Concussions

Concussion is defined as a complex pathophysiological process affecting the brain induced by traumatic forces:

• Concussion may be caused by either direct blow to the head, face, or neck, or elsewhere on the body with an impulsive force transmitted to the head.
• Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously, i.e., confusion, dizziness, fogginess. See below for more exhaustive list of symptoms.
• Concussion may result in more a functional disturbance rather than a structural injury (Meaning there will be no outside evidence of injury, such as swelling or bleeding, however, the athlete may exhibit confusion, dizziness, loss of balance, or fogginess, etc.).

Signs and symptoms of an acute concussion

If any of the following symptoms or problems are present, a head injury should be suspected and appropriate management taken. A player does not need to have loss of consciousness to suffer a concussion!

• Cognitive features that may be present for an athlete may be the fact that they are unaware of the period or quarter, the opposition, or score of game, general confusion, amnesia, loss of consciousness, and unawareness of time, date, or place.
• Typical symptoms can be a headache, dizziness, nausea, unsteadiness, or loss of balance, feeling “dinged”, stunned, or dazed, having my “bell rung,” seeing stars or flashing lights, ringing in the ears, and double vision. Other symptoms such as sleepiness, sleep disturbances, and a subjective feeling of slowness and fatigue, in the setting of an impact, may indicate that a concussion has occurred or has not resolved.
• Physical signs such as loss of consciousness/impaired conscious state, poor coordination or balance, convulsions or seizures, gait unsteadiness, slow to answer questions or follow directions, being easily distracted or having poor concentration, displaying unusual or inappropriate emotions (such as laughing or crying), nausea/vomiting, a vacant stare/glassy eyes, slurred speech, personality changes, inappropriate playing behavior (running in the wrong direction), and significantly decreased playing ability.

Acute Response

When a player shows any symptoms or signs of a concussion:

1. The player should not be allowed to return to play in the current game or practice.
2. The player should not be left alone and regular monitoring for deterioration is essential. You do not have to wake a sleeping child every few hours, unless directed by your physician.
3. The player should be medically evaluated following the injury.
4. Return to play must follow a medically supervised stepwise process.

In general, a player should never return to play while symptomatic. “When in doubt, sit them out!”

Return to Play Protocol

The return to play following a concussion follows a stepwise process:
(Not to be administered by a parent.)

1. No activity, complete rest. Once asymptomatic, proceed to level 2.
2. Light aerobic exercise, such as walking or stationary cycling.
3. Sport specific training, such as skating in hockey, running in soccer.
4. Noncontact training drills.
5. Full contact training after medical clearance.
6. Game play.

With this stepwise progression, an athlete should continue to proceed to the next level if asymptomatic at the current level. If any post-concussion symptoms occur, the patient should drop back to the previous asymptomatic level and try to progress again after 24 hours (see above symptoms for reference).

In conclusion, the serious treatment of concussion is essential for any athlete, but especially young athletes. Returning to play too soon can have devastating results. Traumatic brain injuries tend to accumulate, and if unresolved and a second impact occurs, the situation can be grave. With head injuries, always err on the side of conservancy, taking extra time with yourself or the athlete before returning them to play. We have to remember that these are just games, and permanent impairment resulting from traumatic brain injuries is irreversible. If you observe athletes receiving sub-par care in relationship to head traumas, please discuss these guidelines with their coaches or trainers and/or your physician or myself.