A concussion is an injury to the brain. It is usually caused by a blow to the head, but may occur with severe jarring of the body. Although loss of consciousness may occur, it usually does not. Concussions occur most commonly in contact sports such as football and hockey.
Even mild concussions should not be taken lightly. Neurosurgeons and other brain injury experts emphasize that although some concussions are less serious than others, there is no such thing as a "minor concussion." In most cases a single concussion should not cause permanent damage. A second concussion soon after the first one, however, does not have to be very strong for its effects to be deadly or permanently disabling.
People with concussions often cannot remember what happened immediately before or after the injury, and they may act confused. A concussion can affect memory, judgment, reflexes, speech, balance, and muscle coordination. Paramedics and football trainers who suspect a concussion may ask the injured person what year it is or direct them to count backwards from 10 in an attempt to detect altered brain function.
Following a concussion, the athlete may experience a number of problems, including:
• Blurred vision
• Unsteadiness / loss of balance
• Confusion Memory loss
• Difficulty concentrating
• Ringing ears
• Sensitivity to light
• Loss of smell or taste
The parent of an athlete who has suffered a concussion should take this injury seriously. Check on your child regularly, until he/she feels normal. The following symptoms are concerning and further evaluation by a physician should be sought immediately:
• Neck stiffness
• Severe headache
• Difficulty walking or speaking
• Frequent vomiting
• Worsening confusion
• Extreme fatigue/unusual sleepiness
Symptoms of a concussion may resolve quickly or may persist for weeks, months or longer. An athlete should not return to sports until the symptoms have resolved and a doctor has cleared him/her. Returning to activities too soon following a concussion increases the likelihood of recurrent concussions and possibly more severe and even catastrophic injury. Repeated concussions could cause some permanent damage to the brain.
Grading the concussion is a helpful tool in the management of the injury (see Cantu Guidelines below) and depends on:
1) Presence or absence of loss of consciousness
2) Duration of loss of consciousness
3) Duration of posttraumatic memory loss
4) Persistence of symptoms, including headache, dizziness, lack of concentration, etc.
Some team physicians and trainers evaluate an athlete's mental status by using a five-minute series of questions and physical exercises known as the Standardized Assessment of Concussion (SAC). This method, however, may not be comprehensive enough to pick up subtle changes.
According to the Cantu Guidelines, Grade I concussions are not associated with loss of consciousness, and posttraumatic amnesia is absent or is less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week.
Players who sustain a Grade II concussion lose consciousness for less than five minutes or exhibit posttraumatic amnesia between 30 minutes and 24 hours in duration. They may also return to play after one week of being asymptomatic.
Grade III concussions involve posttraumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.
Following repeated concussions, a player should be sidelined for longer periods of time and possibly not allowed to play for the remainder of the season.
The standard treatment for concussion is rest. For headaches, acetaminophen (Tylenol) can be taken. Postconcussive headaches are often resistant to stronger narcotic-based medications.
If available, an athletic trainer or physician should examine the athlete. If the injury is serious, the athlete should be transported to the nearest Emergency Room. Less serious injuries require observation and evaluation by a physician.
People who suffer a head injury may suffer from side effects that persist for weeks or months. This is known as postconcussive syndrome. Symptoms include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia, or excessive drowsiness. Patients with postconcussive syndrome should avoid activities that put them at risk for a repeated concussion. Athletes should not return to play while experiencing these symptoms. Athletes who suffer repeated concussions should consider ending participation in the sport.
Second Impact Syndrome results from acute, sometimes fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. This causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control. The risk for second impact syndrome is higher for sports such as boxing, football, ice or roller hockey, soccer, baseball, basketball, and snow skiing.
Head Injury Prevention Tips
Buy and use helmets or protective head gear approved by the ASTM for specific sports 100 percent of the time. The ASTM has vigorous standards for testing helmets for many sports; helmets approved by the ASTM bear a sticker stating this. Helmets and head gear come in many sizes and styles for many sports and must properly fit to provide maximum protection against head injuries. In addition to other safety apparel or gear, helmets or head gear should be worn at all times for:
• Baseball and Softball (when batting)
• Horseback Riding
• Powered Recreational Vehicles
Head gear is recommended by many sports safety experts for:
• Martial Arts
• Pole Vaulting
Supervise younger children at all times, and do not let them use sporting equipment or play sports unsuitable for their age.Do not dive in water less than 9 feet deep or in above-ground pools.Follow all rules at water parks and swimming pools.Wear appropriate clothing for the sport.Do not wear any clothing that can interfere with your vision.Do not participate in sports when you are ill or very tired.Obey all traffic signals, and be aware of drivers when cycling or skateboarding.Avoid uneven or unpaved surfaces when cycling or skateboarding.Perform regular safety checks of sports fields, playgrounds and equipment.Discard and replace sporting equipment or protective gear that is damaged.
Rule Changes in Contact Sports to Prevent Head and Neck Injuries
The National Athletic Trainers' Association and the American Football Coaches Association (NATA/AFCA) Task Force, headed by Ron Courson, director of sports medicine for the University of Georgia, focused on two primary problems this year with head contact.
Head-down contact still occurs frequently in intercollegiate footballHelmet-contact penalties are not adequately enforced.
Rule changes implemented by the NCAA related to head-down contact and spearing in collegiate football have been distributed to all coaches and officials throughout the country. The objective is to eliminate injuries resulting from a player using his helmet in an attempt to punish an opponent.
With the rule changes and more diligent enforcement of the rules, there is hope that a significant reduction in head and neck injuries will result.
Copyright, the American Association of Neurological Surgeons, July 2006.