Concussion Evaluation and Treatment
A concussion clinic led by neuropsychologists: ImPACT testing, a clear picture of the injury, and treatment instead of rest.
Navigating the Concussion Clinic
What Is Concussion Evaluation and Treatment?
Concussion evaluation and treatment is specialty care for a mild traumatic brain injury: a structured assessment of how the injury has affected thinking, mood, sleep, and daily function, followed by a targeted treatment plan matched to those findings. A concussion changes how the brain works without showing up on a scan, which is why the concussion clinic starts with the evaluation, not the imaging. That’s where the answers are.
The advice people get after a concussion still leans on rest: a dark room, no screens, wait it out. It’s usually given with care, but the research has moved on. Concussions are treatable, and the evidence points toward early specialty care and a gradual return to activity, not toward avoidance. Our neuropsychologists specialize in how the brain impacts behavior. They use a multimethod evaluation, including ImPACT testing, the Vestibular/Ocular Motor Screening (VOMS), and questionnaires, to treat the headaches, fogginess, poor sleep, and low mood in a holistic way, with a plan that gives you something to do besides wait.
What Are the Symptoms of a Concussion?
Concussion symptoms fall into six areas: physical (headache, nausea, dizziness, fatigue), thinking and memory, sleep, mood, balance and vision, and sensitivity to light and noise. They can start within minutes or surface over the following days. Two people with the same injury often look nothing alike, which is one reason a concussion is easy to miss and easy to underestimate.
Physical Symptoms
Thinking and Memory
Sleep Changes
Mood and Irritability
Balance and Vision
Light and Noise Sensitivity
Persistent post-concussion symptoms are those that last past the initial few weeks and even these symptoms respond well to treatment.
Which Warning Signs Need Emergency Care?
Go to an emergency department or call 911 for any of the signs below:
A Worsening Headache
Not a headache that comes and goes, but one that builds steadily over hours instead of easing off.
Repeated Vomiting
Being sick once can happen after a concussion. Being sick again and again is a different signal.
A Seizure
Any seizure after a head injury, however brief, and even if the person seems fine afterward.
One Pupil Larger Than the Other
Compare both eyes in the same light. A new difference in pupil size counts, however small.
Slurred or Garbled Speech
Words that come out wrong, or speech that sounds unlike the person, in the hours after the hit.
Unusual Drowsiness
Someone much sleepier than normal, or hard to rouse from sleep, isn’t simply resting it off.
Increasing Confusion or Agitation
Someone who gets more disoriented or more restless as the hours pass, rather than settling down.
Weakness or Numbness
New weakness, numbness, or tingling in an arm or a leg that wasn’t there before the injury.
Any Loss of Consciousness
Loss of consciousness regardless of duration is an immediate sign of a concussion, but a more prolonged loss of consciousness should be evaluated by a physician. Even loss of consciousness for a few seconds could possibly warrant neuroimaging.
Once a physician has seen you for any of these, the concussion evaluation can start. Nothing on this page replaces emergency care, and if you’re unsure, treat it as an emergency.
Why Does Early Specialty Care Matter?
Early specialty care matters because the first week changes the odds, and the numbers are specific: in a study of 162 patients aged 12 to 22, those first seen at a concussion clinic 8 to 20 days after the injury took longer than 30 days to recover 81% of the time, compared to 48% of those seen within the first week. In a separate study of 3,063 children seen in emergency departments, follow-up showed that 1 in 3 children still had persistent symptoms 28 days later.
5.8x
Higher Odds of a Prolonged Recovery When Seen Late
Patients first seen 8 to 20 days after injury, compared with those seen within 7 days (adjusted odds ratio 5.8). Source: Kontos et al., 2020, JAMA Neurology.
1 in 3
Children Still Had Symptoms Four Weeks After a Concussion
Of 3,063 children aged 5 to 17 enrolled at nine emergency departments, 31% of the 2,584 who completed follow-up had persistent symptoms at 28 days. Source: Zemek et al., 2016, JAMA.
What Are the Five Concussion Profiles?
There are five profiles that the University of Pittsburgh Medical Center’s concussion group outlines below in its clinical profiles screening, and most people experience more than one. Our neuropsychologist concussion specialists’ job is to evaluate which profiles are leading your symptoms and provide specific treatments. Not every profile responds to the same treatment.
| Profile | What It Looks Like |
Anxiety and Mood | Worry that spikes with every symptom, low mood, or a fear of doing the thing that set it off. Often the last piece to settle. |
Cognitive and Fatigue | Fog, slowed thinking, and a tiredness that arrives after mental effort rather than physical effort. School and screen work drain the tank fast. |
Migraine | Headache with light or noise sensitivity and nausea, in a pattern that behaves like a migraine whether or not you had them before. |
Ocular | Eyes that struggle to track, focus, or work together. Reading a line of text or scanning a busy room becomes tiring within minutes. |
Vestibular | Dizziness, unsteadiness, and motion sickness. Moving or crowded places, like a hallway between classes or a long car ride, make it worse. |
The same screening names two modifiers, sleep and neck symptoms, that can sit on top of any profile and slow the whole picture down.
What Happens in a Concussion Evaluation?
A concussion evaluation uses several methods together: ImPACT testing, the Vestibular/Ocular Motor Screening (VOMS), self-report questionnaires, and a clinical interview. The findings become a plan matched to you.
Here’s what the evaluation covers.
A Clinical Interview
We go through your symptoms, your sleep, your mood, how school or work is going, and what your health looked like before the injury. This is where the story of the injury gets filled in.
ImPACT Testing
ImPACT is FDA-cleared, computer-based testing of memory, processing speed, and reaction time after a concussion. It runs as short tasks on a screen, and a neuropsychologist reads the result in context rather than as a score standing on its own.
Vestibular/Ocular Motor Screening (VOMS)
A short screening of eye movements and how the eyes and head work together, checking whether they bring on symptoms such as headache, dizziness, nausea, or fogginess.
Self-Report Questionnaires
Questionnaires you fill out about your symptoms and how you’ve been feeling since the injury.
Findings and a Plan
The findings become a plan matched to you: what to ease back into this week, when to return to school or work, and a staged return to sport.
Coordination With Your Referrer
With your permission we share what we found with the athletic trainer, pediatrician, or physician who sent you, so everyone is on the same page helping you get back to your baseline.
How Do Psychological Factors Affect Recovery?
Psychological factors impact how the injury takes shape and how quickly an individual may recover: a history of anxiety, depression, or migraine before the injury, and depression or headache in the weeks after it, are all linked to a slower recovery.
What the Research Shows
A systematic review of 101 studies found that a history of mental health difficulties before the injury raises the risk of persistent symptoms, and that depression and headache in the weeks afterward are likely risk factors too. In a study of 600 pediatric patients at concussion specialty clinics, those with a history of migraine, anxiety, or depression recovered more slowly.
Why a Neuropsychologist Is on the Team From the Start
Neuropsychologists are well-trained to account for symptoms such as anxiety, low mood, and disrupted sleep within the context of a concussion. Treating them early is part of treating the concussion instead of something that waits until the headaches ease.
What Are the Treatment Options After a Concussion?
Treatment after a concussion follows a targeted plan matched to the profiles the evaluation found: behavioral strategies such as graded physical activity and sleep guidance, treatments such as vestibular or vision therapy when they fit, and a staged return to sport, rather than open-ended rest. In a study of 2,413 children and adolescents, those who returned to physical activity within a week of the injury were less likely to have persistent symptoms a month later than those who rested.
Treatment Matched to Your Profiles
Vestibular, ocular, migraine, cognitive and fatigue, anxiety and mood: each profile gets its own strategies. Your neuropsychologist builds the plan around what’s driving your symptoms, and because recovery is rarely a straight line, adjusts it at each follow-up as your symptoms change.
Behavioral Strategies for Concussion
Behavioral management strategies specific to concussion: gradual exposure to the stimuli and environments that bother you, sleep guidance, and graded physical activity. They bring structure to the foggy weeks, when the hardest part is knowing how much you’re up to.
Treatments We May Recommend
Depending on what the evaluation finds, your plan may also include vestibular therapy, vision therapy, physical therapy, physical activity and exertion, psychotherapy, or psychiatric medications, each recommended when your profiles call for them.
Getting Back to School, Work, and Sport
Many people go back to school and work right away. Return to contact sport is staged, with testing rather than the calendar deciding when you’re ready. Going back is a process, not a date, and follow-up checks how it’s going.
Is the Concussion Clinic Available Online?
Yes, which can mean access to specialty care for all individuals. Secure video conferencing removes the barrier of access to a concussion specialty neuropsychologist.
In Person in Pennsylvania
The concussion clinic runs in person at our Pennsylvania office in Bala Cynwyd, just outside Philadelphia, for families close enough to come in.
Online Across the PSYPACT States
Sessions can happen by secure video wherever the PSYPACT compact reaches. The PSYPACT map shows which states are in.
Fewer Barriers in the Way
A missed school day, a parent’s shift that can’t move, a car ride that makes symptoms worse: telehealth removes the reasons an appointment gets postponed.
The Same Team When Life Moves
A student who goes away to college, or a family that travels for a season, keeps the same neuropsychologist instead of starting over somewhere new.
What Are the Common Myths About Concussions?
Each of these myths changes what somebody does in the first week, and that’s the week that matters most.
Fact. A blow to the body that whips the head and neck hard enough, as in whiplash, will do it. Plenty of concussions happen without the head touching anything at all.
Fact. Only a minority of concussions involve any loss of consciousness: in one season of 544 high school concussions, under 5% did. Most people stay awake through the injury and walk away or off the field under their own power.
Fact. People recover faster with a gradual return to activity than with prolonged rest. Waiting it out in the dark is the advice the research moved away from.
Fact. A CT rules out bleeding and fracture, which is worth knowing. It can’t see a concussion, because a concussion is a change in how the brain works rather than in how it looks.
Fact. A helmet prevents skull fractures and bleeds, and that’s reason enough to wear one. It can’t stop the brain moving inside the skull, and that movement is the injury.
Fact. Different brain systems recover at different rates, which is why a return to contact sport should follow objective testing rather than the calendar.
How Do You Get a Concussion Evaluation?
Getting a concussion evaluation starts with a call, the contact form, or a free consultation for parents and patients, and the Patient Referral Form for athletic trainers, physicians and pediatricians. The first days after a concussion are the ones that matter most, so the path in is short. Here's exactly what happens, from the first contact to a treatment plan.
Reach Out or Refer
Parents and patients can call us, fill out the contact form, or schedule a free consultation. Athletic trainers, primary care physicians, and pediatricians can refer a patient through the Patient Referral Form.
A Quick Screening Call
Our team will call to hear how and when the injury happened, what’s changed since, and whether the emergency warning signs have been ruled out. If you’d rather skip the phone, this step can happen over email.
Intake and Evaluation With a Neuropsychologist
Your neuropsychologist starts with an intake. ImPACT testing, the VOMS, and a detailed clinical interview, taken together, then give you a treatment plan specific to you.
Your Treatment Plan
A plan specific to you: what to do this week, what to ease back into, when to return to school or work, and a staged return to sport. Follow-up tracks the plan and adjusts it.
Who You'll Work With at the Concussion Clinic
The neuropsychologists below administer the ImPACT test, complete the evaluation, and lead the concussion treatment that follows.
Concussion Clinic Evaluator
Tori Togashi
Ph.D. · Clinical Psychologist
- Licensed in Pennsylvania
- Online
Dr. Tori Togashi is a licensed clinical neuropsychologist at the Rowan Center for Behavioral Medicine. She has specialized experience in traumatic brain injuries, neurodegenerative disorders, spinal cord injuries, and other types of nervous system insults. She completed a two-year fellowship at University of Pittsburgh Medical Center’s Sports Medicine Concussion Program.
Read Tori’s full profile
Concussion Clinic Evaluator
Bindal Mehmel
Ph.D. · Clinical Psychologist
- Licensed in Pennsylvania
- PSYPACT telehealth
- In person and online
Dr. Bindal Mehmel is a clinical neuropsychologist at the Rowan Center for Behavioral Medicine. She specializes in concussion and mild traumatic brain injury, following completion of a two-year fellowship in sports concussion at the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program. She has also worked with athletes and understands the unique psychological factors they may experience.
Read Bindal’s full profileWhy Choose Rowan's Concussion Clinic?
Our neuropsychologists specialize in how the brain impacts behavior, so a concussion is treated as what it is: an injury that affects thinking, mood, sleep, and daily life all at once. Your physician rules out the injuries that need a scan. We treat the one that doesn't show up on it.
The first weeks decide the length of a recovery, so the evaluation is the first appointment, not the fifth. The odds in the research above belong to the people who were seen early, and the clinic is built around getting there.
You'll find ImPACT at plenty of clinics. What's different here is who reads it. The neuropsychologist who interviewed you weighs your score against your sleep, your mood, and your history, so the number never stands alone.
Vestibular, ocular, migraine, cognitive, anxiety and mood: the evaluation shows which profiles are driving your symptoms, and the plan treats those, not a generic checklist for "concussion."
When an athletic trainer, pediatrician, or physician refers a patient, the findings go back to them with the patient's permission, in plain terms: which profiles are active and what the plan is. Return-to-learn and return-to-play stay shared decisions.
A migraine history, anxiety, or a sleep problem that predates the injury changes how a concussion recovers, and our neuropsychologists account for them as part of the concussion. The parts of your history that matter to this injury are handled here, not at a second clinic.
The concussion clinic runs in person at our Pennsylvania office in Bala Cynwyd, just outside Philadelphia, and by secure video across the PSYPACT states, so a student away at college can keep the same team.
Questions About the Concussion Clinic
Who does the concussion clinic see?
The concussion clinic sees athletes from youth sports through college, students whose grades or attendance have slipped since a head injury, and adults hurt at work, in a car, or in a fall, including older adults whose concussion symptoms get mistaken for something else. We see people in the first days after an injury and people whose symptoms have already dragged on for months. Both benefit from an evaluation, though earlier is better. Treatment here focuses on the concussion, and if therapy for other concerns would help, we'll connect you with another psychologist in our practice for that. Parents and patients can contact us, and athletic trainers, primary care physicians, and pediatricians can refer a patient through the Patient Referral Form.
Is it too late if the concussion happened weeks or months ago?
No. Persistent symptoms after a concussion respond to treatment even when the injury is months old, because the evaluation identifies which profiles are still active, such as vestibular, ocular, migraine, cognitive, or anxiety and mood, and each one has treatments that work. Earlier care is associated with a faster recovery, which is a reason not to wait any longer, not a reason to give up. If you've been resting and avoiding activity for a long stretch, part of the plan is a careful, graded return.
What is ImPACT testing, and what does it involve?
ImPACT is a computer-based cognitive test, cleared by the FDA for concussion management, that measures memory, processing speed, and reaction time. It runs as a series of tasks on a screen, and we use it as one part of the evaluation alongside the Vestibular/Ocular Motor Screening (VOMS), questionnaires, and a clinical interview about your symptoms, sleep, mood, and history. The score isn't a diagnosis on its own. It's a measurement a neuropsychologist reads in context, and it gives us something objective to track as you recover.
Does insurance cover concussion evaluation and treatment?
Rowan is in-network with Medicare, Aetna, and Cigna, and credentialed with Tricare East and West as non-network providers. Most of our providers can also bill Medicare Advantage PPO plans and accept the out-of-network copay, without balance billing. For other out-of-network PPO plans we provide a superbill, and our team can walk you through what to ask your insurer about a concussion evaluation and ImPACT testing before your first appointment. Full details are on our payment information page. Psychological care usually runs through your behavioral health benefit, so ask about that benefit specifically when you call your insurer.