What Is a Concussion?
 

A concussion, also called a mild traumatic brain injury, occurs when the brain sustains a physical injury resulting in injury to the cells and neurochemical changes in the brain. 

A concussion can occur with or without loss of consciousness.

Common Causes
 

Concussions commonly result from:
 

• Falls

• Motor vehicle accidents

• Sports and recreational injuries

• Physical assault

Common Symptoms
 

Symptoms may appear immediately or manifest afterwards. Symptoms that last longer than a few weeks are referred to as post-concussive syndrome.  

Physical & Sensory Symptoms
 

• Headache

• Feeling pressure in the head

• Dizziness

• Balance problems

• Nausea or vomiting

• Blurred or double vision

• Sensitivity to light

• Sensitivity to noise

• Ringing in the ears

• Neck pain

Thinking and Memory Problems
 

• Feeling mentally "foggy"

• Difficulty concentrating

• Difficulty remembering new information

• Forgetting events before or after the injury

• Slower thinking

• Feeling confused

Psychological Symptoms
 

• Irritability

• Anxiety

• Sadness

• Mood swings

• Fatigue

• Increased emotional sensitivity

Sleep Problems
 

• Sleeping more than usual

• Sleeping less than usual

• Difficulty falling asleep

• Feeling unusually tired during the day

*Emergency CT imaging and care may be advised depending on certain factors such as: 
 

• Sustained loss of consciousness

• Repeated vomiting

• Severe or worsening headache

• Increasing confusion

• Difficulty waking up

• Weakness or numbness

• Slurred speech

• Seizure

• Unequal pupils

• Suspected skull fracture

• Blood thinner use

• Significant facial injury

• A dangerous mechanism of injury

How Is a Concussion Diagnosed?
 

Although imaging may be used to diagnose other conditions that can occur alongside concussion, there is currently no imaging or test that can diagnose a concussion. Instead, a concussion is diagnosed through a history and physical exam.

There are standardized concussion asssessment tools that may be used to evaluate symptoms and recovery. One popular tool for athletes is the Sport Concussion Assessment Tool, 6th Edition (SCAT6) for adolescents and adults, or the Child SCAT6 for children ages 8–12.
 

The SCAT6 evaluates:
​

• Memory

• Orientation

• Concentration

• Balance

• Coordination

Management
 

Current guidelines recommend relative rest for the first 24–48 hours, followed by a gradual return to normal activities as symptoms allow. Concussions before complete recovery may result in prolonged recovery and, in some cases, second impact syndrome, a potentially life-threatening condition characterized by rapid brain swelling. Additionally, patients may be at increased risk for future concussions.

Treatment typically includes:

• Adequate sleep

• Staying hydrated

• Eating regular, healthy meals

• Light physical activity as tolerated after the first 24–48 hours

• Limiting activities that significantly worsen symptoms

• Avoiding another head injury during recovery

Returning to School (Return-to-Learn)
 

Current concussion guidelines recommend 24–48 hours of relative rest, followed by a gradual return to school as tolerated. Prolonged complete cognitive rest is not recommended, as it may actually delay recovery. Some students may benefit from temporary academic accommodations, highlighted by the CDC concussion school letter, such as:
 

• Shortened school days

• Frequent rest breaks

• Reduced homework

• Extra time for tests and assignments

• Reduced screen exposure

• Quiet testing environments

As symptoms improve, these accommodations should be gradually removed until the student returns to a normal academic schedule without restrictions. Students should reduce activity if symptoms significantly worsen and resume at the last tolerated level before progressing again.

Returning to Sports (Graduated Return-to-Sport Strategy)
 

Athletes should never return to sports on the same day as a suspected concussion.

Before beginning a return-to-sport progression, the athlete should:
 

• Have resumed normal daily activities.

• Have returned to school (when applicable).

• Have symptoms that are improving or resolved.

• Be evaluated by a qualified healthcare professional.
   

The 6th International Conference on Concussion in Sport (Amsterdam 2022 Consensus Statement) recommends the following graduated progression. Each step should take at least 24 hours. If symptoms worsen, return to the previous symptom-free step after symptoms improve.
 

Step 1 – Return to Regular Daily Activities

Resume normal activities of daily living, including school or work.

Step 2A – Light Aerobic Exercise

Examples:

• Walking

• Stationary cycling

Maintain a light intensity (approximately ≤55% of maximum heart rate).

Step 2B – Moderate Aerobic Exercise

Progress to:

• Brisk walking

• Easy jogging

• Moderate stationary cycling

Increase heart rate without any significant provocation of symptoms.

Step 3 – Individual Sport-Specific Exercise

Perform sport-specific drills that do not involve head impact, such as:

• Running drills

• Skating drills

• Ball handling

• Individual skill work

Step 4 – Non-Contact Training Drills

Advance to:

• More complex drills

• Agility exercises

• Resistance training

• Team practice without contact

Step 5 – Full-Contact Practice

After receiving medical clearance, return to full-contact practice.

Step 6 – Return to Competition

Resume unrestricted participation in games and competition.

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How Loria Mobile Medicine Can Help
 

I evaluate suspected concussions in the comfort of your home. During your visit, I will perform a thorough neurological examination, assess memory, balance, coordination, and cognitive function, and use standardized concussion assessment tools, such as the SCAT6, when appropriate. I identify warning signs of more serious brain injuries, determine whether emergency evaluation or brain imaging is needed, and provide personalized guidance for recovery.
 

I also help patients safely return to school, work, exercise, and sports using evidence-based return-to-learn and return-to-play recommendations. If symptoms persist or recovery is delayed, I can help with referrals to neurology, sports medicine, neuropsychology, or other specialists when appropriate.

 

                                                                              References & Guidelines
 

• Centers for Disease Control and Prevention (CDC). HEADS UP: Clinical Guidance for Mild Traumatic Brain Injury.

• Patricios JS, et al. Consensus Statement on Concussion in Sport: 6th International Conference on Concussion in Sport — Amsterdam 2022. British Journal of Sports Medicine. 2023.

• Echemendia RJ, et al. Sport Concussion Assessment Tool — 6th Edition (SCAT6). British Journal of Sports Medicine. 2023.

• American College of Emergency Physicians (ACEP). Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Mild Traumatic Brain Injury.