Head games: Football, TBI and AOA’s brain injury manual

February 5, 2016
With football top of mind, learn 5 things doctors should know about concussions.

Sports clichés run amok for super Sunday: True, it's important to keep your head in the game on football's biggest stage, but not in the bruising way players experienced this season.

Concussions clocked a four-year high (271) across the NFL in 2015, marking a 31% increase from 2014 and shattering a three-season downward trend, according to league data released Jan. 29. And Sunday's super stars didn't escape 2015 unscathed, either. Combined, the Denver Broncos and Carolina Panthers reported nine head injuries this season that cost practice or game time.

This news only fans the flames on the larger discussion about sports and head injuries, in general, and it's one that doctors of optometry prove vitally instrumental.

Knowing how to properly diagnose and manage traumatic brain injury (TBI) is increasingly important for doctors of optometry working on multidisciplinary care teams. To help guide these clinical responsibilities and others, the AOA Vision Rehabilitation Section (VRS) produced the Brain Injury Electronic Resource Manual (BIERM), Volume 1A: Traumatic Brain Injury Visual Dysfunction Diagnosis,—and—Volume 1B: Traumatic Brain Injury: Optometric Management and Advanced Topics

5 things doctors of optometry should know about concussions

With football top of mind, here are five things doctors of optometry should know about concussions, from AOA Vision Rehabilitation Section Immediate Past Chair Brenda Heinke Montecalvo, O.D.

  1. Know the causes and risks. Football may be the obvious culprit, but certain girls' sports also put teens at risk of head trauma. Girls' soccer games have one of the highest rates of concussions among high school sports, and high school cheerleading practice leads the way as the riskiest sport among girls (tied with girls' field hockey practice). And remember that even basic falls and everyday accidents can lead to concussion.

  2. When diagnosing a concussion, go beyond visual acuity, visual field and visual motor tests. Examine a patient's visual thinking process, including spatial orientation, visual memory and problems with figure-ground organization. "There are over 20 different visual skills that can be affected after a TBI," Dr. Montecalvo says. The Visual Motor Integration Test and Test of Visual Perceptual Skills are two assessments that can provide good information about visual perceptual skills, she says.

  3. Know whom to refer a patient. Have updated contact information ready for local neurologists and retina specialists.

  4. Consider proactively testing patients' reaction time. A threshold visual field test can be used to screen peripheral reaction time and awareness for most children older than 7, Dr. Montecalvo says. A  University of Cincinnati study of the school's football team showed lower concussion rates after incorporating visual training into practice, teaching players to improve their peripheral vision, hand-eye coordination, visual processing and ocular motor performance. The training allowed players to avoid a hit or at least prepare to take a hit, as opposed to being blind-sided.

  5. Raise awareness in your community about concussions' effects on vision. Present educational sessions at community events, and ask patients about head injuries and falls during routine exams: "Have you had your bell rung hard this year?"

"When it comes to concussions, optometrists can be proactive in helping prevent and provide early assessment and treatment," Dr. Montecalvo says. "By providing regular comprehensive eye health and visual examination for athletes, they may be able to prevent long-term negative effects from injury."

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