Category: Concussion Care

Untreated mental health issues can complicate and prolong concussion recovery and lead to prolonged outcomes.

When a person is anxious they tend to overthink and focus on the worst case scenario which stops them from doing their normal activities.

A helpful question for clinicians to ask may be: How has your behavior changed as a result of the concussion?

The answer to that question will give you an idea of the level of anxiety that the patient is experiencing. A significant change in behavior is oftentimes based on anxiety and can be problematic in terms of symptoms. One of the most beneficial things you can help your patients with is resuming their normal activities in a methodological, gradual way.

Learn more about how to treat patients experiencing anxiety after a concussion.

The first step in creating a profitable concussion management program is identifying key stakeholders. Identify individuals or departments that your new procedures will impact and educate them on the benefit of what you’re doing.

The next step is getting your concussion care team trained on best practices. ImPACT Applications offers credential programs for different members of the concussion care team.

Next, set up your community outreach program and implement a universal concussion protocol that includes baseline testing.

Once you have your protocols in place, create a process to bill for concussion care services. This includes identifying billing codes you can leverage for reimbursement as well as conducting regular internal billing audits.

Lastly, identify revenue opportunities outside of sports that you may be able to leverage. These opportunities may include industrial medicine, Fire and police departments, or YMCA and recreational facilities.

By following this set up and including ImPACT in their concussion evaluations, our customer Premier Health saw a successful commercial insurance reimbursement on 91% of claims and had a 7% increase in office visit revenue by utilizing multiple and consistent diagnosis codes.

Learn more about how Premier Health set up their concussion management program to get consistently reimbursed.

The first step in creating a tailored concussion rehab plan is to educate patients and set goals for therapy. Make sure patients understand why they were referred to therapy and what you are going to do to help their ongoing symptoms.

Next, ask questions about the patient’s lifestyle and activities. If the patient is an athlete, ask them about their sport and what position they play. If the patient is not an athlete, ask about their work duties and recreational activities.

After you understand your patients’ lifestyle and activities, ask about symptoms, determine limitations, and find a solution. At a minimum you should assess:

• Balance
• Cognitive function
• Smooth / visual pursuits
• Near / Far Tasks
• Saccades
• VOR

Next, you’ll create a plan of care that addresses the specific deficits identified during the assessment. Explain what each exercise is addressing and how it will help patients return to their activities.

Learn more about creating tailored concussion rehab plans in this online guide.

Referral sources for non-athletic concussions may include emergency rooms, urgent cares, primary care physicians, neurologists, physical therapists, chiropractors, and neuro-optometrists. Patients may also find you directly through word of mouth or by looking for a concussion specialist online.

There are a number of ways you can build your reputation as the go-to provider for concussion care services so the community knows your facility is the place to go for concussion treatment.

#1: Have a trained team of multidisciplinary professionals that can offer comprehensive concussion care under one roof.

#2: Provide education sessions to urgent cares, primary care, and other referral sources

#3: Provide ImPACT baseline testing and educational resources to individuals and organizations in the community.

#4: Be able to see patients within a few days of their call. You may also provide a hotline for patients to get their questions answered outside of business hours.

#5: Be aware of your online presence by making sure your website is up-to-date with the latest concussion strategies and getting your clinic listed in a reputable online directory such as ConcussionCareProviders.com

After a concussion, patients may be experiencing cognitive deficits and/or physical symptoms that can impair their ability to drive. Reaction time, concentration, visual perception, and memory are all cognitive tasks used in driving that may be impaired following a concussion.

ImPACT provides objective measures of memory, reaction time, and processing speed which can be helpful in determining a patient’s readiness to return to driving.

Once you feel a patient is fit to return to driving, provide extra precautions for them to take such as

• Practicing in a parking lot or on backroads
• Drive short distances
• Drive familiar routes
• Avoid driving at night
• Avoid additional distractions such as other passengers or music

Returning to work is extremely important in adult populations in that it helps ease patients back into their daily routine. Some patients may be hesitant to return to work before they are 100% symptom-free, but it can actually be beneficial for their recovery.

When you feel a patient is ready to return to work, work with them to understand their specific work environment and provide appropriate workplace accommodations. Here are some things you may incorporate in your return to work accommodations.

Use breaks to manage symptoms. Tell your patient to take a break whenever symptoms are getting higher than 5/10. Breaks should consist of complete cognitive rest as much as possible.

Depending on the severity of symptoms, you may suggest patients start with part-time before returning to work full-time. If part-time is not an option, see if they can be placed on light-duty work until they can handle more demanding tasks.

Contrary to popular belief, concussions are not limited to sports injuries. They can happen anywhere, at any time. According to the CDC, falls are the #1 cause of concussions. Some other non-athletic causes of concussions include workplace accidents, car accidents, and domestic abuse.

There are a few distinctions between athletic and non-athletic concussions to be aware of:

First, is the gap in concussion knowledge. Athletes have a working knowledge of concussion signs and symptoms whereas non-athletes may not have the same baseline level of concussion knowledge.

The second distinction is access to providers. In athletic populations, there is typically an athletic trainer on the sidelines ready to identify potential concussions and refer for further evaluation right away. On the other hand, non-athletes may not recognize their symptoms as being from a potential concussion and may not seek treatment right away.

The third distinction is that athletes are more likely to have taken an ImPACT baseline test than non-athletes. While having a baseline test is preferred, ImPACT provides normative data that can be used when baseline test data is not available.

To accommodate the growing demand for telemedicine, CMS has relaxed its requirements for reimbursement for telemedicine services and they continue to adjust their policy to fit the needs of both patients and healthcare providers.

Here are some ways you can get the best reimbursement rate for your concussion care services:

• Use ImPACT post-injury testing via telemedicine as part of your concussion evaluation.
• Leverage the right billing codes
  • CMS has expanded coverage to include CPT 96116, 96132, 96133, 96136, and 96137 for telemedicine using modifier 95.
• Include thorough and accurate documentation when submitting claims
  • There are some additional things you should document for telemedicine appointments in addition to your normal documentation. Document that it was an audio + video appointment, document any technical issues, and document any other potential threats to validity.

Learn more in the Concussion Care Billing Guide.

Always refer to your local, state, and federal guidelines before billing.

When incorporating a telemedicine component in your concussion care practice, it’s critical to have a reliable workflow in place. Here is an example of a step by step workflow you can adopt for your own telemedicine services.

Step #1: Patient Intake

• First, determine their appropriateness for telemedicine services.
• If the patient is deemed appropriate, send them any necessary paperwork, a link to complete ImPACT remotely, and schedule an appointment.
  • Tell patients paperwork must be completed prior to their appointment or it will be rescheduled.
  • This would also be the time to conduct any pre-appointment checks including technical requirements, and let patients know what to expect during their telemedicine visit.

Step #2: Day-of the Telemedicine Appointment

• Review patients’ medical history and any paperwork or self-evaluations you had them complete prior to their appointment.
• At the start of the telemedicine visit, review your telemedicine policy with the patient.
• Educate your patient on concussions and what to expect throughout recovery.
• Review their medical history with them.
• Review their ImPACT clinical report with them.
• Carry out your concussion assessment and evaluation.
• Create your concussion care treatment plan and explain it to your patient.

Step #3: Post-appointment

• Document your telemedicine visit including any disruptions to the appointment.
• Get reimbursed for your telemedicine visit by utilizing the right CPT billing codes.

Learn more in this webinar replay: Leveraging Telemedicine for Concussion Care.

In the last flash briefing, we covered pros and cons of telemedicine. While there are a lot of clear benefits of using telemedicine, there are some other considerations involved when determining if telemedicine is a good fit for your concussion care practice.

Ask yourself the following questions:

1. Am I comfortable with performing my concussion evaluation or follow up of the patient using telemedicine?
   • It’s important that the healthcare provider conducting telemedicine visits be comfortable using the technology and carrying out the visit. If this is not you, is there someone on your team who could meet this requirement?
2. What parts of my concussion evaluation and follow up can be done or can’t be done via telemedicine?
   • For example, can telemedicine be used for new patient appointments, follow up with established patients, or both?
3. Is telemedicine appropriate for my concussion patient?
   • Telemedicine will be more appropriate for some patients than others. Some considerations will include access to technology, risk of injury due to significant deficits, and need for supervision by a parent or caretaker.
4. Have policies and procedures been put in place for dealing with disruptions and impediments to my telemedicine appointment?
   • For example, what will you do if there’s a technical issue that results in an appointment cancellation?
5. What kind of technology will you need to conduct concussion care via telemedicine?
   • Some technical considerations include bandwidth, internet speed & connectivity, and appropriate devices.

Learn more in this webinar replay: Leveraging Telemedicine for Concussion Care.

Last week we kicked off our physical therapist in concussion management series. Today, we’ll be diving deeper by discussing concussion protocol for physical therapy.

Before recovery begins, a patient must undergo a clinical interview to determine their treatment path forward. There are six clinical trajectories a patient may fall under including vestibular, ocular, cognitive fatigue, post-traumatic migraine, cervical, or mood. This step in the physical therapy concussion protocol allows clinicians to make treatment and recovery plans that meet each patient’s needs.

If a patient’s trajectory is vestibular, ocular, or cervical, they receive a physical therapy referral. Patients who fall under these categories may report headaches, dizziness, neck pain, fatigue, balance disturbances, oculomotor changes, or decreased coordination.

So far we’ve covered the role of athletic trainers and what they do. If you missed these flash briefings, they’re worth going back and listening to. Today, we’ll be discussing athletic trainers and concussion testing.

As the first healthcare provider to assess an athlete for a possible concussion on the sideline, athletic trainers play a crucial role. They can evaluate and manage concussions by using a variety of objective tools. Here are some of the assessments they may use:

• Neurocognitive testing
• Balance Error Scoring System (BESS) testing
• Vestibular-Ocular Motor Screening (VOMS)
• Clinical examinations

Schools that have athletic trainers are seeing improvements in how they handle concussions. At the high school level, 50% of concussed athletes with low athletic trainer availability underwent a return-to-play protocol. This is compared to 100% at schools with high athletic trainer availability.

We recently kicked off our athletic trainer in concussion care series. Today, we’ll be diving deeper by answering the question “What is an athletic trainer”?

Athletic trainers are skilled healthcare professionals who work alongside physicians. Their specialized training and diverse skill set allow them to make removal from activity decisions, assist with injury prevention, and provide emergency and rehabilitative care.

Unlike personal trainers, athletic trainers are required to graduate from an accredited master’s program that supplies a curriculum and clinical training based on the medical model. They may also complete athletic training certifications and take annual continuing education courses to stay up to date on the best practices in concussion care.

Athletic trainers are vital members of any concussion care team. They help maintain the health of not only athletes but also a variety of other patients. Here are a few benefits when it comes to concussion care:

1. Specialized Training – Athletic trainers receive specific training in concussion management.
2. Education – Athletic trainers provide important concussion education to student-athletes, parents, coaches, and school staff.
3. Standard of Care – Schools with athletic trainers are at least 4 times more likely to recognize and diagnose concussions than schools without them.

In the coming weeks, we’ll help you learn more about their role and how an athletic trainer could strengthen your organization’s concussion protocol.

Our concussion myths series is coming to an end. Today we’ll be tackling concussion myth #5 it takes months to recover from a concussion.

Ten years ago, patients with a concussion diagnosis were told to get used to a new life. They wouldn’t be able to do the same activities and they might have some memory issues. However, there have been advances in concussion treatment. Research shows that only 20% of patients will have a concussion recovery time longer than three weeks. With the right treatment and rehabilitation, patients can get back to normal activities in less than a month.

The best way to prevent a concussion is to get educated. Learn the signs, symptoms, and resources that way you’re prepared. You can also take a baseline test to record healthy brain function. If you ever suspect a concussion, your doctor can use these results to help make treatment decisions.

So far we’ve debunked 3 concussion myths. If you missed them, jump back a few episodes to catch up. Today we’ll be discussing concussion myth #4 long rest in a dark room helps with recovery.

Head injuries and rest have been debated time and time again. The “concussion dark room myth” is unsupported by evidence. Experts agree that the best concussion treatment and return to play protocols involve a gradual and progressive increase in activity. Research has also shown that moderate physical activity does not delay recovery time so long as you are following medical advice from a healthcare professional.

Rest in a dark room is okay when within the 24 to 48-hour window, but extended isolation from everyday tasks makes it that much harder to integrate back into normal life.

Today we’ll be discussing concussion myth #3 avoid falling asleep with a concussion.

A frequently misunderstood topic is whether you can sleep after a concussion. There is a common fear that if you sleep with a head injury you could slip into a coma or lose consciousness. However, sleep helps the brain heal and recover post-injury, especially in the first 24 to 48 hours. There are numerous studies analyzing sleep loss and deficits in neurocognitive performance that highlight the importance of uninterrupted rest.

As long as you don’t present danger signs like slurred speech, intense nausea, or increased confusion, it’s safe to sleep after a concussion.

We’ve come a long way with the amount of scientific research about concussions available. With so much new information, it’s important to separate the truth from fiction. Here are the top 5 myths debunked with concussion facts from the experts.

Concussion Facts

1. Falls, car accidents, being struck by or against an object, and assaults are all leading causes of concussion.
2. Losing consciousness after a concussion is rare. More common symptoms include issues with memory, headaches, difficulty with bright light, irritability, nervousness, and changes in sleep.
3. Complete cognitive and physical rest is recommended the first 24 to 48 hours following a concussion for the brain to begin healing.
4. Current concussion treatment standards recommend a gradual return to life under the supervision of healthcare providers instead of extended rest in a dark room.
5. About 80% of patients diagnosed with concussions recover within three weeks, while 20% experience lingering symptoms.

Stay tuned as we dive deeper into the top five myths these facts debunk.

An important consideration when you’re setting up a concussion clinic is determining the types of patients you’ll see. If you’re in a rural area where you’re starting a concussion clinic from scratch, you might be in an ideal position to be the go-to provider for all types of concussions. If there are competitors in your area, you can set yourself up to offer specialized care for pediatric patients, sports injuries, or workplace injuries.

The types of patients you plan to see will help guide the creation of your organization’s mission statement, starting you off on the right foot. If you plan to assess and treat concussions, you’ll want tools that provide objective data to help your assessment. If you want to do concussion rehabilitation, you’ll need to make sure you’ve got the right training to determine individual rehabilitation plans for your patients.

Thinking through your ideal patients is an excellent way to jumpstart the creation of your concussion clinic. Once you know who you’ll be seeing regularly, you’ll be able to tailor your team, tools, and protocols to get an efficient concussion care workflow for your new concussion care medical practice.

Check out the Concussion Care 101 Guide by searching on Amazon for more tips on creating your own concussion clinic.

Let’s go through five quick guidelines to keep in mind when setting up your concussion clinic.

1. There is no “one-size-fits-all” concussion clinic model: every program is different. Set up your practice in such a way that works for your patients and clinical workflow.
2. Concussion care is constantly developing. Make sure you and your medical professionals follow best practices and keep up on current research.
3. There is no “one stop shop” for concussion care. Look for tools to evaluate and measure brain function so you can have an objective picture of each traumatic brain injury you examine.
4. Your concussion care medical practice should be a reflection of your passion. Strive to improve patient outcomes and reduce long term negative effects of a concussion.
5. A reliable treatment plan for a concussion requires interdisciplinary care. Partner with primary care, physical therapy, and sports medicine professionals to make sure you offer well-rounded concussion care.

You’ve decided to set up a concussion care practice and you know you can’t do it alone, but you don’t know who to include in your care team. Let’s talk about the disciplines commonly involved in concussion care. When you’re creating your concussion medical practice, it’s important to keep in mind the scopes of practice each professional covers to make sure there are no gaps in your team:

Point Person: this is a qualified healthcare provider who serves as the point person on the concussion care team and makes return to activity decisions.

Athletic Trainer: Athletic trainers get specific education in recognizing signs and symptoms of concussion at the point of injury. They also serve as an important liaison between family members, school, and other healthcare providers.

Physical Therapist: Physical therapists work in vestibular therapy, active rehabilitation, or target specific deficits identified by the point person. Every patient’s needs are different and PTs are trained to assess and treat the individual problems a person might experience after concussion.

Physiotherapists working outside the US: Their scopes of practice depends on country laws. But they might be involved in concussion assessment, concussion treatment, and concussion rehabilitation.

Occupational Therapist: OTs help restore occupational function (or activities of daily living) after concussion. Folks that need help driving, performing daily tasks, or even restoring full visual function can benefit from an OT.

Optometrist: If a patient is experiencing severe vision issues after concussion, an optometrist is a great resource.

School Nurse: School nurses are a cornerstone in concussion care at the school level. They help concussed students return to school safely and avoid activities they shouldn’t engage in. They also pay attention to the appropriate academic workload for a student returning to school after concussion.

Speech Language Pathologists, School Psychologists, other multi-disciplinary team members: There are SO MANY disciplines that add value to a concussion care team. It’s up to you to decide the folks you have the resources for. These additional care team members may participate in return to school, anxiety/mood issues while recovering from a concussion, or other areas as needed.

So, you’re interested in setting up a concussion clinic but you’re not sure how to go about it. Let’s talk about where you should start to create your own concussion care medical practice.

Concussions are a common injury that requires complex treatment. Because so many disciplines are involved in treating concussions (this includes athletic trainers, physicians, physical therapists, nurses, occupational therapists, and others.), the very first step is to determine who will be the concussion care team leader.

It is important to designate one person who can conduct initial assessments, coordinate referrals, and make return to activity decisions. This point person should be licensed to make return to play / return to activity decisions in the area in which you practice and should have good knowledge of a concussion.

Ideally, this person would be a Credentialed ImPACT Consultant – a qualified healthcare provider who has been specially trained in the management of a concussion. This person will complete an application and go through a 10-hour online training and exam process. Check out ConcussionCareTraining.com to learn more.

Check out BaselineTesting.com and ConcussionManagement.com to learn more tips about how you can get involved in the ever-growing field of concussion care.