It’s been a long recovery for Brenda McKenzie, who suffered a concussion in December 2013 when she fell and hit her head twice on the kitchen floor of her Abington, Pa., home, the second time as she tried to get up. She had difficulty finding the right words when she spoke, and couldn’t focus.
“I just felt like a slate was completely wiped clean,” she says. “It was very difficult to get back on track.” Since her fall, McKenzie has had an ImPACT Test, or Immediate Post-Concussion Assessment and Cognitive Testing, the standard for post-concussion testing, as well as other cognitive testing. As of early March, she was undergoing “vocational rehab” at MossRehab, engaging in simulated work activities such as multitasking and dealing with interruptions like phone calls, to help gauge when she’ll be ready to return to her job as a trauma nurse.
Much like concussion symptoms and recovery, treatment options vary and are subject to change as more information becomes available. Researchers currently seek tests that provide a clearer picture of what patients need, and what they can safely do. “We don’t have a lot of objective measures ... for making decisions about things like return to play or return to activities,” says Brenna McDonald, a neuropsychologist and associate professor at Indiana University School of Medicine in Indianapolis.
In January 2014, General Electric Co. and the NFL announced they’d awarded 16 $300,000 research grants, as the first stage of the $20 milion “Head Health Challenge,” for programs geared to speed diagnosis and improve treatment for mild traumatic brain injury.
McDonald and a fellow researcher at Indiana University School of Medicine in Indianapolis received one of the grants and she says she hopes their study, specifically of blood flow in the brains of high school athletes who’ve sustained a concussion, will help doctors determine when it’s safe to return to full physical and cognitive activity.
“I hope this new study will give us more insight into how brain differences are related to actual symptoms or function differences that kids are experiencing in their life,” McDonald says.
Education and research are key to treating concussions, says Dr. Stephen Olvey, an associate professor of clinical neurology/neurosurgery at the University of Miami Miller School of Medicine, and chief medical officer for the United States Grand Prix. He notes that treatment starts with recognizing that a person potentially sustained a concussion in the first place.
“Usually it’s during play or sports or an accident in the home,” says Olvey, who practices neurocritical care at highly rated Jackson Memorial Hospital in Miami. Positive strides have been made in identifying concussion signs — which include difficulty thinking clearly, nausea or vomiting, irritability and sleeping disruptions, according to the Centers for Disease Control and Prevention — and treating them, says Dr. Thomas Watanabe, clinical director of the brain injury center at MossRehab, based in Elkins Park, Pa.
“Historically, [people] weren’t being seen for concussion. People who would not have been diagnosed are now being diagnosed and treated,” he says. That includes addressing specific symptomatic issues, including balance, vision problems and headaches.
Though experts generally agree that rest remains the best option for treating concussion, for how long and to what extent remains difficult to pinpoint, say doctors and researchers, underscoring the need for continued research.
“We say that every concussion is different. Every concussion is a like a snowflake; supposedly no one is the same,” says Dr. Stephen Rice, director of Jersey Shore Sports Medicine Center in Neptune, N.J.
Under Watanabe’s guidance, McKenzie says she’s already regained the ability to multitask at home, and handle the demands of three children, ages 9 and younger. McKenzie said she hoped to return to work in March.
“It was hard to accept that I had a head injury that was this disruptive,” McKenzie says, adding that her headaches have ceased and she’s regaining her ability to focus for longer periods without tiring as much. “I’m continuing to improve. The goal is I need to be safe. I need to be 100 percent for my patients, as well as myself.”