Treatment Guide

Concussions

Prompt treatment is key

Every year, an estimated 1.7 million Americans suffer a
concussion from falls, sports activities and car accidents.
Unlike many more visible injuries, the signs and symptoms
of a concussion may be very subtle, and thus much more
difficult to see. They also may be more difficult to treat.
Patients and those around them may be slow to recognize
the seriousness of a head trauma that leads to a concussion which may then cause delayed evaluation and
treatment. Educating yourself about concussions and their
potential dangers can help lead to more prompt recognition, and thus avoid any potential delay in not only the
evaluation, but the recovery as well.
At Cleveland Clinic Concussion Center, we are committed
to raising awareness about concussions to help ensure
patients of all ages receive early and appropriate care. It is
our goal to minimize long-term effects of concussions and
further research to improve tomorrows care.

USING THIS GUIDE

Please use this guide as a resource as you begin to explore
concussions and our treatment approach within Cleveland
Clinics Concussion Center. Remember, it is your right as a
patient to ask questions, and to seek a second opinion.

OUR CONCUSSION CENTER BRINGS TOGETHER EXPERTS

IN A WIDE NUMBER OF SPECIALTIES:

Sports and exercise

medicine physicians

Ophthalmologists/
optometrists

Neurologists

Neurosurgeons

Primary care physicians

Radiologists

Pediatricians

Psychologists

Physiatrists

Chiropractors

Certified athletic trainers Speech therapists

Physical therapists

Acupuncturists

Vestibular therapists

Massotherapists

Neuropsychologists

Researchers

Together, they accurately and promptly diagnose concussions, manage symptoms, monitor recovery, and help
patients return to their daily activities, as soon as safely
possible. Our team develops an individualized, customized
treatment plan for each patient, utilizing the most up to
date evidence and technology to guide care. Our team
approach is tailored to the specific needs of the patient,
with attention to the age, activities, concussion history,
and any impediments to the recovery process, including
identifying and treating any associated injuries that may
have occurred at the time of the head trauma.

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

What is a concussion?
A concussion is typically a short-lived brain injury caused by a
bump, blow or jolt to the head that causes a mild, transient disturbance of brain function. Most concussions occur without loss of
consciousness, and most do not cause brain swelling or permanent
brain injury.

What are the signs and symptoms

of a concussion?
Symptoms of a concussion can occur immediately, or even hours or
days after the initial hit or fall. Symptoms can change over time,
depending on activity level and potentially other associated injuries,
making them difficult to recognize and manage. The sooner the
injury is evaluated and treatment starts, the better. Anyone who
experiences any of the following symptoms after an injury to the
head should be evaluated by a healthcare provider.
Signs:
A dazed or stunned appearance
Personality or behavioral changes
Confusion
Loss of consciousness even brief
Clumsiness
Forgets plays or assignments
Seems out of it Forgetting events prior to or after a hit
Slow response to questions, or repeatedly asking questions
Symptoms:
Headache
Nausea
Balance problems
DID YOU KNOW?

Double, blurry or changed vision

Car accidents are the second leading

cause of concussion. However, concussions from traffic accidents cause more
deaths than concussions caused by
sports injuries or falls.

Sensitivity to light and/or noise

Excessive fatigue or drowsiness
Changes in sleep patterns
Trouble comprehending, concentrating and/or paying attention
Irritability, nervousness, feeling emotional or sad
Feeling just not right or in a fog

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Its important to know that concussion symptoms

often worsen with physical and mental activity, such
as using a computer, gaming system, texting, or any
activity that may increase your heart rate. It is recommended that you recognize and avoid the triggers that
worsen any of your symptoms.

and should be taken to the emergency room, if they

are experiencing any of the following symptoms:

Risk factors include:

Worsening headache

Individuals with a history of previous brain

impairment

Unusual, bizarre or irritable behavior

Younger individuals whose brains arent fully

developed

New clear watery discharge from the nose or ears

Previous concussion
Not wearing correctly fitting or worn out protective
equipment when working or playing sports

Increasing confusion, inability to recognize people

or places, significant decline in alertness
Nausea and repetitive vomiting
Pupils that are unequal in size

Seizures (arms and legs jerking uncontrollably)

Bloody discharge from the ears after injury
Fainting
Slurred speech

Careless or reckless behaviors

Declining level of consciousness

Ignoring the signs and symptoms of concussion

and continuing to play.

Weakness or numbness in arms or legs

Non-adherence to rules of play

Evaluating and treating

concussions
If an individual is suspected of having a concussion,
the most important thing is for them to be assessed
by a healthcare provider experienced in evaluating
and treating concussions.
A medical professional should provide a thorough
neurological examination. This includes a comprehensive history of the injury, a review of their concussion
symptoms, a pertinent physical exam to identify any
subtle abnormal findings or other injuries, balance
testing, and cognitive functions such as memory,
concentration and recall. No concussed athlete
should return to their sport that same day. Caution
should be exhibited in returning to school or work.
Recovery from a concussion isnt always smooth
sailing. Know that symptoms may worsen within the
first 48 hours. Anyone who has suffered a concussion
should be monitored closely during this period of time

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Steps to a rapid, but safe recovery:

The Three Rs:
1. Recognize your symptoms.
Identify and avoid triggers causing symptoms. Individuals should
steer clear of any activities that bring on symptomssome of the
most common include reading, studying, texting, watching TV, playing video games, or even just walking. Limit other common triggers
including light and noise.

2. Rest and Recover. Listen to your symptoms.

Allow your body and brain to rest immediately after the injury. If
symptoms arise during any activity, dont push through them; stop,
rest and recover before you return to the activity again. Sleep allows
the brain to heal. A good nights sleep can refresh the brain for the
next day so dont cut your sleep short. There are times when your
health care professional may suggest sleeping aids, if disordered
sleeping is inhibiting recovery.

DID YOU KNOW?

Children and teens are more likely to
get a concussion and take longer to
recover than adults.

Light and noise sensitivity should be managed with

sunglasses and noise-reducing devices.

Avoid alcohol immediately after the injury.

Dont mask your symptoms during waking hours. You may unintentionally push through activities and potentially hinder your healing
progress if you cannot recognize your symptoms. After an appropriate initial evaluation, if medications are needed for head or neck
pain, it is preferable to take them prior to bed to decrease pain that
may potentially interfere with restful sleep. Taking the medications
prior to sleep should not interfere with the recognition of symptoms
during other activities. If you have questions regarding medications,
contact a healthcare provider.

3. Return to activity.
The individual must be symptom-free, feel back to their normal
self, and cleared to return to school, work or play by their health
care provider. No one should pressure someone who has suffered a
concussion to return to their regular activities before theyre ready.

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

How long after a concussion can

individuals return to normal activities?
Appropriate relative physical and mental rest is the key to a successful and full recovery. Activities such as driving, riding a bike,
or using a computer, may need to be limited or eliminated while
recovering from a concussion. If an activity bothers the brain while it
is being performed, limit or avoid it.
If at any point signs or symptoms of concussion recur, the individual
should return to rest until they are symptom-free. The individual
should be symptom-free and cleared to return to school, work or
play by their healthcare provider.

What is the danger of returning to

activities too soon?
Individuals who resume activities too soon could suffer second-impact syndrome (SIS) or post-concussion syndrome (PCS). SIS occurs
when someone suffers another blow to the head while still healing
from a first concussion. While this is a rare occurrence, it is very
serious and can result in permanent brain injury, paralysis or death.
Post-concussion syndrome is a condition when recovery
from a concussion is delayed. Symptoms persist for
weeks, months or years. Additional therapies are
often prescribed to help individuals with PCS
recover from their injury.

When in doubt, it is
safer to sit it out.

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

How can concussions be prevented?

Concussions happen for a number of reasons not all of which are
entirely under an individuals control. But these general tips can help
reduce the chance of suffering a concussion:
For sports, use the proper sports equipment. It must be the correct
equipment for the game, be worn correctly, fit well, used every time, and
be in good condition. Always follow the rules of the game and practice
good sportsmanship.
Protect yourself on the roads. Always wear your seatbelt. Use the
appropriate helmet when biking, or riding a motorcycle. Never consume
alcohol or use drugs, and drive.
Use all necessary safety equipment at work to avoid injuries or falls.
For older adults, it is important to reduce any chances of a fall. They
should increase strength and balance with exercise, talk to their doctors
about any medications that make them dizzy, have regular vision checks,
and get rid of hazards in the home such as objects that are easy to
trip over and ensure they have adequate lighting.

Cleveland Clinic concussion team

on the sidelines
Our team utilizes its vast experience taking care of athletes at all levels
recreational, high school, collegiate and professional to provide
customized care to ensure a safe return back to sport. Our certified athletic
trainers provide care to athletes at more than 50 high schools and four
colleges in Northeast Ohio.

Special Protocols:
Cleveland Clinic has a comprehensive, multidisciplinary program that
utilizes special concussion protocols, which are helping improve care for
patients. These include:
DID YOU KNOW?
Playground injuries and bike riding
are the most common causes of concussion in children up to 9 years old.

Cleveland Clinic Imaging Our imaging center, when needed to assist in

the evaluation of head injuries, uses leading edge MRI scanners. Based on
the latest research and developments in imaging we designed and utilize
concussion specific protocols such as image sequencing, These Cleveland
Clinic-designed sequences are used to examine patients who have sustained a concussion. This testing helps detect more subtle signs of injury
than other more commonly used MRI sequences.

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Specialized protocols used in the emergency room also help determine which patients would benefit most from CT scanning, helping
avoid unnecessary radiation exposure.
Return to play Cleveland Clinic has specialized protocols designed
to help transition athletes with concussion back to play in the safest
manner possible. A Return to Learn protocol also helps students
appropriately continue their studies.
Neurocognitive assessment and rehabilitation Cleveland Clinic
neuropsychologists specialize evaluating memory and thinking
problems that may occur following head trauma. Using this testing
and other specially designed assessments, our speech therapists will
develop a tailored program of cognitive rehabilitation to help patients
recover.
Physical therapy Cleveland Clinics physical therapists use specific
criteria to evaluate patients and provide rehabilitation for head and
neck discomfort, balance, function and pain management.
Chronic head and neck pain We provide unique multidisciplinary
care for children through our Pediatric Chronic Pain Program and
for adults in our Interdisciplinary Method for the Assessment and
Treatment of Chronic Headache (IMATCH) program.
Sleep evaluations For patients who have suffered a concussion
and are having trouble sleeping, Cleveland Clinic offers individualized evaluations and treatment.

CONCUSSION CENTER BY THE NUMBERS

6,000 baseline assessments performed annually
1,200 + patients evaluated for concussions
6 concussion-related active research projects
61 athletic trainers
83 physical therapists, including 17 with
special training in treating dizziness and balance
dysfunction

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Cleveland Clinic Concussion app

Changing the trajectory of sports concussion care, the Cleveland
Clinic Concussion (C3) mobile application is a tool used for assessing concussion symptoms. Cleveland Clinic athletic trainers used
the C3 app to conduct baseline assessments of motor and cognitive
function in nearly 11,000 high school and college athletes who
play contact sports across Northeast Ohio and in several locations
throughout the United States. After baseline data are collected, the
C3 app can be utilized to document the individuals impairments, to
assist in managing symptoms, and to help determine when recovery
is complete. The C3 app compares assessments of balance, reaction
time, memory and vision after a hit to baseline and normative data.
The app-based assessment pinpoints the areas of most concern and
helps guide therapy over time.

The Trust
Cleveland Clinic has been named a medical partner for The Trust, a
clinical program powered by the NFL Players Association. A team of
clinicians provides a two-day brain and body assessment for former
NFL players at one of three sites: Cleveland Clinic main campus,
Cleveland Clinic Florida (Weston, Florida), and the Lou Ruvo Center
for Brain Health in Las Vegas, Nevada. The clinical team is made up
of neurologists, internal medicine physicians, neuropsychologists,
health behavior psychologists, radiologists, physical therapists and
dietitians. For more information about our partnership with The
Trust, call 216.445.9815.

Above: Cleveland Clinic Main campus,

Cleveland, OH
Cleveland Clinic Florida, Weston, FL
Lou Ruvo Center for Brain Health, Las
Vegas, NV

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Convenient Locations

LAKE COUNTY

Lake Erie

Cleveland Clinic
Willoughby Hills

Cleveland
Clinic
Avon Lake
Cleveland
Clinic
Cleveland
Avon
Clinic Avon
Pointe

Cleveland Clinic
Cleveland
Clinic
Westlake

Childrens
Hospital for
Rehabilitation
Fairview
Hospital

Cleveland Clinic
Middleburg Heights
Orthopaedics and
Cleveland Clinic Rehabilitation
Strongsville

LORAIN COUNTY

Cleveland Clinic
Beachwood

GEAUGA
COUNTY

Cleveland Clinic
Independence
Sports Health
Center

CUYAHOGA COUNTY

Hillcrest Hospital

Cleveland
Clinic Solon

Cleveland Clinic
Twinsburg

Cleveland Clinic
Chagrin Falls
PORTAGE
COUNTY

SUMMIT COUNTY
MEDINA
COUNTY

Cleveland Clinic
Brunswick
(WAYNE COUNTY)

Ready to make an appointment?

Evaluations and management for concussions, from an interdisciplinary and experienced team

Same-day appointments. Call 877.440.TEAM.

Evaluations and management for concussions, from an interdisciplinary and experienced team located across
Northeast Ohio and beyond.
Visit clevelandclinic.org/concussion for more information.
Get information on injury prevention, strength and conditioning and nutrition, as well as heatlh tips for athletes
and coaches. Sign up for our free Competitive Edge newsletter at sports-health.org/competitiveedge. Find tips
on the latest sports concerns and trends for the younger athlete. Sign up for our free KidSports newsletter at
clevelandclinic.org/kidsports.

877.440.TEAM (8326) | clevelandclinic.org/concussion

CLEVELAND CLINIC | CONCUSSION | TREATMENT GUIDE

Connect with Cleveland Clinic

Get tips for raising a healthier family. Sign up for Parents Be Well
e-newsletter at clevelandclinicchildrens.org/parentsbewell.
Like us on Facebook at facebook.com/clevelandclinic

Explore our services, locations and more at clevelandclinic.org

Find a wealth of family health & wellness tips at
health.clevelandclinic.org

MyChart
Cleveland Clinic MyChart is a secure, online personal healthcare
management tool that connects patients to their medical record.
Patients can register for MyChart through their physicians office or
by going online to clevelandclinic.org/mychart.

877.440.TEAM (8326) | clevelandclinic.org/concussion

14-CON-911