs of a Concussion

• Appears to be dazed or stunned
• Forgets instruction
• If playing a game or sport, is unsure of score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even briefly)
• Cannot recall events PRIOR to hit or fall (retrograde amnesia)
• Cannot recall event AFTER hit or fall (anterograde amnesia)

Symptoms Reported by Subject

• Headache or pressure in head
• Nausea or vomiting
• Dizziness or balance problems
• Double or blurred vision
• Sensitivity to light
• Sensitivity to noise
• Feeling sluggish, hazy, foggy, groggy or slowed down
• Concentration or memory problems
• Confusion
• Generally does "not feel right" or is "feeling down"

Keep in mind that, while some symptoms present themselves soon after a head injury, others may take longer to appear. It is important to continue to monitor athletes for at least a few days after an injury to check for signs of a concussion.

The Centers for Disease Control and Prevention (CDC) recommends that coaches and parents understand and implement the HEADS UP action plan if there is even the slightest suspicion that an athlete may have sustained a concussion.

A concussion-trained physician who is properly trained to diagnose concussions will look at the patient’s medical history and ask them to describe any symptoms they may be experiencing in as much detail as possible. This discussion, combined with basic vision, cognitive and vestibular (balance) assessments, will generally give the specialist a good idea of whether or not a concussion is present.

Concussions typically manifest as functional limitations, meaning standard diagnostic imaging cannot be used to confirm a concussion diagnosis. However, in some cases an MRI or CT scan may help rule out more severe brain injuries or cerebral swelling.

According to CDC recommendations, patients with concussion-like symptoms should see a specialist as soon as possible. Waiting to receive concussion treatment (or not seeking treatment at all) may lengthen recovery times and could potentially cause more severe health issues in the future. With this in mind, it is always a good idea to ask your primary care physician to refer you to a specialist for proper diagnosis and treatment.

Baseline and Post-Injury Neurocognitive Testing

Baseline testing is a pre-season exam conducted by neuropsychologists, neurologists, or other physicians and medical professionals such as athletic trainers specifically trained in concussion management. Baseline tests are used to assess an athlete's balance and brain functions (.i.e., learning and memory skills, ability to pay attention or concentrate, and how quickly he or she thinks and solves problems) prior to a concussion being sustained. The results from baseline tests can then be used and compared to similar post-injury tests in the event the athlete suffers a concussion.

Baseline testing ideally should take place prior to the first practice of the season. Most cognitive testing (both paper-pencil and computerized testing) is suggested for athletes 10 years of age and older. Additional neuropsychological tests are available to assess children under the age of 10.

ImPACT™ (Immediate Post‐Concussion Assessment Cognitive Test) is a web‐based, scientifically validated computerized concussion evaluation test used to test your cognitive ability.  It is NOT an IQ test. It is a test of verbal and visual memory, processing speed and reaction time. It tests aspects of cognitive functioning in athletes with attention span, working memory, sustained and selective attention time, response variability, non‐verbal problem solving and reaction time. ImPACT™ baseline testing takes approximately 30 minutes to administer and the Memorial Hermann | Rockets Sports Medicine Institute Concussion Program at Memorial Hermann offers this baseline test free of charge to all school-aged athletes.

Schedule a Post-Concussion ImPACT™ Test

When to Seek Medical Attention at an Emergency Room

If a concussion has occurred, be observant for the following signs. If any of the signs with an asterisk (*) are observed, seek medical attention at the nearest emergency room or call 9-1-1.

• Headache that increases in intensity*
• Nausea or vomiting*
• Difference in pupil size from left eye to right eye or dilated pupils*
• Blurred or double vision*
• Slurred speech*
• Noticeable changes in level of consciousness (difficulty awakening or sudden loss of consciousness)*
• Seizures*
• Decreased or irregular pulse or breathing*
• Dizziness
• Memory Loss
• Ringing in the ears
• Changes in gait or balance

Concussion Treatment Options

Most concussions require no intervention. For a simple concussion, follow-up with a primary care physician or pediatrician is usually sufficient. Careful observation and management of mild symptoms for a brief period is usually enough for recovery. This includes avoiding activities that might result in another head injury, and a few days away from the stress of school or work. Rest is very important after a concussion because it helps the brain to heal. This includes limiting or removing use of television, cell phones, texting, video games, etc.

If these measures are unsuccessful in alleviating mild complaints, or if symptoms worsen, reassessment by physicians who are experienced with head injury evaluation is necessary.

A more detailed evaluation often begins with a visit to an affiliated neurologist or concussion specialist, with further intervention as necessary by neuropsychologists, physical and occupational therapists, speech therapists and psychiatrists. This multidisciplinary specialty approach can help prevent a cycle of frustration and failure for the patient and parents affected by more complex concussive injuries.

Evaluation by a specialist might include a CT scan, MRI or one of a variety of other tests to exclude brain injury that might predict a longer course of recovery. The physician may prescribe a variety of appropriate short-term medications to alleviate the symptoms. Because, in rare circumstances, an apparently trivial head injury can result in major complications such as seizures, blood clot or stroke, establishing a clear understanding of the injury is important for the best outcomes.

At Memorial Hermann, concussion treatments are split between two separate departments depending on the patient’s needs:

Memorial Hermann | Rockets Sports Medicine Institute

Those with acute concussion symptoms sustained through sports or other physical activity will most likely be treated through the Memorial Hermann | Rockets Sports Medicine Institute. As the official health care and sports medicine provider for several professional sports teams and university athletic departments, the Rockets Sports Medicine Institute or the Institute and its affiliated physicians have experience helping athletes of all ages and ability levels recover and resume normal activities quickly and safely.

Learn More About Our Sports Concussion Program

TIRR Memorial Hermann

For more chronic concussion symptoms or traumatic brain injuries, patients may be referred to our TIRR Memorial Hermann program. TIRR staff can address a broad spectrum of concussions from multiple causes, such as falls or motor vehicle accidents, using a multidisciplinary approach that includes treatment for physical, cognitive, behavioral and emotional symptoms. Their concussion program consists of an interdisciplinary team of clinicians, such as physical and occupational therapists, speech-language pathologists, and neuropsychologists, with experience in the rehabilitation of patients with traumatic brain injuries.

Most people with a concussion recover quickly and fully; however, symptoms can last for days, weeks or longer. Research shows that high school athletes with less than 15 minutes of on-field symptoms experienced symptoms lasting up to one week post-injury. Symptoms have been known to last longer than one week.

Rest is very important after a concussion because it helps the brain to heal. This includes limiting or removing use of television, cell phones, texting, video games, etc.

Your physician may recommend additional neuropsychological testing, which many include a full battery of paper/pencil testing, vestibular testing, computerized cognitive testing, and more which can help identify problems with brain function.