When to go to a concussion clinic
The 4 characteristics of a good concussion clinic
Examples of top concussion clinics
When to go to a concussion clinic
It is advisable to go to a concussion clinic if you are experiencing persistent concussion symptoms, which is defined as symptoms lasting past the expected time frame for recovery: 10 to 14 days for adults, and four weeks for children. (There is not yet a consensus on the expected time frame for adolescents.)
An initial medical assessment after a concussion can be with a single provider, but for persistent symptoms, it is important to get a multidisciplinary assessment, which is ideally done at a concussion clinic. (The above information is from the 5th International Consensus on Concussion in Sport.)
The 4 Characteristics of a good concussion clinic
To assess a concussion clinic, ask the clinic the four questions below. The guideline below is from a document created by the Canadian Concussion Collaborative and based on the 5th International Consensus on Concussion in Sport.
ONE: Does the clinic have a medical doctor?
“The treatment of patients with persistent concussion symptoms may involve many health care professionals, but a physician should ideally do the initial assessment of patients and should direct patient care and provide final medical clearance return to sport, school, and work-related activities. Clinics offering concussion care should have timely access to physicians with training and experience in concussion. These physicians should be identified by name.”
TWO: Does the clinic have a team of licensed healthcare professionals?
“In addition to a medical doctor, a team approach is helpful to evaluate and manage concussions more effectively. A good clinic has access to licensed professionals from several healthcare disciplines, either on-site or by referral.” These professionals help provide mental and physical evaluation and help develop and implement an individualized treatment plan of education, rehabilitation, and advice about getting back to work, school, and sport. Professionals in the clinic may include physical therapists, occupational therapists, athletic trainers, neuropsychologists, specialized optometrists or ophalmologists, and more.
THREE: Does the clinic follow the most up-to-date standards of care for managing a concussion?
The clinic should be following the current standard of care, outlined in the 5th International Consensus on Concussion in Sport, which is current as of 2019. This consensus on the management of concussions applies to all concussion patients, whether or not they suffered a concussion during sports activities.
FOUR: What tools and tests is the clinic using?
The clinic should be using tests recommended in the 5th International Consensus on Concussion in Sport. The clinic should perform tests to evaluate:
current patient symptoms and history of prior concussions
mental (cognitive function) and mood
cervical spine (neck)
response to exercise (such as a graded aerobic exercise test, see Physical Therapy)
neurological brain functions.
“The use of pre-season (baseline) neuropsychological testing, including baseline computerized neurocognitive testing, is not recommended in children and adolescents.”
Beware of the following:
* The clinic charges access fees or charges more for concussion treatments. Clinics should have standardized time-base fee schedules regardless of the injury being treated.
* The clinic’s website or publicity materials offer testimonials from patients. This is an unethical practice for most healthcare professions.
* The clinic claims to use a treatment that is proven to improve recovery from concussions. No single treatment has been shown to improve recovery from all concussions.
Some top concussion clinics in the United States
Some of the top concussion clinics are affiliated with a university, and concussion patients can be assessed and treated by a wide range of specialists within the one system. Persistent symptoms can be caused by many different types of dysfunctions, such as autonomic nervous system dysfunction, visual/ocular dysfunction, vestibular dysfunction, cervical (neck) problems, hormone imbalance, etc. It’s possible that smaller clinics, and less well-developed clinics, might miss these dysfunctions and not treat appropriately.
Examples of top concussion clinics affiliated with a university
Concussion Center, NYU Langone Health, New York, New York
The UPMC Sports Medicine Clinic, led by Dr. Michael “Micky” Collins. Pittsburg, PA and Cranberry Township, PA
UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA. The clinic is for “for athletes who have suffered concussions as well as non-sports related head injuries.”
Examples of top privately owned concussion clinics, often with destination care
The Sports Neurology Clinic, clinics in Michigan and Utah. The clinic is led by Dr. Jeffrey Kutcher, and provides destination care for patients from across the globe, and treats athletes, weekend warriors, students, and non-athletes.
CognitiveFX, Provo, Utah. This destination clinic uses “a specialized brain scan called functional Neurocognitive Imaging (fNCI) for initial assessment and development of a week-long rehab program. Imaging is used at the end of the week of rehab as well. See our related newsletter article.
Which professionals would help me with specific concussion symptoms?
This information is provided thanks to Dr. Chris Giza.
Sleep and headache problems
Medical doctor (MD), physicians assistant (PA), family nurse practitioner (FNP), neurologist, or a physiatrist. Look for a professional with a specialty focus in the management of concussion.
Cervical (neck) complaints
Medical doctor (MD), osteopathic doctor (DO), chiropractor (DC), or physical therapist (PT). Look for a PT with credentials such as SCS, OCS, or FAAOMPT. See our page on Physical Therapy.
Neuropsychologist, occupational therapist, or speech and language pathologist. One specialist may be best for assessment; another specialist may be for treatment. For example, a neuropsychologist might assess and diagnose the problem, and an occupational therapist might treat the problem. Consider finding a multidisciplinary occupational therapy program for TBI, or school-based therapists, or occupational therapist who focuses on assessment for readiness to drive.
Neuro-otologist or audio physical therapist. These specialists test for vestibular and hearing issues. Look for a physical therapist with an NCS credential, or who has attended Emory vestibular competency course, or who is listed on the VEDA website. The VEDA listing can be accessed via our Vestibular Therapy page.
Neuroopthamologist or neuro-optometrist. Look for providers who are members/fellows of the College of Optometrists in Vision Development (COVD) or Neuro-optometric Rehabilitation Association (NORA). Search tools for these providers can be found on our Vision Therapy page.
Medical doctor (MD) or counseling support. Look for providers who have knowledge of mTBI/concussion, and are experienced with working with your age group.