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NEUROLOGY SERVICES

Diagnosis & Treatment

Concussion

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How are Concussions Diagnosed?

Diagnosis

The diagnosis of a concussion has not been an exact science. It is primarily based on tests of attention, memory, vision, balance, and other functions. This concussion testing can be performed to determine the severity of the condition and monitor a patient’s recovery. 

At NewYork-Presbyterian’s Concussion Clinics, patients suspected of having a concussion receive a full assessment that may include:

  • A complete physical and neurological examination, including a concussion eye test and other exams specific to concussion care
  • Computerized neurocognitive testing
  • Neuropsychological testing
  • Imaging with CT scanning to rule out other causes of concussion symptoms
  • MRI scanning may be used when someone has persistent concussion symptoms

How are Concussions Treated?

Treatments

The “rest is best” philosophy for treating a concussion has changed over the years. While brain rest is necessary for the very early days after a concussion, doctors now recommend a gradual return to activity to enhance recovery. 

Depending on the severity of the injury and the patient’s age, recovery may take days or weeks, with most people recovering within a month. There is a longer recovery time for younger patients compared to older patients, and when a concussion is not sports-related. Your doctor may want to check in with you as often as every one to two weeks to monitor your recovery.

Reduce screen time

Avoid sustained screen use—including computers, video games, television, and cell phone use—during the first one to three days of your recovery. Engaging in these activities may trigger your concussion symptoms.

Ease back into work or school

Study or work in small blocks of time and take breaks if you start to experience concussion symptoms. Ask for accommodations at work or school as needed during this time. You will gradually be able to work or study longer as you recover.

Physical, occupational, and vestibular therapy

People who have experienced a neck injury may find relief from warm compresses and stretching exercises guided by an athletic trainer or physical therapist. If you have dizziness, balance problems, or visual disturbances that do not improve within three to four weeks of the injury, you may benefit from vestibular therapy (for dizziness), vision therapy for blurred vision, or occupational therapy exercises to help your symptoms resolve. 

Light aerobic exercise

After the first couple of days, you may be instructed to partake in light aerobic exercise guided by feedback from a heart rate monitor. For example, you may ride a stationary bike for 20 minutes at half of your maximum heart rate (your physician will provide instructions) and then gradually increase the intensity of your workout each time. 

If you experience concussion symptoms during exercise, you will remain at a lower exercise intensity and not increase it until you can exercise without your symptoms worsening. Studies have shown that patients who perform aerobic exercises recover from concussions more quickly than those who do not.

Medications for concussion pain

If you have a headache, ask your doctor if you can take over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). You may be advised not to take any for more than 72 hours after your injury.

Behavioral health support

Some people who have mood disturbances or sleep difficulties after a concussion benefit from counseling from a psychologist or psychiatrist. Sometimes medication is required to treat the worsening of a pre-existing mood disorder. Do not be afraid to speak to your doctor if you are struggling with your emotional health after a concussion.

Concussion Recovery

Recovery

As you rest and heal from a concussion, there are several steps you should take before you can be considered completely recovered. Depending on the severity of your concussion and how you are recovering, you should check with your doctor before going back to playing sports, driving a car, riding a bike, or operating machinery. NewYork-Presbyterian uses neuropsychological testing to monitor a patient’s recovery.

Steps of concussion recovery

Your recovery will likely take you through these phases:

  • Rest during the first one to three days after the injury
  • Light to moderate activity, such as a return to school or work and gradually increasing aerobic exercise. If you feel your concussion symptoms getting worse, take breaks as needed and do not increase exercise intensity until you can do so comfortably.
  • Full return to all normal activities when you can do so without experiencing any concussion symptoms

Six stages of concussion recovery for student-athletes

At NewYork-Presbyterian, our concussion care teams use a computerized assessment tool called ImPACT to monitor an athlete’s recovery. This technique measures an athlete’s visual and verbal memory, reaction time, and processing speed. There are six steps of recovery for athletes who have sustained a concussion.

  • Step 1: Return to regular activities (such as school). Athletes can return to school and light activity, such as short walks or riding a stationary bike, if these actions do not make symptoms worse
  • Step 2: Light aerobic activity. Light aerobic exercise can be completed to slightly raise the heart rate, such as 5-10 minutes on an exercise bike, walking, or light jogging
  • Step 3: Moderate activity. The athlete can progress to moderate jogging, brief running, and moderate-intensity stationary biking or light weightlifting
  • Step 4: Heavy, non-contact activity. Sprinting/running, high-intensity stationary biking, regular weightlifting, and non-contact sport-specific drills may be added to the fitness regimen
  • Step 5: Practice and full contact. In controlled practice, a young athlete may return to practice with full contact (if appropriate for the sport)
  • Step 6: Competition. The athlete may return to sports competitions

Research

Investigators at Columbia University and Weill Cornell Medicine are conducting research studies to evaluate new ways to diagnose and monitor concussions. Such studies will help refine the care of patients with concussions and enhance our understanding of their effects on the body.

FAQs

FAQs

If you experienced an impact to the head or a blow to the body that rattled your head and you have symptoms such as headache, nausea/vomiting, dizziness, foggy thinking, light sensitivity, confusion, or if you lost consciousness, you may have sustained a concussion. See a doctor for a full evaluation.

Treatment for a concussion starts with rest for the first 1-3 days, followed by gradually increasing time spent at work, school, or light aerobic exercise. You may also benefit from physical, occupational, vestibular, and/or vision therapy to help you recover from neck pain, dizziness, blurred vision, or other symptoms. Some patients benefit from medication and counseling.

Depending on the severity of the injury and the patient’s age, recovery may take days or weeks and, in some cases, months. It typically takes up to two weeks for an adult to recover from a sport-related concussion and up to one month for children and teens. The recovery from a non-sports-related concussion can take up to 3 months. Most people recover within a month, but some have symptoms longer—a condition called persistent post-concussive symptoms. Continue to see your doctor until you get the green light to go back to your regular activities.

Get Care

Trust NewYork-Presbyterian for Concussion Treatment

When you come to NewYork-Presbyterian for concussion care, you’ll benefit from a team of experts with experience diagnosing and treating concussions who have routinely helped patients return safely to sports and  other regular activities. 

Our concussion specialists are part of our world-renowned team of neurology and sports medicine professionals who are dedicated to your care and recovery. Call us to make an appointment for a consultation.