THESPORTSINSTITUTE CONCUSSION … patient have a baseline ImPACT test? Yes No Does patient have a...

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THE SPORTS INSTITUTE CONCUSSION MANAGEMENT PROGRAM DIRECTIONS TO THE SPORTS INSTITUTE The Sports Institute is located at 555 Route 17 South in Ridgewood. From Route 17 Northbound: Take the Hollywood Avenue/Ho-Ho-Kus exit and follow the U-turn signs onto Route 17 South. Stay in right lane. Building 555 is immediately after the Park & Ride facility. From Franklin Turnpike: Take Franklin Turnpike through Ho-Ho-Kus. Bear left at the split for Race Track Road and Route 17 South. Bear right onto Route 17 South. Stay in the right lane. Building 555 is immediately after the Park & Ride facility. From The Valley Hospital to 555 Building: Turn right onto North Van Dien Avenue. Turn right at the end of North Van Dien onto East Glen Avenue and follow road around cemetery. Turn right onto Banta Street. Turn right at the end of Banta Street onto Race Track Road. Bear right onto Route 17 South. Stay in the right lane. Building 555 is immediately after the Park & Ride facility. THE VALLEY HOSPITAL SPORTS INSTITUTE CONCUSSION MANAGEMENT PROGRAM 555 Route 17 South, Ridgewood, NJ 07450 Phone: 201-447-8133 Fax: 201-251-3253 Referral Information Patient Name Referring Doctor Address Office Phone Office Fax Email How would you prefer to receive test results?: ■ Phone ■ Fax ■ Email ■ Mail ■ Patient Date of injury Does patient have a baseline ImPACT test? ■ Yes ■ No Does patient have a baseline balance test? ■ Yes ■ No If yes, please provide facility name and contact information If No, test results will be compared to normative data. Services Available ■ Comprehensive post-injury concussion assessment (includes ImPACT test(s) and all services listed below) OR select the services you would like: ■ Follow-up post-injury ImPACT test ■ Balance, coordination, reaction-time assessment ■ Symptom severity assessment ■ Return-to-play activity progression plan Services are provided by The Valley Hospital Sports Institute based on a fee schedule. Payment is required at time of service with check or credit card. 2/14 The Valley Hospital Sports Institute 555 Route 17 South Ridgewood, NJ 07450 201-447-8133 www.ValleyHealth.com/SportsMed www.Facebook.com/ValleyHospital www.Twitter.com/ValleyHospital www.Pinterest.com/ValleyHospital www.YouTube.com/ValleyHospital www.Instagram.com/TheValleyHospital Concussion Mgnt Broch:Layout 3 2/21/14 2:30 PM Page 1

Transcript of THESPORTSINSTITUTE CONCUSSION … patient have a baseline ImPACT test? Yes No Does patient have a...

Page 1: THESPORTSINSTITUTE CONCUSSION … patient have a baseline ImPACT test? Yes No Does patient have a baseline balance test? Yes No If yes, please provide facility name and contact information

THE SPORTS INSTITUTE

CONCUSSIONMANAGEMENT

PROGRAM

DIRECTIONS TOTHE SPORTS INSTITUTE

The Sports Institute is located at 555 Route 17 Southin Ridgewood.

FromRoute 17Northbound:Take theHollywoodAvenue/Ho-Ho-Kus exit and followtheU-turn signs onto Route 17 South. Stay in right lane.Building 555 is immediately after the Park&Ride facility.

FromFranklin Turnpike:Take Franklin Turnpike throughHo-Ho-Kus. Bear left at thesplit for Race Track Road andRoute 17 South. Bear rightonto Route 17 South. Stay in the right lane. Building 555is immediately after the Park&Ride facility.

FromTheValleyHospital to 555Building:Turn right ontoNorthVanDienAvenue. Turn right at theend ofNorthVanDien onto East GlenAvenue and followroad around cemetery. Turn right onto Banta Street.Turn right at the end of Banta Street onto Race Track Road.Bear right onto Route 17 South. Stay in the right lane.Building 555 is immediately after the Park&Ride facility.

THE VALLEY HOSPITALSPORTS INSTITUTE CONCUSSION

MANAGEMENT PROGRAM555 Route 17 South, Ridgewood, NJ 07450Phone: 201-447-8133 Fax: 201-251-3253

Referral Information

PatientName

ReferringDoctor

Address

Office Phone

Office Fax

Email

Howwould you prefer to receive test results?:

�� Phone �� Fax �� Email �� Mail �� Patient

Date of injury

Does patient have a baseline ImPACT test? �� Yes �� No

Does patient have a baseline balance test? �� Yes �� No

If yes, please provide facility name and contact information

If No, test results will be compared to normative data.

Services Available�� Comprehensive post-injury concussion assessment

(includes ImPACT test(s) and all services listed below)OR select the services you would like:�� Follow-up post-injury ImPACT test�� Balance, coordination, reaction-time assessment�� Symptom severity assessment�� Return-to-play activity progression plan

Services are provided by The Valley Hospital Sports Institute based on a fee schedule. Payment is required at time of service with check or credit card.

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The Valley Hospital Sports Institute 555 Route 17 SouthRidgewood, NJ 07450

201-447-8133www.ValleyHealth.com/SportsMed

www.Facebook.com/ValleyHospitalwww.Twitter.com/ValleyHospitalwww.Pinterest.com/ValleyHospitalwww.YouTube.com/ValleyHospitalwww.Instagram.com/TheValleyHospital

Concussion Mgnt Broch:Layout 3 2/21/14 2:30 PM Page 1

Page 2: THESPORTSINSTITUTE CONCUSSION … patient have a baseline ImPACT test? Yes No Does patient have a baseline balance test? Yes No If yes, please provide facility name and contact information

related concussions. ImPACT is suitable for athletes ages 10 and older. It is a 20-minute battery of computerized neurocognitive evaluations, including measures of verbal and visual memory, attention span, brain processing speed, and reaction time.

Ideally, athletes first complete a baseline ImPACT test and a baseline balance test prior to playing sports. If an athlete subsequently experiences a concussion, he or she is re-testedand the baseline data is compared to the post-concussion datato monitor recovery and determine when it is safe for theplayer to return to active sports.

THE VALLEY HOSPITAL SPORTS INSTITUTE CONCUSSIONMANAGEMENT PROGRAMThe Sports Institute is recognized as a trusted resource in theprevention and treatment of sports related injuries with a staffof licensed athletic trainers and a network of orthopedic andsports medicine specialty physicians. The Sports Institute isnow offering the ImPACT test and the BioSwayTM balance testfor young athletes diagnosed with a concussion.

WE CAN PROVIDE:� Baseline ImPACT neurocognitive and BioSway balance testing on scheduled dates or by appointment

� Post-injury concussion assesment and testing by appointment� Neurocognitive assessment reports, comparison to norms,and follow-up testing

� Balance, coordination, and reaction-time assessment� Symptom severity assessment� Medical referral information� Educational resources� Return-to-play activity progression plan and supervised progressive exercise plans

Printed test results will be compared to baseline data and/ornormative data providing valuable information for yourphysician to make critical return-to-play decisions.

For more information or to schedule concussion management testing, contact the Sports Institute at 201-447-8133 or e-mail [email protected].

CONCUSSION MANAGEMENT STEPS� Anytime during a practice or game that an athlete experiencesany sign(s) or symptom(s) of a concussion – the athleteshould discontinue play for that day.

� Seek medical attention to evaluate injury.� Monitor symptoms; if symptoms worsen, go immediately to the nearest emergency room.

� If applicable, take a follow-up ImPACTTM cognitive test within 2-3 days following the injury.

� Return to physical activity only after being symptom-freeand only after being cleared by a medical professional experienced in treating concussions.

� When cleared by a medical professional with experience in treating concussions, an athlete may begin a supervised progressive return to physical activity. The progressionshould be from low intensity, non-contact activities to more intense game simulation activities and spread over several days.

� Stop activity if any symptoms return and seek medical attention.

BASELINE TESTINGAt the forefront of proper concussion management is the implementation of baseline and post-injury neurocognitive and balance testing. Such testing can help to objectively evaluate thepost-injury condition and track recovery for safe return to play,thus preventing the cumulative effects of concussion.

ImPACTTM (Immediate Post Concussion Assessment andCognitive Testing) is a user-friendly, computer-based testingprogram specifically designed for the management of sports-

An athlete experiencing any signs or symptoms of a concussion should be removedfrom play that day and should not be allowed

to return to any activity until evaluated and cleared by a medical professional.

CONCUSSION IS BRAIN INJURY

Aconcussion is a mild, traumatic brain injury usuallyoccurring after a blow to the head. Although the major-ity of athletes who experience a concussion are likely to

recover, an unknown number may experience chronic cognitiveand neurobehavioral difficulties related to recurrent injury. This constellation of symptoms is referred to as post-concussionsyndrome,which can be disabling and, in some cases, permanentfor an athlete.

In addition to post-concussion syndrome, suffering a secondblow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of secondimpact syndrome. Second impact syndrome is a life-threateningcondition in which a second concussion occurs before a firstconcussion has properly healed, causing rapid and severe brain swelling. Second impact syndrome can result from even a very mild concussion that occurs days or weeks after the initial concussion.

Signs and symptoms of a concussion can show up right afterthe injury or may not appear or be noticed until days or weeksafter the injury.� Headache � Dizziness � Confusion � Disorientation� Nausea � Fatigue � Memory Loss

If your child reports any symptoms of concussion, or if younotice the symptoms yourself, seek medical attention rightaway. Concussion severity varies widely, and the number of signs and symptoms vary also. Serious injuries may showfew symptoms. In fact, less than 10 percent of concussed athletes lose consciousness.

Athletes that are not fully recovered from an initial concussionare significantly vulnerable for recurrent, cumulative, and evencatastrophic consequences if another concussive injury occurs. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return-to-play decisions arecarefully made. No athlete should return to a sport or other at-risk participation when symptoms of concussion are presentand recovery is ongoing. In summary, the best way to preventdifficulties with concussion is to manage the injury properlywhen it does occur.

Concussion Mgnt Broch:Layout 3 2/21/14 2:31 PM Page 4


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