By Jeanne Davant, for UCHealth

Awareness of concussions has increased in recent years, in part because of more widespread media attention about brain injuries in professional athletes.

In Colorado Springs and Woodland Park, five concussion care clinics have been established to evaluate and treat these potentially serious brain injuries.

Dr. Nicholas Piantanida, UCHealth’s medical director of sports medicine and lead team physician for the University of Colorado Colorado Springs, was instrumental in rolling out those centers, but he wanted to do more.

Creating concussion evaluation programs

Knowing that young people playing sports are at higher risk, in 2019 Piantanida helped create a concussion evaluation program under which UCHealth partners with individual schools and school systems to provide medical expertise on the sidelines. A team of physicians and athletic trainers participate in the program.

“We watch the injury process as it unfolds,” Piantanida said. “We have a structured concussion assessment to look for evidence and signs of injury during that play.”

A neurological assessment is performed to look at ocular function, motion and strength of limbs, balance and coordination, and cognitive recall. When a deficit is found, the athlete is removed from play. Reassessment is performed at intervals on the sidelines and after the game in the locker room, using a computerized platform that tabulates and categorizes symptoms.

Follow-up is crucial, as symptoms can evolve 24 to 48 hours after the injury. Evaluation of the athlete continues during a six-step return-to-play protocol.

“As they negotiate those increasing steps of physical and cognitive activity, they can move on to the next phase,” Piantanida said. “If they have symptoms during one of the steps, that assessment is held for 24 hours and repeated the next day.”

Once the athlete is symptom-free and has completed the six steps, they can safely return to their sport or activity. The team also helps students obtain accommodations if they need additional time before returning to academic activity.

“We know that antioxidants are really important in our diet through the first several weeks of a concussion, so we talk nutritionally with our injured athletes and patients about high-antioxidant foods and direct them towards those,” he said.

Having sideline expertise and immediate attention is particularly important since concussion is considered a traumatic brain injury. The injury can happen with a direct impact to the brain, or it can be incurred though an injury that translates through the arm, shoulder or neck to the brain. No matter how it occurs, the injury can cause a dysregulation of blood flow and neurohormonal, visual, cognitive and motor function changes, as well as nausea, headache and dizziness.

With a second concussion, the changes happen more quickly and extensively.

“With second impact syndrome, the brain becomes edematous and swollen, and you have irreversible effects that cascade quickly, rendering the patient unconscious,” Piantanida said. “That is part of the reason why we monitor our athletes immediately and early.”

Sports health care for schools and sideline coverage

UCHealth provides sports health care to Falcon, Sand Creek, Sierra and St. Mary’s High Schools, The Classical Academy, Thomas MacLaren School and Fountain Valley School. In addition, it provides backup athletic training services at Academy School District 20 high schools including Rampart, Liberty, Air Academy, Pine Creek and Discovery Canyon.

Sideline football coverage is provided by physicians at Sierra, Falcon and Sand Creek high schools and at The Classical Academy. For the 2023-24 school year, an average of 22.5 sideline concussion evaluations were performed per high school, said Kevin Roberts, UCHealth’s manager of athletic training.

Piantanida and three other UCHealth physicians share duties in the UCCS Team Room, where concussion assessments and care coordination begin with athlete interactions.

“We see anywhere from two to six concussions a month,” he said.

Football games are a leading source of injuries, but concussions can happen in any sport from soccer to baseball.

In its overall concussion assessment program, UCHealth sees concussion injuries to patients from 12 to 90 years old at five locations in Colorado Springs and Woodland Park. Patients range from youth involved in school sports activities to weekend warriors and hikers, as well as older people who take a fall. But patients under 30 are nearly half of the patients who are treated at the five UCHealth concussion clinics in Colorado Springs and Woodland Park, and those from 19 to 30 are more than a quarter of the 330 patients who have been evaluated since the program started.

A rapid access protocol aims to have patients evaluated within 72 hours. An indication of the success of that early intervention is that half of the total number of patients complete treatment within four visits, said Frank Lozano, UCHealth’s manager of patient access.

With the concussion assessment program, UCHealth has “stood up a dedicated and diverse, multidisciplinary group where specialized clinicians treat patients with concussion. We see that they get treated over a series of at least two sessions or more, depending on the injury. And then our goal is to get them back to class, back to work, back to their activities.”