When UPMC first announced the establishment of the UPMC Sports Medicine Concussion Program in 2000, some said that “Pittsburgh could really lead the way” for concussion treatment.
And 25 years later, that’s exactly what has happened.
“We made a lot of promises on that first day,” says Michael “Micky” Collins, PhD, clinical and executive director of the UPMC Sports Medicine Concussion Program. “We said we were going to be evidence-based, we were going to treat patients, and we were going to unravel the mystery of this injury. And we delivered on those promises.”
The first-of-its-kind program is a global leader in diagnosing, treating, and researching this complex injury. It has set the standard for concussion care well beyond Pittsburgh.
World-renowned specialists at the UPMC Sports Medicine Concussion Program manage more than 20,000 patient visits every year. This includes everyone from kids to elite athletes to senior citizens. About 70% of those patients are student athletes, but concussions can happen to anyone.
Dr. Collins leads the program. He recruited research director Anthony Kontos, PhD, in 2010. The two reflect on a generation of transforming the lives of athletes and everyday people.
Changing the Game
The UPMC Sports Medicine Concussion Program changed the game when it comes to treating concussions. Research and treatment work hand in hand with a single purpose: helping patients safely return to the sports and activities they love.
Getting the best outcomes for patients meant learning more about the injury itself.
“Concussion is a complex injury,” says Dr. Kontos. “We say concussions ‘fight dirty’ — meaning that risk factors that patients bring to the table, like migraine or motion sensitivity history, will help drive which symptoms they have.”
More recently, the team broadened its research on concussion to focus on clinical trials and overall brain health.
“We want to be able to treat the patient using evidence-based interventions, no matter which type or types of concussion they have, and regardless of whether they are an athlete, in the military, or someone who was in a car accident,” says Dr. Kontos.
Types of Concussion
Research has uncovered that concussions involve different profiles or trajectories. These can present with different symptoms. There are five types of concussion, including:
- Anxiety/mood — Affects one’s feelings of worry, causing excessive stress and restlessness. It can also cause difficulty with social interactions.
- Cognitive fatigue — Affects mental tasks. These can include concentration, learning, and multitasking. They can also increase fatigue.
- Ocular — Affects visual tasks. These can include looking at screens on devices and following motion with both eyes. They can also include reading.
- Post-traumatic migraine — Affects the senses. This can cause headaches and nausea. It can also cause sensitivity to light or noise.
- Vestibular — Affects balance, motion, and vision. This can cause difficulties with hand-eye coordination.
Concussions can also affect your neck and how you sleep. Identifying the type of concussion you’ve sustained is the first step in determining the most effective treatment.
Innovative Techniques and Treatment
The road to recovery begins by learning more about the patient’s concussion itself. Every patient and every concussion is different.
“There is so much misinformation about concussion,” says Dr. Collins. “This is a highly treatable injury. Conventional treatment used to be telling patients to stay in a dark room and rest. That’s not the way to treat this injury. I love walking into exam rooms, meeting patients, and helping someone get better.”
“When patients come in today, they’re evaluated using a multi-domain assessment,” says Dr. Kontos. “That all leads to identifying what type of concussion you have and how we can target and treat that injury. Our research is all about improving clinical outcomes and having the evidence to back it up.”
In their research, UPMC experts have pioneered multiple tools to diagnose concussions. One of those tools is a test called ImPACT®.
Ideally, athletes take the test when they don’t have a concussion to provide a baseline. Baseline testing is available for kids as young as 5.
If an athlete gets a concussion, they take the test again. The difference in their scores helps determine a treatment plan and when it’s safe to return to the sport.
Vestibular ocular motor screening (VOMS) is another tool used in diagnosing types of concussion. It looks at the symptoms that integrate balance, vision, and movement.
Research shows that it’s 90% accurate in identifying a concussion. The experts at UPMC have also developed a new symptoms scale called the Concussion Clinical Profiles Screening (CP Screen) to evaluate the different types of concussions.
Depending on the type of concussion, the treatment plan can have many different aspects. These can include physical, behavioral, vestibular, and cognitive therapies.
An integrated, multidisciplinary team of clinicians develops a program for each patient. The key is to get the right treatment as soon as possible.
“We’ve learned so much about this injury,” adds Dr. Collins. “We know that girls take longer to recover than boys. We know that car sickness is a risk factor. We know that adolescents take longer to recover than adults. All of these things we know because of the research we’ve done. And we’re learning more every day.”
Global Impact
The UPMC Sports Medicine Concussion Program attracts both regular patients and professional athletes from all over the world to Pittsburgh. Patients have traveled from as far away as Canada, Denmark, Great Britain, Ireland, Israel, and New Zealand. They’ve also traveled from as close as just a neighborhood away for concussion treatment on Pittsburgh’s South Side.
Dr. Collins and the team also share their knowledge with clinicians globally and with the physicians who hope to follow in their footsteps. More than 40 fellows have studied at UPMC and are taking that knowledge around the country and the world.
“When I look at our program, I’m proud of the people who have passed through here and have gone on to start their own programs,” says Dr. Collins. “They are helping this field expand and grow and evolve.”
Under Dr. Collins’ leadership, the program has grown to include eight neuropsychologists and 35 faculty and staff members.
Looking Toward the Future
Much has changed in the field of concussion treatment since UPMC launched the program 25 years ago. What’s next?
“For a long time, we’ve been the tip of the spear, moving the field and the clinical care and the clinical research forward,” said Dr. Kontos. “I think the beauty of our program is that it’s evidence-based and rooted in clinical practice and great clinician training. All of that has allowed it to flourish.”
The ultimate goal isn’t just scientific advancement — it’s a world where concussion no longer represents a barrier to kids enjoying sports, or to their parents feeling safe about letting them play.
UPMC Sports Medicine partners with the Pittsburgh Penguins Foundation for HeadsUP Pittsburgh. HeadsUP Pittsburgh is a program that offers athletes discounted or free concussion baseline testing and educational programs during the summer. These programs help raise awareness about concussions and treatment, as well as the importance of concussion tests.
“I want no parent to feel that they can’t allow their kids to play sports because of their fear of concussion,” Dr. Collins says. “I want parents to know that it’s a fully treatable problem and if you bring them here, we have evidence and data to support that our treatments work.”
Learn more about UPMC’s concussion services and how to contact the UPMC Sports Medicine Concussion Program.