Office-based concussion evaluation, diagnosis, and management: adult

Concussion is a major public health concern, with an estimated 1.6-3.8 million sport-related concussions occurring annually in the United States. Although the majority of injured athletes recover within 7-21 days, 20-30% of athletes experience protracted recovery spanning more than a month, suggesting as many as 320,000-760,000 athletes may experience prolonged symptoms. This highlights the need for efficacious clinical interventions to facilitate recovery. While concussion was historically conceptualized as a homogeneous injury, a more nuanced understanding has recently emerged and led to a refined approach of categorizing concussions into clinical trajectories or symptom profiles. These categorizations correspond with targeted rehabilitation strategies focused on specific symptom clusters and deficits. Multidisciplinary teams, with collaborating neuropsychologists, neurologists, neurosurgeons, sports medicine physicians, athletic trainers, and physical therapists, are valuable to concussion management due to the heterogeneous nature of the injury. This chapter will provide an overview of a multimodal, clinical profile-based approach to assessment and targeted treatment of athletes with sport-related concussion. We describe a profile-based model for conceptualizing the injury, review relevant modifying factors, discuss components of a comprehensive assessment, and examine targeted treatment approaches.