Concussion clinic improves care through integration of specialties

Tyler Duffield, Ph.D., Ryan Rockwood, ATC-R, ITAT, and James Chesnutt, M.D.

A concussion is a mild traumatic brain injury, with transient brain impairment that naturally resolves, but can have prolonged symptoms for some individuals. The Concussion Treatment Clinic within our sports medicine department is constantly assessing how to best diagnose, treat and help people recover from concussions.

Our aim is to treat the whole person by approaching the problem from multiple angles with early and action-oriented intervention, but with enough flexibility to help individuals at any point during recovery.

We’ve found that integrating concussion providers from multiple specialties helps us gain a more comprehensive picture of the patient.

Our athletic trainer (ATC) jointly sees patients alongside our physicians.

The ATC contributes expertise in sideline concussion management, providing reliable information to the provider so they can maximize their time with patients. The ATC also interfaces with schools and coaches regarding concussion status.

The neuropsychology fellow, who has expertise in cognitive and mental health, provides additional information for providers to facilitate decisions about return to play and recommendations regarding accommodations at school.

We also collaborate with physical therapists, speech and language pathologists, and occupational therapists (all housed at the OHSU Center for Health & Healing) when necessary for any given patient.

The clinic’s goals are to return individuals to normal daily activities as soon as possible, which we know prevents prolonged concussion symptoms, as well as  provide treatment for individuals who are experiencing prolonged concussion symptoms.

Entire clinic days are now dedicated specifically to concussion assessment and treatment clinics.

We have also created an acute and prolonged symptom treatment clinic. The acute clinic provides:

  • Physiologic recovery testing (e.g., a treadmill test)
  • Early exercise regimen
  • Sensory/motor interventions from the ATC
  • Early education, including expectation management
  • Brief cognitive/emotional screeners
  • Sleep intervention
  • Plans for incremental resumption of normal daily activities by the neuropsychology fellow

The sports medicine physicians then make medical clearance decisions incorporating information provided by the ATC and neuropsychology fellow.

The treatment clinic for prolonged symptoms uses generally the same protocol, but we typically see people who would have benefited from the prevention work in the acute treatment clinic, but never had the opportunity.

Many of these individuals have experienced prolonged sleep dysregulation, activity withdrawal (physical, recreational, social), mood changes, or a combination of all three.

When we can normalize sleep patterns and return activity levels back to pre-injury levels, prolonged symptoms reliably decrease and often resolve.

OHSU provides full-service care for concussion management. Learn more.

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Tyler_Duffield

 

Tyler Duffield, Ph.D. is a Psychologist Resident and Pediatric Neuropsychology Fellow with the OHSU Sports Medicine Program who specializes in concussion. 

 

 

Ryan Rockwood photo

 

Ryan Rockwood, ATC-R, ITAT is a Certified Athletic Trainer in the OHSU Sports Medicine Clinic.

 

 

 

Jim Chesnutt photo

 

James Chesnutt, M.D. is an Associate Professor of Orthopaedics and Rehabilitation and Medical Director of the OHSU Sports Medicine Program.

 

 

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