For Concussion Patients, the Care They Need

It was a typical injury: During a Saturday soccer game, an opposing player’s wayward shot smacks a youngster in the face and knocks her out of the game for several minutes. The player returns to the field, but seems slow and confused for the remainder of the game. Irritability and moodiness follow the day after, and by day two, dizziness, nausea, and headaches set in.

What was not typical, says Farah Hameed, MD, was how quickly she saw the patient—two days after the injury. Dr. Hameed, assistant clinical professor of rehabilitation & regenerative medicine and a sports medicine specialist with Columbia’s new Concussion Clinic, says some concussed patients take weeks to find their way to the appropriate physician. 

“Parents don’t know if they should call their pediatrician, look for a neurologist, or seek neuropsychological testing,” says James Noble, MD, assistant professor of clinical neurology. “We realized that Columbia has all this expertise, and we could make it easier for patients to find the right doctor.” Parents who call a central number will be directed to the appropriate person based upon their child’s age and symptoms. 

“With concussions you want to see the patient as soon as possible after the injury because there can be disastrous consequences such as second impact syndrome if an athlete returns to play while still symptomatic and without adequate rest,” says Dr. Hameed.

Although awareness about concussions among athletes, parents, and coaches has grown significantly over the past several years, the injury remains common in many sports, with approximately 300,000 concussions sustained each year in high school contact sports. In college, concussions are reported in more than one in three football players, with many players suffering multiple times. Most states—including New York, New Jersey, and Connecticut—have laws outlining specific protocols for young athletes who sustain concussions on public school teams. 

Columbia’s Concussion Clinic combines the experience of several neurologists, neuropsychologists, sports team physicians, and athletic trainers: Drs. Hameed and Noble; James Kirkland Roberts, MD, associate clinical professor of neurology; Jim Gossett, head athletic trainer for Columbia University varsity athletes; William Levine, MD, vice chair of orthopedic surgery and head team physician for Columbia athletics; Christopher S. Ahmad, MD, head team physician for the New York Yankees; Edwin R. Cadet, MD, head team physician for City College of New York; and Reet Sidhu, MD, assistant professor of clinical neurology and of clinical pediatrics. 

Nothing can accelerate concussion recovery so rest is the most important treatment, including rest from the mental demands of daily life. “It takes 10 times more brain work to read a physics text than remember a football play,” notes Dr. Levine. “So if a concussion is suspected, it is essential to identify the problem and get the patient to rest.” 

The Concussion Clinic uses a series of cognitive, balance, and neuropsychological tests to help determine when a patient is ready to return to play and school. In some cases the physicians can measure progress against a baseline score taken before the start of the season.

Despite growing interest in concussion treatment, however, few scientific studies exist to guide physicians to the best possible treatment. To improve concussion treatment, Dr. Noble is mining a clinical dataset drawn from a group of accomplished collegiate athletes having serial neuropsychological measurements. 

“We want to know if there are measurable differences between people with and without a concussion history, both at baseline as well as following recognized concussions,” says Dr. Noble. “Are there differences in how long it takes them to return to play? Are the conditions we use to deem an athlete ready to play acceptable?”

“I imagine that in time we will be able to develop protocols that allow us to determine whether players can be express-laned through recovery and return-to-play or whether they need to be monitored more closely,” says Dr. Levine. “I think the program will evolve as we collaborate more and learn from each other as well as from our athletes.”

The Columbia Concussion Clinic can be reached at 212-305-3472.