Treatment & Procedures

Houston Methodist’s team of neurologists, neuropsychologists, neurosurgeons, primary care sports medicine physicians and athletic trainers provides evaluations and innovative care for patients suffering from concussions. While you cannot see a concussion, certain signs and symptoms appear immediately after the injury or may evolve over the next day. An evaluation by a concussion specialist will determine the necessity for further testing, monitoring and an eventual progressive return to play protocol. 


Signs and Symptoms of a Concussion
Below are lists of signs and symptoms to watch for if you suspect an injury that may have resulted in a concussion. If your experience one or more symptoms listed below, you should seek medical attention immediately.

 

Observable Signs

  • Appears dazed or stunned
  • Confused about assignment or position
  • Forgets an instruction
  • Unsure of game, score or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (evenly briefly)
  • Shows mood, behavior and personality changes
  • Cannot recall events prior to hit or fall
  • Cannot recall events after hit or fall
  • Loses balance or is unsteady when walking

 

Symptoms Reported by Athlete

  • Headache or feeling pressure in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise (too bright or too noisy)
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Just not “feeling right” or is “feeling down”

 

Be alert for symptoms that worsen over time. If you experience more serious symptoms, such as those listed below, go to the emergency department right away.

 

More Serious Observable Signs

  • One pupil (the black part in the middle of the eye) is larger than the other
  • Drowsiness or cannot be awakened
  • Headache that gets worse and does not go away
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech

 

More Serious Symptoms Reported by Athletes

  • Convulsions or seizures
  • Difficulty recognizing people or places
  • Increasing confusion, restlessness or agitation
  • Unusual behavior
  • Loss of consciousness (even a brief loss of consciousness should be taken seriously)

 

Diagnosing Concussions
If any of the above symptoms are severe or worsening, you should contact your physician or visit an emergency room for an immediate evaluation. Your physician may recommend brain imaging to determine the severity of your injury. A computed tomography (CT) scan is sometimes performed after an injury. This is a series of X-rays that provides cross-sectional brain and skull images. Also, magnetic resonance imaging (MRI) can help diagnose potential complications, such as bleeding or swelling in your brain or skull.

 

ImPACT Baseline Testing
As the first and most scientifically validated computerized concussion evaluation system, ImPACT Baseline Testing is the gold standard of testing across the MLS, NFL, NHL and other professional and collegiate sports teams. Houston Methodist offers Immediate Post Concussion Assessment and Cognitive Testing (ImPACT) Baseline Testing to student athletes at their schools or in several of our concussion center locations. This web-based computerized test provides a cognitive ability baseline. It is a test for memory, attention and reaction time, and is not an IQ test. The baseline test provides a basis for comparison in the event that the athlete sustains an injury, requiring a post-injury test.

 

The ImPACT Baseline Test is administered by the use of a computer and typically takes 20 to 30 minutes to complete. The test is designed for the patients between the ages of 10 and 59 years, but other options are available for anyone outside that age range. We recommend that athletes take the test when entering the 7th grade and again when entering the 9th grade, as well as when you enter college (most colleges and universities require a baseline and do the testing on campus). The cost of the ImPACT baseline test conducted by Houston Methodist is $5 per athlete (junior high through college) and $25 for adults. All tests are confidential and stored on a secure server that only the school athletic trainers and Houston Methodist doctors and staff can access. You will not receive a copy; the test results will only be used in the event that you suffer a concussion.

 

Following a concussion, you would take a post-injury test and those results are compared with your initial test results. If you go to the emergency room (ER), be aware that ER physicians are not trained to interpret ImPACT data and will not administer a post-injury test. If you see your primary care doctor, they can request a copy from Houston Methodist by calling 713.441.8277. Anyone who has not had a baseline test performed can still make an appointment to take a post-injury test, which our concussion specialist would use to compare with the results of people within your age group and the same gender for a very general baseline. Of course, the best measurement is being able to compare the results with an original baseline test, so we recommend that you schedule an appointment for an ImPACT test.

To set up ImPACT Baseline Testing at your school or for an appointment at a Houston Methodist testing facility, please call 713.441.8277.

 

Locations for ImPACT Baseline Testing
Houston Methodist offers ImPACT Baseline Testing at the following four locations (see below for addresses and telephone numbers):

  • Houston Methodist Concussion Center
  • Houston Methodist Sugar Land Hospital
  • Houston Methodist St. John Hospital
  • Houston Methodist Willowbrook Hospital

 

Return to Play Protocol
A gradual, incremental approach to a patient’s return to play (RTP) is recommended following a concussion.  First, an athlete must be symptom-free, cognitively intact (i.e., memory or concentration is fully restored), exhibiting no school problems and maintaining good balance. The athlete must meet the following criteria in order to return to activity:

  • No concussion symptoms at rest and with exertion (including mental exertion in school)
  • No symptoms with light contact
  • Demonstrates normal scores on cognitive assessment (e.g., ImPACT test) as determined by the neuropsychologist

 

Only after meeting the criteria above can a return to play exercise protocol begin. Progression is individualized and will be determined on a case-by-case basis. We recommend slowly introducing the athlete to competitive athletics with exertional testing, then non-contact practice, contact practice and, finally, game play.  There should be approximately 24 hours between each step; the athlete cannot have any return of concussion symptoms following each step. If concussion symptoms return, the athlete must rest (no exercising) until all symptoms have again resolved. Then the RTP can be reinitiated.

Gradual Return to Play Protocol Stages and Objectives

Rehabilitation Stage

Functional Exercise at Each Stage of Rehabilitation

Stage Objective

No activity

Complete physical and cognitive rest

Recovery

Light aerobic exercise

Walking, swimming or stationary cycling keeping intensity, 50 percent to 70 percent maximal predicted heart rate (MPHR); no resistance training

Increase heart rate (HR)

Sport-specific exercise

Skating drills in ice hockey, running drills in soccer; no head impact activities 60 percent to 75 percent

Add movement

Non-contact training drills

Progression to more complex training drills, e.g., passing drills in football and ice hockey; may start progressive resistance training  80+ percent MPHR

Exercise, coordination and cognitive load

Full contact practice

Following medical clearance, participate in normal training activities

Restore confidence. Assess functional skills

Return to play

Normal game play

 

 


Returning to the Classroom
Reintegrating back into classes can be tricky, as brain dysfunction can linger. Teachers and school staff can help by being informed about a student who has suffered a concussion. Watch for signs of emotional responses, stress, fear of falling, depression, over-achieving, etc. Be prepared to support the student with a slow reintegration and work with the student, parents, athletic trainers, medical staff and health care providers to offer the necessary support to ensure a smooth reintegration process.

 

Schedule an Appointment
Our concussion specialists are prepared to work with you to assess your condition and recommend an individualized plan of treatment. Call 713.441.8277 to schedule an appointment.

TREATMENT LOCATIONS

Our physicians at Houston Methodist specialize in managing concussions at the following convenient locations.