Concussion

What is a Concussion?

A concussion is a disturbance in brain function resulting from direct or indirect force to the head. It can cause significant and sustained impairment in thinking ability, memory, balance, and other functions. Most concussions do not involve a loss of consciousness, and an athlete does not have to hit his or her head to suffer from a concussion. Many concussion symptoms last less than 72 hours, and most concussions resolve in seven to ten days. 

What are some common symptoms of Concussion? 

Signs and symptoms of concussion can vary. They may include loss of consciousness, amnesia, behavioral changes (irritability), cognitive impairment (slowed reaction times, inability to focus/learn), sleep disturbances (too much, too little), physical disturbances (vision changes, balance problems, vision changes), physical symptoms (headache, nausea), cognitive symptoms (feeling slowed down, "in a fog"), and/or emotional symptoms (mood changes).  

What should an athlete do if a Concussion is suspected? 

If any of these signs and/or symptoms are noticed following a blow to the head, the athlete should have an evaluation by an athletic trainer or physician.  These providers will recommend a treatment such as sitting out the remainder of the competition or activity, visiting an emergency department, or following up with a primary care doctor or sports medicine doctor.  The injured athlete should not be allowed to return to play until he or she has received clearance from a physician.  

The athlete should not be left alone for the first few hours following a concussion; an adult should monitor him or her for signs of worsening symptoms. If a parent or coach notices that the athlete has progressively worsening symptoms following a head injury, they should take the athlete to the emergency room right away for an evaluation. 

When should someone seek medical attention? 

The athlete should medical attention if he or she has: 

• A headache that gets worse and does not go away 
• Weakness, numbness, or decreased coordination  
• Repeated vomiting or nausea 
• Slurred speech 
• A very drowsy look or cannot be awakened 
• One pupil larger than the other 
• Convulsions or seizures 
• An inability to recognize people or places 
• Growing confusion, restlessness, or agitation 
• Unusual behavior 
• Loss of consciousness 

How is a Concussion diagnosed? 

A physician will take a careful medical history and perform a physical exam on the patient.  The exam includes questions and tasks that assess memory, balance, reaction time, and attention. The physician may also have the athlete perform a computerized exam that tests these abilities. The athlete may see a neurologist or neuropsychologist if symptoms are prolonged or there are suspicious findings observed during the physical exam. 

The physician may order scans of the brain, such as a CT or MRI scan, to check for the presence of other conditions.  However, not everyone with a concussion or head injury needs a brain scan, and patients with concussions usually have normal scans.  The physician will determine if a scan needs to be done based on the athlete’s injury and observable signs and symptoms. 

How is a Concussion treated?  

In order to recover properly from a concussion, the athlete needs complete rest from regular activities. This includes cognitive and physical rest. Some students will need time off of school in order to fully recover from a concussion.  

The injured athlete should refrain from: 

• Contact sports or other activities that could increase the risk of another head injury 
• Physical activities that elevate the heart rate or blood pressure and/or exertion that worsens or brings on symptoms 
• Cognitive activities that require concentration and can worsen symptoms, such as class, reading, learning, or memorizing 
• Media such as television, radio, computer, text messaging, and social media 
• Late nights or erratic sleep 
• Driving (due to the slowed reaction time) 

To enhance recovery, the athlete should: 

• Get plenty of rest and sleep at the same time each night to regain a normal sleep cycle 
• Drink lots of fluids and eat lightly for the first 24 hours 
• Take Tylenol (if cleared by a physician) 
• See the physician regularly for follow up as indicated 

What about school? 

The injured athlete should also notify his or her teachers of the injury and the progress of treatment and recovery.  The patient's physician can write a letter to inform the school that the athlete may experience: 

• Increased problems paying attention or concentrating 
• Increased problems remembering or learning new information 
• Longer time needed to complete tasks, assignments, or tests 
• Greater irritability and less ability to cope with issues 
• Worsening symptoms (headache, fatigue) when doing assignments 
• What can happen if the injured athlete suffers another concussion while still having symptoms? 
• "Second Impact Syndrome" occurs when an athlete suffers from a second concussion while still having symptoms from a previous concussion. It can lead to rapid development of a severe impairment, brain injury, and even death in some cases. This is why it is so important to wait for clearance from a doctor before returning to play. 
• Returning to Activities & Sports 

The physician will develop a schedule for the athlete's return to activities safely, once all symptoms have resolved. Below is an example of a schedule for return to activities:  

Day 1: Light jogging 

Day 2: Simple drills with no risk of contact 

Day 3: Fast running; light resistance/strength training such as push-ups and sit-ups 

Day 4: Complex drills with no risk of contact; moderate resistance training 

Day 5: Full practice; higher resistance training 

Day 6: Games 

If symptoms return while following this activity schedule, the athlete should stop the activity and return to the previous step the following day.