Concussion 101 for SLPs

The rationale for addressing mild traumatic brain injury (mTBI)/concussion is to bring attention to a growing national health problem, to increase public awareness, and to encourage graduate students and practicing speech-language pathologists to have on hand the latest information about this significant health issue. This issue includes the work of four speech-language pathologists, three kinesiologists, a physical therapist, a pharmacologist, a biochemist, three researchers, a physician, and several graduate students. Most of them work collaboratively in the University of Texas at El Paso Concussion Management Clinic.

This issue addresses mTBI in the adult population. The terms concussion and mild traumatic brain injury are used interchangeably. Outstanding specialists in a variety of disciplines discuss the diagnosis, treatment, and prevention of mTBI, including cognitive-linguistic, balance, pharmacology, and behavioral assessment as well as short- and long-term management practices for collegiate, professional, and amateur athletes following a concussion. Frequently when the topic of concussion is discussed, thoughts go to professional sports and the possibility of these individuals to develop chronic traumatic encephalopathy. However, one should also consider the variety of amateur sports activities that adults in the United States participate in: club soccer, community baseball and softball leagues, touch football leagues, rugby clubs, all-terrain vehicles, basketball leagues, lacrosse, swimming, and officiating/umpiring these games. Sport is basic to all cultures. Outlawing sports is not going to happen. Given that all of these activities put an individual at increased risk for concussion and the potential short- and long-term dysfunctions that may impact the individual's academic, economic, and social activities, speech-language pathologists must be prepared to help reduce the long-term risks to individuals who suffer a concussion.

The sequence of the articles in this issue begins with the pathophysiological consequences of concussion, then moves to discussion of cognitive-linguistic and balance assessment, then on to descriptions of the forms of prevention. The hope is to help speech-language pathologists understand that there are several open questions about the assessment, diagnosis, treatment, and prevention of concussion in adults.

Dr. Wright begins the journey with a description of the role of the physician and the nature of the medical workup. A concussion is a pathological disruption of the metabolic status of the brain as the result of an accelerating-decelerating movement of the brain associated with a hit to the body or head or both. Dr. Dominguez and Ms. Raparla describe the basics of the metabolic cascade that characterizes concussion and more specifically mild concussion. Understanding the pathophysiology is crucial in the diagnosis and treatment of concussion. The care of individuals with concussion in the community setting is described by Ms. Crawford and Dr. Sirmon-Taylor. Dr. Bene and Ms. Sepulveda describe the history of behavioral assessment of concussion in the collegiate setting. They provide a useful perspective on the past and the need for continued research in the future. Dr. Reed-Jones and her colleagues describe the current status of the assessment of balance dysfunction in individuals with concussion. They also offer useful clinical advice for the practicing speech-language pathologist. Dr. Rivera describes the role of drugs in the remediation and control of symptoms in concussion and moderate to severe TBI and describes the impact the various drugs have on cognitive-linguistic and swallowing behavior. Postconcussion syndrome assessment and treatment from a physical therapist's perspective is described by Dr. Diaz. The issues surrounding the prevention of concussion and the use of models to understand this issue are discussed by Drs. Lo and Sirmon-Taylor. The prevalence of motor speech disorders associated with concussion is unknown; Dr. Cannito reviews what we do know and describes a standard assessment protocol for individuals with concussion. Speech-language pathologists are strategically placed across the continuum of medical care and educational settings to have a major impact on the prevention of sports- and recreation-related concussion. Finally, Drs. Lim and Salvatore describe the potential gap between imaging neurologic status in the acute phase and during recovery and measures of behavioral recovery. The apparent disconnect between these two is a crucial area of research that will impact the diagnosis and treatment of concussion and potentially reduce the long-term effects of repeated concussions. Their article implies that a conservative approach to return to play/daily activities/classroom is needed until the nature of neurologic recovery is clear.

Finally, as Guest Editor, I would like to thank Dr. Audrey Holland, Editor of this journal, for the opportunity to address this health issue and for her incredible editorial abilities and her patience with me. Also thanks to the publisher for permitting me to cover the breadth of these issues. Special thanks to the authors in this issue whose ongoing research and clinical expertise made this volume possible. Thanks to our predecessors who developed the foundations for the care of adults with concussion. In the end, however, without the support of my wife, Penny Salvatore, RN, I would not have completed the work in this issue.