Stricter Guidelines Direct Assessment and Recovery of Concussions

A greater awareness of the lasting impact that concussions can have on a person’s cognitive and neurobehavioral function has resulted in stricter guidelines in the way we assess and recover from concussions in recreational and professional sports.



“The grading scales that used to be utilized have fallen out of favor, as have the return to play guidelines that used to be associated with them,” says Harris Frankel, MD, neurologist at The Nebraska Medical Center. “There is no magic number that determines whether or not one should return to play following a concussion. Because of individual variability, it is difficult to predict when “the next blow” might be catastrophic and/or result in serious neurologic impairment, especially if one is not allowed to recover completely from the previous concussive injury.”

We need to be especially careful of children knowing that their brains take longer to recover than that of an adult. As such, the consequences in children and adolescents can be more severe. Relying on the physical symptoms reported by the athlete may not be reliable enough. In addition, a concussion does not have to involve a loss of consciousness. Any athlete that suffers head trauma during a sporting event and appears momentarily dazed, should be removed from the field until he or she has had a thorough evaluation by a trained professional.

Assessment of a concussion has also changed. “Concussions are a functional disturbance, not a structural injury per se and therefore, CTs and MRIs cannot be used to diagnose concussions,” notes Dr. Frankel. Imaging studies such as CT and MRI may be indicated to look for structural injuries such as bleeding and/or swelling in the brain that can occur following head trauma.”

Dr. Frankel strongly encourages all athletes participating in contact sports to undergo some form of baseline neurocognitive function testing prior to beginning a sport/activity. In the event an individual suffers a concussion, repeat testing is advisable to compare with the initial/baseline test. This can assist medical professionals in determining when it might be safe to “return to play.” These tests can be taken at most Omaha schools or at a doctor’s office with providers certified to administer the tests.

The Nebraska Medical Center is a credentialed ImPACT provider. ImPACT is just one of the neurocognitive tests that are used to help determine the cognitive recovery following a concussion. “If a physician is provided with an ImPACT test and isn’t sure how to interpret the test, they can call us and our credentialed physicians will be happy to confer with them,” says Dr. Frankel.

“Prior to returning to competition, athletes should go through a gradual return to play progression,” explains Rusty McKune, certified athletic trainer at The Nebraska Medical Center. “Should an athlete exhibit or develop any signs or symptoms, he or she needs to stop this progression and consult with a medical professional. Providing the brain adequate time to heal may not only include refraining from sports but may initially include refraining from school and things like TV, texting and video games until symptoms subside.”

Once a child suffers a concussion, they are at higher risk of sustaining a second concussion, which can invoke more serious complications than the first, says Dr. Frankel. Multiple concussions over time can result in long-term side effects such as chronic headaches, fatigue, sleep difficulties, dizziness, personality changes, sensitivity to light and noise, as well as deficits in short-term memory, problem-solving and intellectual functioning. Athletes should not be allowed to return to play until they are asymptomatic at both rest and exertion. The presence of symptoms indicates that the brain is still suffering from the effects of the previous injury. If a subsequent injury occurs before the first injury is completely resolved (as is evident by any persistent symptoms), a catastrophic and potentially deadly condition known as second impact syndrome can occur.


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