Sports Concussion is a complex neurological disorder. Symptoms include an acute and chronic headache, vestibular dysfunction (i.e. trouble with balance), cognitive issues (trouble with attention, concentration, and memory), sleep disorders and psychological dysfunction i.e. depression and anxiety. As is the case with all complex medical problems, success is almost always achieved with a multi-disciplinary approach to the patient. The Florida Center for Headache and Sports Neurology has over the past 15 years developed an on-site multi-disciplinary concussion management program which addresses all aspects of the athletes care with a focus on full and safe return to play. The program incorporates the use of medical management, interventional techniques, physical medicine and rehabilitation, cutting edge neuroimaging techniques, neuropsychological evaluation and treatment, behavioral modification techniques, return to play management.
Sports Concussion Treatment Program: Medical Management
Medical management at the Florida Center for Headache and Sports Neurology involves the use of medications to treat symptoms such as headache, depression and sleep. Concussed athletes have unique physiological needs. For example, medications typically used to prevent migraine i.e. beta blockers which in most cases will lower pulse rate, are not appropriate in athletes who tend to have low resting pulse rates. More importantly pharmacologic treatment of elite professional and elite amateur athletes needs to take into account governing bodies rules and regulations for banned substances. Dr. Conidi is very familiar with anti-doping rules and regulations and tailors his treatment regiments to avoid banned substances.
Sports Concussion Treatment Program: Interventional Techniques
Over the past few years there has been an increase in the use of interventional techniques to treat neurological disorders. Headache is the most common symptom of sports related concussion and current consensus is that the cervical spine (i.e. neck) and associated muscles and nerves play a major factor in triggering and prolonging headache in concussed athletes. Our clinic regularly uses nerve blocks (greater occipital, lesser occipital, supraorbital, supratrochlear, and auriculotemporal) on athletes with sports related post traumatic headache. Dr. Conidi has also recently published an article describing a concussed athlete that had complete resolution of his headache and associated concussion symptoms after Botox injection. With that said this treatment is not recommended for most concussed athletes as it requires a three month waiting period before the athlete can return to play. Certain athletes, especially those with prolonged headache, neck pain and even dizziness will sometimes respond to cervical epidural injections and even facet blocks. Other athletes do very well with trigger point injections. In addition, we are currently looking into studies using Transcranial Magnetic Stimulation (TMS) and Hyperbaric Oxygen Therapy in shortening the duration of concussion symptoms.
Sports Concussion Treatment: Physical Medicine and Rehabilitation
A major and often overlooked modality in the treatment of concussed athletes is the use of physical medicine techniques. The Florida Center for Headache and Sports Neurology has on staff a part time physical therapist, full time physical therapy assistant and full time massage therapist that work as a team to address the various components of the concussed athlete i.e. vestibular dysfunction, neck pain and headache. Each athlete receives one hour of individual attention by our therapists during each session. We are currently in the process of developing evidence based treatments which can employee the latest technology. For example using the Wii Fit balance board to treat and evaluate vestibular symptoms.
Sports Concussion Treatment Program: Neuroimaging
Athletes with concussion do not normally have findings on standard brain imaging studies. However, there are new cutting edge technologies which are beginning to show promise in the evaluation of concussed athletes. They include Diffusion Tensor MRI (DTI), Function MRI (fMRI) and MRI spectroscopy (MRSpect). The later two have the greatest potential in clinical research on brain physiology and cognitive dysfunction. However, DTI MRI is already in use and there have been a number of studies on civilian and military populations showing both permanent and short term effects of concussion. We have a on site MRI facility with a Harvard trained specislist neuroradiologist, Andrew Walker MD, who has years of experience with DTI techniques and is considered a thought leader in the field. The Florida Center for Headache and Sports Neurology is currently using DTI technology as part of our comprehensive evaluation process of athletes (both professional and amateur) who have sustained multiple concussions and are considering retiring from their sport. We also hope to shortly begin a multicenter study, where we will pre-screen athletes with DTI and then if they suffer a concussion serially image them until their symptoms resolve. Dr. Conidi and other concussion experts feel that this type of longitudinal diffusion tensor magnetic resonance imaging holds significant promise as the first objective form of testing to return an athlete to play. We also have an affiliated PET imaging facility with two Cleveland Clinic trained neuroradiologists where we use FDG PET imaging to look for Traumatic Brain Injury and Beta Amyloid and Tau PET imagining to look for neurodegenerative disorders such as Alzheimer’s Disease and CTE.
Sports Concussion Treatment Program: Neuropsychological Evaluation
Cognitive symptoms including trouble with attention, concentration, retrograde amnesia and short term memory loss are a common and usually early manifestation of sports concussion. However, athletes with prolonged post-concussion symptoms often have a persistent neuropsychological issues which can be quite disabling. Dr. Conidi has an extensive background in neuropsychology including undergraduate (BS) and graduate (MS) degrees in the field. While at Boston University he was trained by some of pioneers in the field including Dr’s Edith Kaplan and Howard Goodglass who developed many of the formal neuropsychological tests (see below) which are in use today. Most professional, college and even many high school sports teams use pre-season computerized baseline testing which is then repeated if an athlete is suspected of suffering a concussion. Computerized testing is a useful tool in screening the athlete for concussion however should never be used as the sole means to return an athlete to play. The Florida Center for Headache and Sports Neurology uses Axon Sports product i.e. CogSport@ in conjunction with a concussion specific neurological exam when assessing our local amateur athletes. Most professional and elite athletes that come to our clinic for evaluation have already had computerized neuropsychological testing and require a more traditional and detailed neuropsychological testing and evaluation. Our program offers evaluation and treatment of both acute, chronic and refractory neuropsychological issues (i.e. an athlete who is considering retirement). We use a battery of formal neuropsychological tests which measure the athletes short and long term memory, attention, concentration and executive function to name a few. Once the athlete has been properly assessed we address any adverse findings with a comprehensive cognitive rehabilitation program. Our facility has a working relationship with a number of excellent and well trained neuropsychologists in the area (many of which also consult for professional sports teams) and as our practice continues to grow will begin to offer on- site specialists evaluations.
Sports Concussion Treatment: Cognitive/Behavioral Therapy
An often neglected part of concussion are the psychological symptoms which include depression, anxiety, irritability, mood swings, poor tolerance of frustration and in rare cases suicidal ideations. These symptoms can be directed related to the mild traumatic injury, secondary to the chronic pain and disability from the concussion symptoms themselves, or situational secondary to fear of non-recovery and/or never being able to return to play his/her sport. Our practice has a behavior psychologist that works directly with athletes and who provides counseling and behavioral modification techniques. Behavioral modification techniques include relaxation training, biofeedback therapy (often administered in conjunction with relaxation training), and cognitive-behavioral training (also known as stress-management training). Relaxation therapy uses techniques that train patients to control muscle tension and teach patients to use mental relaxation and/or visual imagery to achieve treatment goals. Biofeedback is administered by a highly trained therapist and includes Thermal, i.e. hand-warming and Electromyographic (EMG) techniques. Cognitive/Behavioral therapy involves teaching the patient to identify and control stress as well as minimizing the effects of stress. It is also geared towards improving thinking, more specifically addressing issues with attention, concentration, recall, and short term memory. Modalities include: Education, where the patient is taught to understand the thinking process and with increased awareness, individuals begin to gain a feeling of control over their condition. Compensation, in which the therapist provides the patient with practical ideas they can implement to compensate for cognitive difficulties. Process specific training, which in general involves the use of repletion and routine to compensation while the brain recovers.
Sports Concussion Treatment Program: Return to Play
Before a concussed athlete can consider returning to sports participation, he or she must be completely asymptomatic, off of all medications, with a normal neurological exam and all baseline testing must be back at their pre-concussion levels. Current guidelines suggest a graded return to play protocol (see above) where the athlete gradually increases physical and cognitive activity and eventually contact. At the professional and elite level this is normally administered by an athletic trainer working closely with the team specialist physician. Dr. Conidi also has prior sports back ground which he uses to design specific stages geared towards the athletic particular sport. The Florida Center for Headache and Neurology is currently exploring implementing a tele-con concussion program where athletes can be cleared and evaluated remotely allowing Dr. Conidi to work closely with any athlete trainer in the world. At the non-elite and amateur sports level athletic trainers are often not available. Our main office has on site capabilities to take an athlete through the necessary stages whereby they are eventually cleared to return to play his/her sport.
Concussion expert: Dr. Conidi
Dr. Frank Conidi receives referrals from all over Florida and the United States and treats some of the most refractory headache and concussion patients in the world. He is currently evaluating and has evaluated over 600 retired NFL players for signs of progressive neuro-degenerative disorders related with sports concussion.
10377 S. US Highway 1. Suite 104
Port St. Lucie, FL 34952
1.877.648.4762 - 1.772.337.7272
Map and Directions
2525 Burns Road
Palm Beach Gardens, FL 33410
1.877.648.4762 - 1.772.337.7272
Map and Directions