Cobblestone Medicine And Rehab Centre
Concussion Therapy and Testing Program

To Schedule An Appointment OR To Book Your Concussion Testing Procedures;
Please Call: (519) 442 -2237
For Concussions it is important to get into the clinic as soon as possible

Our Community Team Partners

Paris Mounties Junior C Hockey, Brantford Minor Hockey, Brantford Minor Girls Hockey, Ayr Minor Hockey, Paris Minor Hockey, Brantford Soccer, Brantford Swimming, Burford Minor Hockey, Brantford Bisons Football, London Football, Semi-professional Paris Lacrosse, Paris Ringette, Ayr Ringette and Cambridge Ringette

What Is A Concussion?

“Concussions are defined as a COMPLEX pathophysiological process affecting the brain induced by traumatic biomechanical forces.” (Zurich, 2008)

A concussion is a type of traumatic brain injury that results from a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth creating a whiplash effect. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells (axons) and creating biochemical changes in the brain not due to bleeding, tearing or bruising of the brain. Concussions result in temporary alteration of mental functioning. Furthermore this can include physical, emotional/social, cognitive symptoms and sleep disturbances. Signs and symptoms can be delayed appearing hours or days later. Concussions cannot be seen on X-ray or CT scan. Concussions do not have to be a result of loss of consciousness. When a student is injured and has a second concussion while he/she still has symptoms from a previous concussion which can lead to permanent disability and even death. The second injury may be very mild but can progress and have serious consequences.

Concussions are caused by a sudden shift of the brain in the skull. This quick shifting of the brain causes the brain to have altered function and metabolic properties resulting in a variety of symptoms that can range from mild to severe. Even blows to the body, face or head can result in shearing effects leading to rotation injuries as well as flexion/extension injuries.
Note: Most gold standard imaging techniques such as MRI and CT will also show up as negative.

Diagnostic Criteria

Concussion/mTBI is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic, and biomechanical injury constructs that may be utilized in defining the nature of a concussion/mTBI include:

1. Concussion/mTBI may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an‘‘impulsive’ force transmitted to the head.

2. Concussion/mTBI typically results in the rapid onset of short-lived impairment of neurological function thatresolvesspontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes tohours.

3. Concussion/mTBI may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.

4. Concussion/mTBI results in a graded set of clinical symptoms that may or may not involve loss of consciousnessResolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged. (MTBI guidelines)

Signs and Symptoms Of A Concussion

Recognition of the signs and symptoms are crucial when diagnosing a concussion. Symptoms can vary from physical dysfunctions, mental disturbances, emotional changes and sleep changes. These symptoms will vary from patient to patient.


May include: Dazed, confusion, reduced memory, “unsureness”, clumsy, slowly answers questions, possible loss of consciousness, and slower behaviour.


May include: Headaches or intense pressure in head, Concrete head feeling, nauseau or vomiting, reduced balance, dizziness, blurred vision or problems tracking objects, sensitivity to light or noise, slowed down, fatigue, reduced memory, reduced concentration and “does not feel right”.

Red Flags – Get Medical Help ASAP!fe9431ca6fcd47ce278f7440c29011bd

1. Progressive worsening headache
2. Worsening vomiting and nausea
3. Unequal dilated pupils
4. Decline in mental status
5. Deteriorated sleep habits

Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if an athlete exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. “When in doubt sit them out.” It is important to notify a parent or guardian when an athlete is thought to have a concussion. Any athlete with a concussion must be seen by an appropriate health care provider before returning to practice (including dryland/weight lifting) or competition.

“Having even just one sign or symptom may be a sign that the athlete has had a concussion and should be looked at by a experienced health professional dealing with head injuries”

What Can We Do To Prevent Concussions

Regardless of the steps taken to prevent injury, some students will continue to be injured. The severity of the injury can be mitigated by the following:

1. Education for coaches, staff, parents and students to:
a) Recognize the symptoms of concussion;
b) Remove the athlete from play;
c) Refer the athlete to a physician.
2. Wearing the protective equipment appropriate for the sport engaged in:
a) Equipment should fit properly;
b) Equipment should be well maintained;
c) Equipment should be worn consistently and correctly
3. Students should follow their coaches’ rules for safety and the rules of the sport
4. Instruct absent student/athletes on previously taught safety skills prior to next activity session
5. Parents need to teach their child that it is not smart to participate in sports if they received a head injury
6. It is not a badge of honour to play injured
7. Discourage others from pressuring injured students to play
8. Parents/coaches must not convince the child/student that he/she is “just fine”
9. Sharing of information with the school and the school coaches about any concussions the student may have suffered in the past
10. Provide reassurance, support and request/offer academic accommodations as needed
11. Outline the risks associated with the activity/sport for a concussion
12. Demonstrate how the risks can be minimized e.g. teach proper sport techniques – correct tackling in football, effective positioning in soccer, how to avoid over-crowding when using the creative playground. Take attendance in class and interschool sports and instruct absent student/athletes, on previously taught safety skills, prior to next activity session
13. Document safety lessons e.g. date, time, brief content, list of students in attendance
14. Teach skills in proper progression
15. Enforce the rules of the sport
16. Emphasize the principles of head-injury prevention e.g. keeping the head up and avoiding collision
17. Eliminate all checks to the head
18. Eliminate all hits from behind
19. Check that protective equipment is visually inspected prior to activity and well maintained20. Enforce the principles of: respect for the rules of the game and practice fair play

Our Advanced Rehab Process

At Cobblestone Medicine and Rehab we use collaberative rehabilitation care using the latest evidence and research to get the individual back to their NORMAL life as soon as possible.

  • Proper Pacing and detailed concussion education
  • Impact Concussion testing (Baseline and post injury testing will be completed on the first visit and usually 2-4 weeks thereafter)
  • Our Multidisciplinary Rehab team including physiotherapy, chiropractic, acupuncture, counselling, kinesiology and family medicine physician.
  • Visual/ocular rehab, balance rehab, strength/stretching exercises, gait analysis, postural analysis and heart rate/BP analysis
  • Proper return to learn techniques following evidence based methods
  • Proper return to play/sport following evidenced based methods
  • Final Sign off with our clinic family medicine physician and/or referral back to patients family physician


Current recommendations are for a stepwise return to play program. In order to resume activity, the athlete must be symptom free and off any pain control or headache medications. The athlete should be carrying a full academic load without any significant accommodations.

Finally, the athlete must have clearance from an appropriate health care provider. The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often require a very different return to activity program and should be managed by a physician that has experience in treating concussion.

The following program allows for one step per 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity, notify their healthcare provider before progressing to the next level. When returning, the athlete must start with the step last completed successfully.
Stage 1 – Complete cognitive and physical rest
Stage 2 – light aerobic exercise
Stage 3 – Increase sport specific exercise
Stage 4 – Non contact practise
Stage 5 – Full contact practise
Stage 6 – Return to Full Activity

Other Sources for Concussion Information

The following web links and organizations have information, videos and interactive games for parents, teachers and students on concussion recognition, prevention and management. Some organizations such as Bikes Boards and Blades will make school visits targeting grade 2/3 students at no cost.

Bikes, Boards and Blades Education Program: Hamilton Brain Injury Association. (905) 538-5251

OREGON CENTER FOR APPLIED SCIENCES, INC. (has concussion information and recognition tool apps available for mobile phones) (a brief but informative video for young children and adults describing the cause, signs, symptoms and recovery of concussions) (has e learning modules for coaches from the National Coaching Certification Program. Currently the modules are free and they are working on some sport specific modules. They take 60-90 minutes to complete)

Researchers: Gender Does Not Play Role in Athletes’ Responses to Sports-Related Concussions

Written by Us!

Cobblestone Rehab’s Concussion Articles:

Our start to finish Concussion management team will get your athlete back to sport and school as soon and as safely as possible! Despite prevention strategies listed above, head injuries will still occur. Our staff and volunteers who are involved in intramural or inter-school athletics or any part of the health and physical education curriculum will not be held personally liable in a civil proceeding for an act or omission if the person acts reasonably in the circumstances and in good faith.

If you have ANY questions or concerns about your athlete, please call us as soon as possible, we are here to help!