The last 10 years have produced more advancements in concussion care than the previous 100. Advancements in imaging technology, public awareness, and breakthroughs in treatment have all led to a new standard of care. However, this emerging field still has a lot of room to grow. This article will examine the potential growth opportunities and highlight some gaps that need to be filled to ensure that 20% of those with lingering symptoms promptly get the help they need.
Understanding concussions: a foundation for future care
Concussions, often referred to as mild traumatic brain injuries, come with a laundry list of potential complications. Dizziness, brain fog, fatigue, headaches, cognitive challenges, and eye-tracking issues are just a few. While traditionally seen as a sports-related injury, concussions can stem from various activities and accidents, making their diagnosis and management critical to long-term brain health. Despite their prevalence, millions of concussions go undiagnosed each year. This gap in diagnosis is one of the essential areas that needs to be filled to improve the standard of care for concussions.
The evolution of concussion care and diagnosis
Over the years, advancements in neuroimaging, neuropsychological testing, and clinical guidelines have enhanced our understanding and approach to concussion care. Accepting diagnosis is essential and is a big step forward from 30 years ago. For example, it’s common to hear men in their 50s say something to the extent of “I might have had a few concussions playing football. I never got knocked out, but I saw some stars before they put me back in the game.”
These stories highlight the history of negligence, once a standard practice in nearly all sports. The idea that you never had a concussion because you were never knocked unconscious is an insidious false belief that has long prevented us from acknowledging concussion as the hazardous condition it’s now known to be. Below are some advances that allow us to diagnose concussions with a higher degree of speed and accuracy.
Key innovations shaping the future of concussion care
Here is a list of crucial concussion innovations that have made a significant impact on the diagnosis, management, and understanding of concussions over the last 30 years:
1. Advanced imaging techniques
The introduction of advanced neuroimaging technologies such as magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) has revolutionised the ability to visualise and assess structural brain changes associated with concussions, providing valuable insights for diagnosis and treatment planning.
2. Sports concussion assessment tool (SCAT)
The development of the SCAT, a standardised tool that combines symptom evaluation, cognitive assessment, balance assessment, and neurological examination, has become a cornerstone in evaluating and managing sports-related concussions, ensuring comprehensive and consistent care for athletes.
3. Concussion management guidelines
Establishing evidence-based concussion management guidelines by organisations such as the Concussion in Sport Group (CISG) and the Centers for Disease Control and Prevention (CDC) has standardised best practices for diagnosing, treating, and rehabilitating individuals with concussions, promoting safer and more effective concussion care.
4. Cognitive testing tools
Computerised cognitive testing tools like the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have been instrumental in assessing cognitive function, tracking recovery progress, and guiding return-to-play decisions in athletes and individuals with concussions.
5. Helmet technology
Innovations in helmet design and technology, including impact-absorbing materials, rotational force mitigation systems, and sensor technology, have helped improve helmets’ protective capabilities in reducing the risk of head injuries and concussions in high-risk activities such as sports and motorcycling.
6. Virtual reality rehabilitation
Integrating virtual reality (VR) technology in concussion rehabilitation programmes has provided immersive and personalised environments for balance training, visual-motor coordination exercises, and cognitive rehabilitation, enhancing recovery outcomes and promoting neuroplasticity.
7. Blood-based biomarkers
Research into blood-based biomarkers for concussions has shown promise in identifying specific protein levels associated with brain injury, offering potential diagnostic and prognostic insights that could revolutionise concussion diagnosis and monitoring in the future.
8. Neurocognitive rehabilitation programmes
The development of specialised neurocognitive rehabilitation programmes tailored to individuals with concussions has focused on addressing cognitive deficits, emotional well-being, and functional recovery through personalised interventions, cognitive-behavioral therapy, and adaptive strategies.
9. Concussion education and awareness campaigns
Increased awareness and education initiatives on concussions, their signs and symptoms, and the importance of timely reporting and proper management have led to a shift in attitudes towards brain injuries, fostering a culture of safety, prevention, and early intervention.
10. Telemedicine and remote monitoring
Integrating telemedicine platforms and remote monitoring systems for concussion evaluations, follow-up care, and rehabilitation support has improved access to healthcare services, enhanced communication between patients and providers, and facilitated continuity of care for individuals with concussions, especially in remote or underserved areas.
These concussion innovations over the past three decades have significantly advanced our understanding of concussions, transformed clinical practices, and paved the way for a future where concussion care is more personalised, evidence-based, and patient-centered. By leveraging these innovations and continuing to invest in research, technology, and collaborative efforts, we can further improve outcomes for individuals affected by concussions and promote brain health and resilience for future generations.
Areas of future improvement
1. Education and awareness
Increasing education and awareness efforts among athletes, coaches, parents, healthcare providers, and the general public about concussions, their signs and symptoms, the importance of early detection, and the potential long-term consequences can help promote a culture of safety and proactive concussion management.
2. Advanced imaging
Improving the accessibility and efficacy of imaging modalities is a crucial area of improvement over the next decade. Currently, the imaging modalities only detect significant damage that needs immediate intervention. Moving towards more sensitive imaging that can detect small changes in function will help promptly direct people to the appropriate care. Making modalities like functional MRI and diffuse tensor imaging (DTI) more accessible will assist direct care and diagnosis.
3. Baseline testing
Implementing widespread baseline testing programmes for athletes and individuals at risk of concussions. It can provide valuable pre-injury data for comparison in post-injury assessments, aiding in the accurate evaluation of cognitive function, balance, and symptoms during recovery.
4. Multidisciplinary approach
Adopting a multidisciplinary approach to concussion management that involves collaboration among healthcare providers should be a priority. Neuropsychologists, physical therapists, athletic trainers, and other specialists can ensure comprehensive care, tailored treatment plans, and holistic support for individuals with concussions.
5. Individualised treatment plans
Customising treatment plans based on the specific needs, symptoms, and recovery trajectory of each individual with a concussion can optimise rehabilitation outcomes, address cognitive deficits, and promote a gradual return to daily activities and sports participation.
6. Long-term monitoring and follow-up
Establishing structured protocols for long-term monitoring, follow-up evaluations, and post-concussion care can help track recovery progress. It can also identify persistent symptoms or complications and provide ongoing support for individuals with prolonged or complex concussion outcomes.
7. Mental health support
Integrating mental health services, counselling, and psychosocial support into concussion management programs can address emotional distress, anxiety, depression, and other psychological challenges that may accompany concussions, promoting holistic recovery and well-being.
8. Research and innovation
Investing in research initiatives to enhance our understanding of concussions can open up a whole new level of care. We can explore new treatment modalities, validate biomarkers for diagnosis, and develop innovative technologies for rehabilitation to shape future best practices.
9. Post-concussion rehabilitation programmes
Offering specialised post-concussion rehabilitation programmes that focus on cognitive rehabilitation, vestibular therapy, visual training, and gradual return-to-play protocols can address a variety of concussion complications. These include lingering symptoms, improving functional outcomes, and reducing the risk of re-injury or long-term complications.
10. Policy implementation and advocacy
Advocating for policies that prioritise concussion safety in sports, schools, workplaces, and recreational activities is crucial. Promoting standardised concussion protocols, and ensuring access to quality care for all individuals with concussions are also essential steps in advancing concussion management on a societal level.
Takeaway
Concussion care has come a long way, but work still needs to be done. We need to ensure that awareness grows, diagnostic technology advances and treatment becomes more integrated. These improvements will ensure that the millions of undiagnosed concussions begin to shrink and the 20% of concussions that don’t heal on their own have access to the best treatments.
Julian Carter, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.
