Concussion is defined as ‘a brain injury where complex pathophysiological process affecting the brain.’ It is caused by an impact to the head or elsewhere on the body that transmits forces to the head. Concussion is more common in sports such as ice hockey, rugby and American football but it does not only occur due to sport.
Side line Evaluation of Concussion
When a player is suspected to have concussion, they should be assessed by a member of the medical staff first to rule out other injuries such as cervical neck injuries and then for concussion using Maddock’s questions initially and a SCAT 3 for a full assessment. If a player is showing any signs of concussion they should be removed from play immediately until they have been cleared by a medical professional to return and not on the same day of injury.
Signs and Symptoms
There are no exact rules into which signs and symptoms predict if someone has concussion as they can be different for everyone. This makes it harder to diagnose a concussion hence why a medical professional is needed. The most common signs and symptoms are headaches, nausea, vomiting and confusion. See the table below for a comprehensive list of the signs and symptoms of concussion. If you are at all concerned then the player should be checked out in hospital. If they vomit or the symptoms get worse then they must also seek medical attention to rule out bleeding or swelling on the brain.
|Drowsiness||Fatigue||Sensitivity to light||Dizziness|
|Headache||Memory loss||Sensitivity to noise||Visual disturbance|
|Nausea||Dazed||Difficulty concentrating||Speech difficulties|
|Vomiting||Irritability||Delayed responses||Balance problems|
|Seizures||Unconsciousness||More emotional||Feeling slowed down|
The initial treatment for concussion is physical and cognitive rest as something like school work or sitting at a computer could make symptoms worse. It is suggested this rest period lasts for 24-48 hours but this length of time is only a guide and can be different for each person. Following this resting period a graded return to play must be followed and each stage must be signed off by a medical professional before they can progress. The gradual return to play protocol is outlined below.
|Rehabilitation Stage||Objective of stage||Functional Exercises|
|No activity||Recovery||Physical and cognitive rest|
|Light aerobic exercise||Increase heart rate||Stationary bike, swimming or walking <70% maximum HR.|
|Sport-specific exercise||Movement||No head impact, running drills in football, skating drills in ice hockey|
|Non-contact training drills||Co-ordination, exercise and cognitive load||More complex drills e.g. passing drills, start resistance training|
|Full contact training||Assess function skills, regain athletes confidence||After medical clearance, start normal training including contact|
|Return to play||Full recovery||Play in a full contact game as normal|
The use of helmets and head gear has not been scientifically proven to prevent concussion but it has been shown to reduce the impact forces have on the brain. Helmets and head gear do protect from other injuries such as skull fractures so there is still a need for them.
Recurrent concussions are very dangerous, this is when someone returns too early without following the gradual return to play protocol and then sustains another concussion. Without giving the brain time to heal, it is more susceptible to injury and the damage could be worse. By making people aware of the dangers this can cause, it might make them more likely to comply with the return protocol.
The best prevention of concussion is education. By educating not only athletes but relatives of athletes and parents could mean that they spot the signs and symptoms, can track progression or regression or even make sure they are doing everything possible to reduce their chances of getting concussion. Concussion is a huge topic within recent research and there are developments that may not always be transmitted down to athletes or the general population which is where the information could make a difference.
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