The Physician and Sportsmedicine
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[EDITOR'S NOTES]

Toward Better Concussion Management

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 7 - JULY 98


For assessing brain function in the conscious athlete, neuropsychological testing, the subject of ongoing clinical research, promises to be a quantum leap ahead of traditional neurologic assessments (see the news brief "Baseline Neurologic Testing Grows"). For the past 50 years, we've been forced to use not-so-subtle tests like subtracting serial sevens, which many athletes—and doctors—can't do even in their normal mental state.

On the other hand, simplified neuropsychological tests that are specially designed for sports medicine enable clinicians to quickly check brain function in areas such as memory, attention, mental processing speed, and motor speed. It's true that an astute clinician can often pick up impaired cognition simply by talking with the athlete, especially if the doctor knows the athlete pretty well. For example, a few well-framed questions about how things went in class that day can reveal problems, as can noncognitive symptoms like headache or fatigue. But standardized tests may eventually allow more consistency and clearer documentation in concussion assessment and management.

This approach works best when athletes take a baseline test at the start of the season. Then, if the patient is given the same test after an injury, changes are easily observable. If the baseline and postinjury test results differ significantly, the physician can be appropriately cautious about allowing return to play. This may become an important tool in avoiding the deadly second impact syndrome and other serious sequelae of concussion.

If simple versions of this tool can be validated over time, return-to-play decisions for team physicians may be eased, not only at the professional level, but wherever sports medicine is practiced.

Cordially,
Richard H. Strauss, MD
Editor-in-Chief

P.S. This issue is also full of tips to help you and your patients through the summer. William J. Reed, MD, discusses emergency care of near-drowning victims; Robert Norris, MD, guides you through recognition and treatment of common arthropod bites and stings; and our Exercise Adviser department covers summer skin care essentials in a clip-and-copy format for patients.


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