Concussion diagnosis, treatment evolves

Concussion treatment has evolved over the years, and Stephanie Aldret, D.O., with The Core Institute at Louisiana Orthopedic Specialists at the Acadian Medical Center, is working on a concussion research study with members of the Louisiana Ice Gators hockey team.
“It used to be, if you weren’t knocked out, then you didn’t have a concussion,” Aldret said. “We have come a long ways from there. Now, its usually found that if you are knocked out from a head injury, that usually your recovery is going to be a little bit faster. It’s almost like hitting a reboot on a computer or control-alt-delete.
“Even now, a headache is usually the traditional sign of what we see from a concussion, but now you don’t even have to have a headache (to be suffering from a concussion).”
Aldret, a doctors of osteopathic medicine who specializes in non-surgical orthopedic care, spoke to the Eunice Rotary Club on Wednesday.
“The way I describe a D.O. is to take an M.D., a chiropractor, a massage therapist, put them all together, and you’ve got me, she said. “From the chiropractic and massage therapy side of stuff, I can crack and pop. I can work a lot within the body. The cracking and popping is not my favorite thing to do whenever it comes down to the manipulation side of stuff.
“If I have a patient who is needing manipulation and they are seeing a chiropractor, then I do different stuff. The two can coexist somewhat together for a patient’s optimum health.”
Aldret said that some injuries do not always require surgery, and there are many means of non surgical relief for injuries.
“The Core Institute gives people more options,” Aldret said. “A lot of the injuries we have, whether it’s overuse or a new injury that happened, doesn’t necessarily need surgery. Or surgery isn’t necessarily in your vocabulary, and if surgery is something you want to totally stay away from altogether, that’s where I provide some different options.”
In addition to manipulation, fracture care and dry needling, Aldret also does steroid injections, regenerative joint injections and PRP or platelet rich plasma injections.
“PRP is where we draw your blood, spin it down and then inject that into that joint,” she said. “It re-coats and regrows that area and decreases pain, so those are other options that are available before a knee replacement. The knee is the joint we most commonly have problems with, but it (PRP injection) can go for any area.”
With her concussion work, Aldret serves as one of the team physicians for the University of Louisiana at Lafayette football team, and she also works with Acadia Parish football teams, mainly Church Point High School. Her research work with the Louisiana Ice Gators centers around treating repetitive head injuries. This is the first year of the study, and data is being gathered. The ice hockey season is still in session, and Aldret hopes to have some ideas about the study this summer.
“We are looking at some of the measures of what we do right now, baseline and impact scores, computer based tests that we look at and how the brain functions and balance, tracking eye movement and a neurological exam,” Aldret said. “We are also looking at blood proteins.”
In the future, the study may also make use of helmet sensors, which Aldret said are already being used by Louisiana State University’s football team, to register different forces and MRI components that look at the displacement of water.
“The idea behind all of this is to come out with something that is readily available to people, something we can use with junior high and high school athletes,” Aldret said. “Athletes always want to know how many head injuries are too much. Parents want to know that, too — where is the line where we have to hang it up?
“If we can give a definitive measure of that and not a guess of what we think is best practice then that will give us a little more, take the gray out of it and make it a black and white issue.”
When it comes to concussions, the injury is often caused by a direct head blow, blunt force trauma, whiplash or rotational force. Aldret said she defined a concussion as anything that is an disruption of neurological function due to either a rotational or whiplash injury or direct blow, and symptoms of a concussion include dizziness, fatigue, sensitivity to light, sensitivity to noise, nausea and feeling confused or disoriented.
“Typically it takes 36 to 72 hours for concussion symptoms to peak, and that’s where a lot of things have changed,” Aldret said. “It used to be, if somebody gets hit in the head, they see stars for a second, shake it off, everything is fine and they go back into the game. Well, we have only seen the beginning of what that injury, that insult, so we are going to have to take them out of the game to see if injury has peaked.
“If there is nothing else that seems to pop up, after 24 hours, then, OK, you just got bumped in the head, it’s not a concussion. But if their symptoms change, if it’s something where they persistently have a headache that can’t be prescribed to anything else or they have a difference in attitude, put it together that they probably have a concussion.”
Aldret said rest is the most important part of treating a concussion, and once a person’s headache or any other symptoms start to subside, then that person can be integrated back into school and activities. The doctor also prescribes supplements to patients suffering from a concussion.
Treatment of a typical concussion lasts about seven to 10 days, but each concussion is different.
“They are kind of like snowflakes,” Aldret said. “Each one can be very unique and different.”