Help is just A-Head!

Help is just A-Head!

by evergreenpt, August 24, 2017

Interview with Dr. Elisabeth Ashoff, DPT: Busting concussion myths and learning how PT can help prevent and treat concussion injuries.

Written by Tabitha Wang

If you’re a parent like me, you freak out at the slightest bump to the head your kid gets, toddling around the room on their unsteady feet. I try to reign in the crazy by checking off all the symptoms that I vaguely remember as signs of a concussion: lethargy, vomiting, dizziness. It only works about half of the time. The other half of the time I’m frantically texting my medically inclined friends for reassurance.

Or, maybe, you’re on the opposite end and are the epitome of the three C’s: cool, calm, and collected when your dare devil kid takes a dive, head first, off the couch for the hundredth time. Whichever camp you find yourself in, it never hurts to be better informed.

What exactly is a concussion and how do we, as parents of active and athletic kids recognize, prevent, and get the right treatment for concussion injuries? I sat down with Dr. Elisabeth Ashoff, DPT; our resident concussion specialist here at Evergreen, to discover just these things in the hopes that the next time a child takes a fall we can get them the right help, right away.

How would you describe a concussion to a non-medically trained person, like me?

Let me first start by correcting the most common myth about concussions: concussions can be seen on imaging, such as an MRI or X-Ray.

In actuality, you can’t see a concussion on an MRI, CT scan, or X-Ray, which is what people commonly have done after a head injury. Imaging is used primarily to rule out more life threatening conditions, such as bleeds in the brain.

In the simplest terms, a concussion is a bruise to the brain, and though may not be life threatening, is still a brain injury. Often times bruising occurs much deeper in the brain than just on the surface, from side to side or whiplash injuries. Such injuries can go as deep as the corpus callosum, also known as the bridge between the left and right hemispheres of the brain. This is the part of the brain that research has shown to atrophy the most after traumatic brain injuries.

Currently, we recognize concussions through subjective clinical testing after the event and without a baseline understanding of what the individual was like before it can make concussions more difficult to both diagnose and treat correctly. An example would be situations where the individual had pre-injury learning or attention deficits that are escalated after a concussion.

What should I do if I think my child might have a concussion?

If you notice your child is feeling or acting differently, bring them to a doctor, physical therapist, or athletic trainer who are specifically trained to rule out concussion symptoms. Children may try to minimize symptoms in order to get back to playing sports quickly, however this can be extremely detrimental to their recovery, especially if they sustain a second concussion while still in the process of healing from the first one. This can result in prolonged recovery and possibly even greater damage to the brain. This tendency to jump back into activity before a concussion has healed, makes concussions the one injury where it takes kids longer to heal than adults.

What can you do, as a physical therapist, for people who have suffered concussions?

At Evergreen, we now provide ImPACT testing when we first see the patient for a concussion, which provides a baseline for neurocognitive function. The ImPACT test is a validated testing measure for neurocognitive function following a concussion. Ideally, your child should have an impact test prior to even having a concussion, this ensures we have accurate baseline data of their neurocognitive function prior to injury. Because a concussion can not be seen on imaging, we rely on this validated measure to compare pre and post concussion neurocognitive function. This allows us to  keep track of the progression throughout their treatment and towards recovery, as we are able to compare it back to the first baseline test.

In regards to physical therapy treatment, we also treat underlying balance, vestibular, and occular-motor deficits that contribute to dizziness, difficulty concentrating, or reading in school. A big part of what we do is help the patient  return to the activity of their choice. If they’re an athlete, we take recovery a step further and progress them properly into a graded exertional program. As they increase their activity, we are tracking vitals signs and response to sport specific activity to ensure they are returning to sport symptom free. Concussion treatment is a multi-disciplinary approach. Doctors, Physical Therapists, and in some cases Ophthalmologists will work together to treat all aspects of a concussion. The medical doctor will give the final “ok” for official return to sport.

What is the best advice you can give for a young athlete who may have suffered a concussion?

Don’t minimize or play the injury off if you feel like you might have a concussion. Get medical attention quickly so that you can recover faster and avoid more serious injuries in the future along with any lasting symptoms that may occur. No pain, no gain is not part of the concussion language. While the prevention of concussions is not always possible, athletes’ awareness and honest communication of symptoms is the next best thing.



“A well-managed concussion is the best form of prevention”

Dr. Michael “Micky” Collins, executive director, UPMC Sports Medicine Concussion Program.  Source:



If you’d like to learn more about ImPACT testing and read other resources about concussions, please click on the links below.


The information and reference materials contained here are intended solely for the general information of the reader. It is not to be used for treatment purposes, but rather for discussion with the patient’s own physician or physical therapist. The information presented here is not intended to diagnose concussions or to take the place of professional medical care.

Originally published on August 24, 2017

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