Concussion Management and Rehabilitation

Concussion Management

Dr. Williams takes a highly individualized approach to concussion management. He believes this is important because, while there are commonly experienced groups of signs and symptoms associated with concussion, each individual presents uniquely. Furthermore, an individual with multiple concussions in their history might experience completely different symptoms from one concussion to the next. This is why a detailed history, validated concussion-specific clinical examination, and focused interventions are particularly important with this population.

  • Dr. Williams’ approach begins with Cognitive Restructuring – educating patients and other stakeholders on state-of-the-art approaches and appropriate expectations regarding recovery. We believe we can help everyone! We just need to find the appropriate intervention for the individual we’re focused on at that time.
  • He Searches for Treatable Conditions in an effort to help patients overcome symptoms and return to baseline or better than baseline, rather than the outdated and misguided approach of teaching compensation strategies for a “new normal”.
  • And Dr. Williams utilizes Stratified Care philosophy – meaning he is aggressive with the intensity of interventions for severe and chronic symptoms, but reasonable and conservative with milder symptoms that are resolving spontaneously. With a wealth of interventions and technologies at his disposal, Dr. Williams maintains a common-sense approach.

Concussion symptoms typically fall into different categories of clinical presentation, all of which require evaluation and management. Signs and symptoms may include cognitive/thinking, affective/mood, vestibulo-ocular (balance/vision), somatic (headache), cervicogenic (neck-related), and/or cardiovascular/autonomic issues. Dr. Williams’ multidisciplinary and interdisciplinary team approach to concussion management ensures that each of these systems are being identified, evaluated, and treated.

How Are Concussions Treated?

  • Consult with Sports Neurologist for expert and focused neurological assessment, treatment, and “quarterbacking” the plan of care.
  • Referral to appropriate specialist team member (based on signs and symptoms identified) for individualized programs built based on clinical presentation. Dr. Williams works closely with pain psychology, sports psychology, athletic trainer, and concussion-focused physical therapist team members, as indicated, to develop treatment plans and monitor recovery.
  • Provide education and communicate with patient, family, coaches, schools, and involved healthcare practitioners regarding treatment plan and return to activity. Dr. Williams believes STRONGLY in the power of education and effective knowledge transfer. He wants all stakeholders to understand what he and his team are doing and why..Dr. Williams believes that kind of buy-in is critical to recovery. His goal is to return the athlete, injured worker, or military member in better condition than they were prior to the injury.

What testing, interventions and rehabilitation techniques do we use to help with Concussions?

  • Diagnostic testing including traditional imaging (MRI), advanced imaging (Qauntitative MRI, DTI and fMRI), electrodiagnostic (EEG, QEEG, and Brain Network Assessment), Advanced Visual and Balance Assessments, and Cognitive Testing (Computerized and/or formal Pen and Paper Neuropsychological Assessments) are often used to evaluate aspects of the patient’s signs and symptoms.
  • A physical therapy/athletic training assessment is performed of vestibular, visual, cervical spine, proprioceptive/balance, and cardiovascular systems.
  • iPad and/or EEG-based baseline/follow up assessments
  • Vestibulo-ocular examination, including tests of vision, vestibulo-ocular reflex, and oculomotor function
  • Balance and/or gait assessment
  • Cervical spine screen
  • Cardiovascular assessment, including HR/BP monitoring and concussion treadmill testing
  • Individualized programs are built, which may include:
    • Visual and vestibular rehabilitation
    • Head-eye-neck coordination exercises
    • Balance exercises
    • Dual tasking
    • Cervical spine treatment
    • Graded aerobic program
    • Sports-specific training
    • Expert pain management strategies ranging from topical and oral medications, to interventional procedures (such as injections), to Neuromodulation (with cryoablation, radiofrequency, Neurofeedback, and/or Trans-Cranial Magnetic Stimulation) are guided by our Sports Neurology staff.
    • Behavioral Medicine consultations and management with Cognitive Therapy, Autonomic Quieting, EMG/Thermal-Guided Biofeedback, Neurofeedback, and Mindfulness Meditation techniques are available for non-pharmacologic approaches to treating signs and symptoms.
    • A number of state-of-the-art technologies are available and utilized in our beautifully designed Peak Performance, and Neurological Treatment/Testing spaces.

Dr. Williams’ Center for Sports Neurology and Pain Medicine boasts decades of expertise managing concussion in elite, professional, collegiate, and high-school/youth athletes, as well as injured workers and weekend-warriors. He has great success treating acute, sub-acute, and chronic Post-Concussion Syndrome as well as chronic neurological impairment associated with multiple concussions and sub-concussive blows. The combination of Sports Medicine expertise and experience associated with Kerlan-Jobe, and the expanded access to services and expertise associated with Cedars-Sinai place us at the head of the pack when it comes to evaluating and managing head injury.

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