Concussion

A concussion may occur when the head hits an object, or a moving object strikes the head. A concussion is a minor or less severe type of brain injury, which may also be called a traumatic brain injury. A concussion can affect how the brain works for a period of time.

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Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious. It is important to know that if somebody shows or reports one or more of the following signs and symptoms listed below, or simply say they just “don’t feel right” after a bump, blow, or jolt to the head or body, they may have a concussion or more serious brain injury and must be removed from play until they are cleared by a medical professional.

Signs and symptoms generally show up soon after the injury. However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. The injured person should be monitored especially in the early stages of a concussion, and the signs of concussion should continue to be checked for a few days after the injury. If the concussion signs or symptoms get worse, you should seek medical attention immediately.

The pocket Concussion Recognition Tool shown below is a great printable sheet that coaches, sports trainers and parents could have on the sideline to use as a non-medical professional to determine whether the athlete has a concussion in the absence of a trained medical professional being available for assessment.

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Available free online: http://bjsm.bmj.com/content/47/5/267.full.pdf

The brain needs time to heal and rest post-concussion, and those with symptoms or who return to play too soon—while the brain is still healing—have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the first injury can be very serious and in the worst case scenario could even be fatal.

Determining when the player has recovered so that they can safely return to competition

The decision regarding the timing of return to play following a concussive injury is a difficult one to make. Expert consensus guidelines recommend that players should not be allowed to return to competition until they have recovered completely from their concussive injury. Currently, however, there is no single gold standard measure of brain disturbance and recovery following concussion. Instead, clinicians must rely on indirect measures to inform clinical judgment. In practical terms this involves a comprehensive clinical approach, including:

  • A period of cognitive and physical rest to facilitate recovery
  • Monitoring for recovery of post-concussion symptoms and signs.
  • Neuropsychological testing to estimate recovery of cognitive function.
  • Graduated return to activity with monitoring for recurrence of symptoms.
  • A final medical clearance before resuming full contact training and/or playing.

Period of cognitive and physical rest to facilitate recovery

Early rest is important to allow recovery following a concussive injury. Physical activity, physiological stress (e.g. altitude and flying) and cognitive loads (e.g. school work, videogames and computers) can all worsen symptoms and possibly delay recovery following concussion. Individuals should be advised to rest from these activities in the early stages (initial 24 to 48 hours) after a concussive injury, particularly while symptomatic. Similarly, the use of alcohol, opiate analgesics, anti-inflammatory medication, sedatives or recreational drugs can exacerbate symptoms following head trauma, delay recovery or mask deterioration and should also be avoided. Specific advice should also be given on cessation of activities that place the individual at risk of further injury (e.g. driving, operating heavy machinery).

(McCrory et al., 2013)

Tests for Concussion & Brain Injury

A medical provider may do a scan of the injured players brain (such as a CT scan) to look for signs of a more serious brain injury. Other tests such as “neuropsychological” or “neurocognitive” tests may also be performed. These tests help assess your child or teen’s learning and memory skills, the ability to pay attention or concentrate, and how quickly he or she can think and solve problems. These tests can help the child’s medical provider or physiotherapist identify the effects of the concussion.

Baseline testing can be done pre-season to determine a level for re-evaluation if a concussive injury is suspected during the season, and this can be carried out through your RHP Physiotherapist in the form of a SCAT-3 test.

A concussion can be a scary injury, particularly for those who are monitoring the injured athlete or player and determining the best course of action. If in doubt, always get the person checked by a health professional as soon as possible. If there are any signs and symptoms of deterioration, loss of consciousness or any of the red flags above get the person to the Emergency Department/call 000 for assistance and management. It is also important to note that through the mechanism of injury to cause a concussion, signs of spinal injury must be monitored and if suspected do not move the injured player, follow first aid protocol, and call 000 immediately.

References:

http://www.cdc.gov/headsup/pdfs/highschoolsports/parents_fact_sheet-a.pdf

http://bjsm.bmj.com/content/47/5/267.full.pdf

McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., . . . Turner, M. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5), 250-258. doi:10.1136/bjsports-2013-092313