The Concussion Clinic

The Concussion Clinic is a new service, provided by the National Sports Injury Clinic at Kingsbridge Private Hospital, bringing together specialists from neurosurgery, radiology, sports medicine and performance physiotherapy to give expert advice on brain injury. This unique multidisciplinary team allows for best-practice concussion management whilst striving to inform the future of concussion management through quality scientific research. Our clinic is available to non-athletes as well as amateur and professional athletes.

The Concussion Clinic at Kingsbridge Private Hospital offers:

  • Specialist clinical assessment by our sports medicine consultant and neurology specialists, if required, in the case of complex concussions.
  • Access to imaging (MRI/CT scan) if required for┬ácomplex and/or severe concussion.
  • Screening of cognitive and emotional symptoms.
  • Cervico-Vestibular injury assessment and rehabilitation.
  • Pre-season screening and assessment for amateur and professional athletes.
  • Education programmes for amateur and professional clubs.

What is concussion and how do you recognise it?

Concussion is a condition that results in a temporary disruption in the normal functioning of the brain as a result of an injury. This injury is often classified as ‘minor’ and can happen as a result of a fall, road traffic accident, an assault or as part of playing sports (football, rugby, hockey, etc.). Concussion can be caused by a direct blow to the head, but can also occur when a blow to another part of the body results in rapid movement to the head, e.g. whiplash type injuries. People with concussions often cannot remember what happened immediately before or after the injury and may act confused.

Contrary to popular belief less than 10% of concussions involve a loss of consciousness and these can be so momentary that they can be missed altogether.

Onset of symptoms:

Concussion symptoms typically appear immediately, but their onset may be delayed and can appear at any time after the initial injury.

Who is at risk?

Concussions can happen to individuals of any age. However, children and adolescents (18 and under) are more prone to brain injury.
PLEASE NOTE: Having a history of previous concussion increases the risk of further concussion, which may take longer to recover from.

Common symptoms of concussion

Concussion affects different people in different ways resulting in a wide range of symptom presentations. The most common symptoms are dizziness and a headache, but people report other symptoms.

Visible signs (clues) of concussion:

What you may see

Any one or more of the following visual clues can indicate a concussion:

  • Dazed, blank or vacant look.
  • Lying motionless on ground/slow to get up.
  • Unsteady on feet/balance problems or falling over/poor coordination.
  • Loss of consciousness or responsiveness.
  • Confused/not aware of events.
  • Seizure (fits).
  • More emotional/irritable than normal.
Symptoms of concussion

What you may be told by the injured person

  • Headache
  • Dizziness
  • Mental clouding, confusion or feeling slowed down.
  • Visual problems
  • Nausea or vomiting
  • Fatigue
  • Drowsiness/feeling like “in a fog”/difficulty concentrating.
  • “Pressure in head”
  • Sensitivity to light or noise.

Our sports medicine specialists utilize SCAT3 as a useful standardized tool for evaluating injured individuals for concussion and this can be used on clients from 13 years and older. A SCAT3 assessment consists of 8 sections:

  1. Glasgow Coma Scale
  2. Maddocks Score
  3. Symptoms evaluation
  4. Cognitive and Physical Examination
  5. Neck Examination
  6. Balance Examination
  7. Coordination examination.
  8. Delayed memory recall.

What to do next?
Immediate management of a suspected concussion.

In the sporting context, anyone with a suspected concussion must be immediately removed from play. Once safely removed from play, they must not return to activity that day.

If a neck injury is suspected, suitable guidelines regarding the management of this type of injury at pitch side should be followed.

In all cases of suspected concussion, it is recommended that the player is referred to a medical or healthcare professional for diagnosis and advice, even if the symptoms resolve.

Ongoing management.
Stage 1: Initial rest period:

Here at the National Sports Injury Clinic we have used best-practice and scientific research to deliver high quality concussion injury management to our clients. The immediate management of a diagnosed concussion is rest which needs to be in the form of both physical rest (resting the body) and cognitive rest (resting the mind).

This initial rest period, which has different mandatory time durations based on whether the individual is a professional or amateur athlete, age, number and frequency of previous concussions, etc.

Following the rest period, the individual will enter a graduated return to play protocol (GRTP) with a progressive exercise program that introduces them back to sport via a staged and systematic process.

Stage 2:
Stage 2 of the GRTP should only be started when a player:
  • Is symptom free at rest and has completed the mandatory rest period.
  • Has returned to normal work duties or education, if not a professional athlete.
  • Is not receiving drugs/medications that mask concussive symptoms, e.g. drugs for headaches or sleeping tablets.
Stage 2-5:

Stages 2 to 5 involve restricted, progressive training-based activity utilizing cardiovascular fitness, resistance training and sports-specific training.

Stage 6:

This involves return to full training and match play.

Under the GRTP protocol, an individual can only progress to the next stage if they had no symptoms at rest and at the current level of physical activity achieved in the current GRTP stage.

In the event of an individual developing symptoms at any stage of the GRTP program, the individual must return to the previous stage and attempt to progress again after a minimum mandatory rest period without symptoms (mandatory time period is dependent on age, athlete amateur/professional status). It is recommended that a medical practitioner confirm recovery and ability to complete Stage 5 – full contact practice.

If you would like to find out more about our Concussion Clinic, please click here