Concussions: An Evidence Based Approach

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Concussions: An Evidence Based Approach

By Dr. Lee Day

Concussions, also referred to as mild traumatic brain injuries or MTBls, can be caused by a blow to the head or a violent shaking of the head and body. Many people think that a blow to the head is the sole cause of concussions but it is important to remember that they can just as easily be caused by a shaking of the head. In these instances, the brain moves in the skull and can violently compress against the hard bone, causing damage. Take an egg and shake it up; then look to see what has happened to the yolk: same concept.

We have come a long way from the “How many fingers do I have up?” test that most coaches used in the past, which, if you answered correctly after being injured, you were back in the game. Concussions, however, don’t just occur in sports– they can happen from trauma anywhere and anytime. Concussion effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Dr. Mickey Collins from the University of Pittsburg has done extensive research on concussion symptoms and has documented 6 categories:

  1. Vestibular
  2. Cognitive
  3. Occulo-motor
  4. Headaches
  5. Cervical problems
  6. Anxiety and Mood

People who suffer concussions can experience any of these symptoms or a combination of some or all of them. Proper diagnosis and tests are provided by a concussion-certified health care professional or a physician that understands how to diagnose concussions and what steps to take following proper diagnosis.

Modifications in lifestyle at this time must be made in order for the person to heal. School, work, sports and life itself need to change. At one time, everyone was treated in the same way: “Go home; don’t do anything for several days” was the typical refrain after a concussion, and this was referred to as the “cocoon phase.” Not any more — with the proper diagnosis, people can modify their lives and take healing steps immediately, of course, with proper instruction and careful monitoring of daily symptoms.

As of recently, in many high schools, colleges and professional sports, every athlete is pre-tested with a program known as the lmPACT@ program. This program is a concussion assessment tool that measures visual and verbal memory, reaction time and processing speed on a computer. It’s a base line test with normative data ranges supported by years of research. These data allow us to choose the correct process to rehabilitate the person. They take the pretest, the results of which last for two years, and if a concussion is sustained, the person retakes the test several days later and those data are compared to the original results. After comparison in each category, if there are any significant differences before and after the concussion, we know how to treat the person because we know what specifically has been affected.

Physical therapy follows with exertional therapy, employed and monitored by a trained therapist. As mentioned earlier, the health care professional must be trained and certified. My partner, Dr. Karen Constantine, and I are ITPT and ITAT professionals, a Certified lmPact@ trained Physical Therapist and Athletic Trainer through the lmPact@ company and Dr. Mickey Collins from the University of Pittsburg.


We are certified and trained to render the test, evaluate the test and provide follow up care, as well as to provide lectures to anyone interested. You can contact us at the number below.
Dr. Lee Day is the owner of Hat City Physical Therapy. He is a Certified Athletic Trainer, certified strength and conditioning specialist, certified ITPT, ITAT concussion specialist through IMPACT and certified CPR and first aid instructor. He has bachelor’s and doctoral degrees in Physical Therapy, and a master’s degree in Exercise Physiology. Dr. Lee has over 35 years of orthopedic and sports medicine experience with many professional, college, high school and little league athletes.
For any questions or assistance with your needs, please contact Dr. Lee at 203- 748- 4278, Hat City Physical Therapy.


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November 21, 2018

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