Video: ReThinking Concussions – Treatment (Part 2)
The experts at the UPMC Sports Medicine Concussion Program are making tremendous strides in understanding concussions and developing active treatment approaches designed to rehabilitate patients in a safe and individualized manner. In this video, clinical and executive director Micky Collins, PhD, explains treatment options for concussion to Hannah Storm.
Read the full transcript from ReThinking Concussions: Treatment, with Hannah Storm and Micky Collins, PhD:
Hannah Storm: So a person, regardless of what kind of concussion they have suffered, can make a complete and total recovery.
Dr. Collins: Yes.
Hannah Storm: What about multiple concussions? Because the notion is out there that each concussion makes a person successively worse.
Dr. Collins: That’s not the case, the best way to prevent problems with concussion, is to manage it properly when you have one. If we can treat the patient fully, we don’t see an increased risk to have another one. However, if people have a history of lazy eye or car sickness or migraine, those patients are more likely to be concussed.
Hannah Storm: They’re more susceptible.
Dr. Collins: Correct, and so that’s really… If I see a patient who’s had three concussions in a year, either A the problem they’re having hasn’t been treated properly, or B they have some risk factor that we need to consider. But even if a patient has had X amount of concussions, the great majority of the time we can treat them and get them back to the sports they love. And that’s another misconception and here’s what happens, so they walk in the front door, they’ll come see me. We do testing or neurocognitive testing, for example. We have a physical exam we do but then I’ll sit down and talk to the patient, and try to figure out what’s really going on, and then, throughout the day, we have appointments with vestibular therapy, exertion therapy, medications if needed, primary care, behavioral optometry or eye stuff, exertion, we can do neural surgery if we need it, you know neurology if we need it. You know, we have the whole assortment of–
Hannah Storm: The spectrum, right.
Dr. Collins: The spectrum and then, at the end of the day, you know we meet as a team and then we go over our findings, and then I translate that into a treatment plan for the patient. And by the time they walk out of here, after their day of being here, “This is what I’m going to do to get better.” And patients having that direction, that’s the most powerful thing. It’s like, this is what I’m going to… First of all, it’s treatable and telling that to a patient means something, that they’ve been going through this for a long time, right? And then to have a plan. “This is what I’m going to do to get better.” And the plan is nuanced to what is actually happening. You know, and every patients plan is going to be individualize.
Hannah Storm: Is it something they can take home?
Dr. Collins: Yeah.
Hannah Storm: And by and large do on their own?
Dr. Collins: Yeah, correct, now do we need some time, some support, for X, Y, or Z that occurs in some patients? Yes, but the great majority of the time, no. They have their treatment plan. We actually like them to do it on their own. And they come back and see us a few months later, or a month later, or whatever it is and if we got it all, great. If not, we’ll put the next plan together. But it’s very rare that we see a patient that we can’t improve. I mean, it’s very very infrequent that occurs.
Hannah Storm: And where is the research going in this area?
Dr. Collins: I think that’s… We’re challenged as clinicians, as academicians, and as people that we have a job to do in translating this knowledge to the rest of the medical community and translating it the popular community, popular press as well and I think there’s a lot to be told there but, to answer your question, right now we have a pretty good idea of how to treat the different problems of concussion, but we need more research looking at dosing, timing of treatments, you know duration of treatment. We need to look at our outcomes in a cohort of patients. We need good data on long-term outcomes, that doesn’t exist, Hannah, and no matter what you hear out there, the reality is we don’t know. We haven’t followed patients over 40 years and said, “These are kids playing sports and concussion does this.” You know what about all kinds of other risk factors, other things that are going on and so I think every… There’s a lot of discussion on long-term problems. The reality is we don’t have the science to back it up at this point, so to answer your question, in a convoluted way, we need data looking at longitudinal research for sure, 100%. We need randomized controlled trials looking at treatments, timing, dosing, etc. We don’t have all the answers. And please don’t mistake my confidence because I am confidant we can treat this but we still have a lot to learn and we need more research. We need great scientists coming together to do that and that’s occurring.
Hannah Storm: It’s happening?
Dr. Collins: It’s happening. We have multi-disciplinary, multi-institutional things going on, we work together well collegiality you know. There’s a group of people doing this for a living just like me that we’re learning from each other. We’re getting together, we’re doing the research and we’re going to have great answers for parents in due time. And, right now, I can tell you, though, if you send your kid with problems with concussion, I promise you we can give you more answers, and give you a better understanding of how to get better from this.