What is a Concussion Clinic?

After experiencing a concussion, it is often overwhelming to decipher what treatment options are out there and which ones would be the most beneficial to pursue. This piece is taken out of the equation at a concussion clinic through a multidisciplinary team of healthcare providers who will create a personalized recovery plan.

Doctors and Treatments may include:

Initial Intake Process

The initial intake process is designed to set the patient up for the best path to recovery. Dr. Steven Flanagan (NYU Langone physiatrist) helped outline the following steps:

  • A complete physical exam testing not only reflexes and strength but auditory and visual systems as well. If more than 6 weeks after injury, the physician may refer the patient to a psychologist for neurocognitive testing.

  • The physician will ask about how the injury occurred as well as the date of the injury. Have a timeline prepared for previous concussions, how long recovery took, and symptoms experienced after each concussion.

  • Other medical histories will be discussed, including any known learning disability, a history of migraines, or any previous mental health issues. After sustaining a concussion, these can be exacerbated, and knowing your entire medical history will allow the physician to consult with the best team of doctors for each patient.

  • Finally, the providers want to know who the patient is outside the injury. The psycho-social history (what is going on in the patient’s life beyond just the concussion) may provide the most insight into why recovery is taking longer.

Timeline for Treatment

Timeline with a brain on the left, then what to do immediately after a concussion (to to the ER), then what to do 48-72 hours after a concussion (see your healthcare provider) then what to do at 3-4 weeks after a concussion

This flowchart, created by Julia Brzac (2021 Concussion Alliance Intern), explains the timeline for treatment after sustaining a concussion including which providers to seek care from. Click here or on the image for a printable PDF.

You can seek care from a concussion clinic immediately after injury, after consulting with a primary care provider, or if symptoms are not clearing up on their own after 3-4 weeks. However, when seeking treatment from a concussion specialist, the earlier the better. Dr. Flanagan noted that in all cases, during the initial physical examination, the physician should check the cervical spine in case of injury. Then, if needed, they will refer you to physical therapy and schedule a follow-up because neck injuries cannot stabilize on their own.

After locating a clinic, the intake process will begin. Aside from what the provider screens for, it is crucial to self-advocate by describing any symptoms that weren’t addressed. The physician is working in the patient’s best interest and will consult the appropriate providers regarding the next step. If the clinic is not local, or you cannot conveniently seek in-person care, there may be an option to do the initial intake and some treatments over the phone. The clinic can also work with you to schedule all necessary in-person appointments in the same week for lower travel costs and convenience.

Just like how every concussion is different, every treatment plan is different.

The Science Supporting Multidisciplinary Care

Inbal Eshel: Why an Interdisciplinary Team of Specialists is Crucial to Patients with Brain Injury

A multidisciplinary approach to treatment is a relatively new paradigm in the realm of concussions. The 5th International Consensus Statement stressed the importance in 2016, stating, “A detailed multimodal clinical assessment is required to identify specific primary and secondary pathologies that may be contributing to persisting post-traumatic symptoms. At a minimum, the assessment should include a comprehensive history, focused physical examination, and special tests where indicated (e.g., graded aerobic exercise test).”

At the University of Pittsburgh, a study was conducted on military personnel to determine the impact of multidisciplinary care. They found an overall decrease in symptoms and improved verbal memory, smooth ocular pursuits, vestibular ocular reflexes, visual motion sensitivity, convergence distance, and Activities-specific Balance Confidence (ABC) score.

Deciding Between a Concussion Clinic and a Rehabilitation Center

When looking for a treatment center, both concussion clinics and rehabilitation centers are an option. Dr. Elizabeth Sandel helped provide the following insight and differentiation between the two facilities.

A concussion clinic is a relatively new type of practice that only treats those who have sustained a concussion. They may be staffed with a physician specializing in sports medicine. Unless it is very large, most concussion clinics do not have on staff many of the professionals necessary for concussion rehabilitation, such as physical therapists. If a patient needs physical therapy, they will be referred elsewhere. Some concussion clinics only accept athletes, or they only accept “young adult” athletes, so they don’t provide services for adults.

Rehabilitation centers have been treating traumatic brain injuries, including concussions, for much longer. Rehabilitation centers can be outpatient or inpatient centers with all of the disciplines represented within the same practice, often in the same building; outpatient centers are appropriate for concussion patients.

Outpatient rehabilitation centers can be ideal because they have on staff many of the professionals necessary for multidisciplinary team management of concussion. These staff typically include physical therapists, occupational therapists, speech-language pathologists (for cognitive rehabilitation), and neuropsychologists.

When deciding between these two facilities, a potential factor may be the timeline of the injury. A concussion clinic aims to help resolve post-concussion symptoms and those still within the typical recovery time frame of 3-4 weeks. (Although long wait times to get into a concussion clinic may make it difficult to get care in a timely manner.) A rehabilitation center is typically for those who are still experiencing persistent symptoms beyond the standard recovery period (3-4 weeks).

What to Look for in a Concussion Clinic

When deciding which clinic to go to, the Canadian Concussion Collaborative has identified four questions to ask before making an appointment:

  • Does the clinic have a medical doctor?

    • During the initial intake process, it is imperative that the physician is knowledgeable about concussion and be the point of contact for treatment. This physician is responsible for ruling out other potential health issues, making the appropriate referrals, and providing a suitable plan for return to work, play, and/or school.

  • Does the clinic have a team of licensed health care professionals?

    • The clinic should have a publicly available list of its providers in many different disciplines, whether the clinic is a virtual practice with each provider in a different location or on-site, such as a hospital. Critical specialties to look for include neurology, physiatry, physical therapy, and vision therapy. For a more extensive list, refer to the top of this page.

  • Does the clinic follow the most up-to-date standards of care for managing concussions?

    • You can find the most current standards of care in the 5th International Consensus Statement. This statement is from 2016, with the following consensus in 2020 delayed due to COVID-19. This next consensus is meeting in 2021 and is expected to include a recommendation for vision therapy.

  • What tools, tests, and recommendations is the clinic using?

    • Identifying the best treatment plan following a concussion includes testing for persistent symptoms, changes in mental functions, imbalance, cervical spine issues, changes in mood, and response to exercise and neurological functions.

If the answer to any of the above questions was “no,” then that clinic is not practicing the best and most up-to-date practices.

If the answer was “yes” to all the above questions, still watch out for the following red flags:

  • If the clinic has additional fees for treating concussions

  • If there are testimonials given on the clinic’s website

  • If the clinic claims to use a universal treatment “proven” to improve a patient’s recovery

3rd-party Resources

The Concussion Legacy Foundation has a useful tip sheet on what to look for in a concussion clinic.

Additional Resources

How to Find a Concussion Clinic

To find a clinic near you, click here. The link will send you to the Concussion Legacy Foundations locator tool. It will prompt you to enter your zip code and provide you with the closest clinics to your home.

Brainline has a locator tool by state. After clicking the link, find your state on the map and click on it; there will be a list of options for you. This list is ordered alphabetically, and not best to worst. Look for your state’s non-profit organization for concussions or brain injury. Your state-based organization may have Brain Injury Alliance or Brain Injury Association in the title. Not every state has an alliance/association but will have another non-profit organization for concussion or brain injury. There are a few states, such as Texas, that don't have any nonprofit for concussions or brain injury. Once you find your state’s non-profit, call the organization to ask for the best clinics in your area. Look for a phone number connected with a help-line or resources.

Note: Concussion Alliance is not affiliated with CLF, Brainline, or any other organization or clinics listed on their websites.