KEYS TO CONCUSSION MANAGEMENT

Goals

  • Recognize that a concussion has occurred.
  • Remove athlete from activity.
  • Treat the athlete.
  • Determine when it is safe to return to activity.

Recognition

What is a concussion?

  • “A concussion, or mild traumatic brain injury, is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. Disturbance of brain function is related to neurometabolic dysfunction, rather than a structural brain injury, and is typically associated with normal structural imaging findings (CT scan, MRI).
  • Concussion may or may not involve loss of consciousness.
  • Concussion results in a constellation of physical, cognitive, emotional, and sleep-related symptoms. Symptoms may last from several minutes to days, weeks, months, or even longer in some cases.” – CDC Physicians tool kit

Sign & Symptoms

Signs: Things observed by others.

  • Dazed or stunned
  • Vacant stare
  • Confusion
  • Amnesia
  • Unsure of surroundings
  • Answers questions more slowly
  • Repeatedly asks the same questions
  • Balance problems
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Retrograde amnesia (unable to recall events prior to hit or fall)
  • Antegrade amnesia (unable to recall events after the hit or fall)

Symptoms: Complaints experienced by the athlete.

  • Headaches
  • Nausea
  • Visual problems
  • Balance problems
  • Sensitivity to light
  • Sensitivity to noise
  • Numbness or tingling
  • Vomiting
  • Dizziness
  • Irritability
  • Sadness
  • Feeling more emotional
  • Nervousness
  • Mentally foggy
  • Concentration problems
  • Memory problems
  • Drowsiness
  • Sleep disturbances
  • Fatigue
  • Feeling slowed down

Treat the Athlete

MANAGEMENT

An increasing number of studies have revealed that concussions, if not properly treated, can result in permanent mental difficulties. Data also suggests that concussions can lead to the development of dementia earlier than expected and has lead to mandates by athletic governing bodies (NFHS, NCAA, NFL).

-Physical Restrictions

Recovery from a concussion requires limitation of physical activity, especially sport activity such as practice, drills, games, and physical education classes. A return to activity must be gradual, starting slowly and increasing in intensity if no recurrence of symptoms appear. Limit texting, video games, and watching television.

-Academic Accommodations 

In significantly symptomatic athletes, mental activities should also be limited to allow the brain time to heal. These activities may include limiting assignments, allowing greater time to complete quizzes and tests or assignments. The athlete may have to be absent from school or attend on a limited basis. Treatment should always be individualized for each athlete.

-Neuropsychological Testing

Neurocognitive testing such as ImPACT, is a computerized test that documents an athlete’s cognitive and speed skills. The test has been validated as an accurate measure of brain impairment and recovery following a sports concussion.

All athletes should have a baseline test prior to participating in practice or competitions. Should an athlete sustain a concussion, a post-injury test can be performed and compared to an individualized baseline test.

Consequences

Post-Concussion Syndrome

Post-concussion Syndrome is a complex disorder in which a combination of symptoms last for weeks and sometimes months after the injury that caused the concussion. These symptoms include: persistent headaches, dizziness, emotional lability, trouble concentrating, or depression. Those with post-concussion syndrome may have a longer recovery, require psychological consultation, and/or medication.

Second Impact Syndrome

Second Impact Syndrome can occur if an athlete is allowed to return to play before the brain has healed completely. A repeat head injury, even minor in nature, may cause brain death.

Determine Return to Play

There are necessary steps that are to be followed before an athlete should be allowed to return to full competition. To ensure full recovery of the brain, activity should not increase until symptoms are not present at rest. These steps should by followed by a healthcare professional trained in the treatment and management of concussions.

  • Athlete must be asymptomatic at rest with a normal neurological exam.
  • A neurocognitive test such as ImPACT must have returned to baseline.
  • Athlete must be asymptomatic with increased activity and pass an activity progression protocol.