Wellness Minute - Concussions
From Mark Seeley, Crossing Rivers Health Athletic Trainer
What is a concussion?
Twenty years ago, we used to call concussions "bellringers". We now know that concussions are a traumatic brain injury that results in temporary loss of normal brain function. These injuries should not be dismissed. They are very serious injuries and they need to be taken care of correctly.
When do concussions happen?
Typically, concussions take place when there is a certain jarring to the head or brain. This can occur during direct contact, such as helmet to helmet contact in football, when a student-athlete gets hit in the head with a volleyball, or it could potentially be a sudden jarring motion where there is a twisting of the head.
How does a concussion affect a person?
Essentially, there are four areas of function which a concussion may affect.
Physical signs of a concussion may include:
- Dazed or confused
- Trouble with simple functions
- Lack of balance/coordination
Cognitive symptoms to look for include:
- Problems thinking or processing
- Inability to pay attention
- Trouble remembering information
An individual may also have emotional symptoms, such as:
- Feel depressed
- Have problems dealing with emotions
The athlete may experience sleep disturbances and may:
- Need more sleep
- Sleep less
- Have interrupted patterns of sleep
What are the signs and symptoms of a concussion?
If an athlete presents with an injury, he or she should be immediately removed from play until cleared by a health care provider. State law requires immediate removal of play for anyone that presents with signs and symptoms of a concussion or that are suspected of being injured. We don't want to allow someone that we suspect may have a concussion to play - we want to keep him or her safe.
Second impact syndrome
Second impact syndrome occurs when an athlete who has already sustained a head injury continues to play and then he or she gets hit additional times. It's possible to have a catastrophic brain bleed which then can relate to very severe long-term consequences, possible death.
Signs of a concussion - what we see
The athlete may:
- Appear dazed or confused
- Experience different levels of consciousness
- Have balance or coordination issues
- Feel slowed down
- Be forgetful
Symptoms of a concussion - what an athlete feels
The athlete may:
- Have a headache
- Feel nauseated
- Be dizzy
- Be affected by bright lights or noise
- Be agitated or emotional
How is a concussion treated?
The first step in the treatment of a concussion after it has been diagnosed is an evaluation. Typically, we use a Sport Concussion Assessment Tool (SCAT) form. The SCAT form assesses the athlete's cognitive abilities - basically a mini-mental test. Then, we can score the assessment to see how they are doing and refer to it over the next couple of days to measure the progress. We will also check balance, perform special tests for the head to see if they have an injury to the vestibular system, and conduct a symptom checklist where the athlete will rate their symptoms and how they are feeling over the course of the injury. We hope to see that the symptoms decrease over the next two weeks or so.
For the first 24 - 48 hours, physical and cognitive rest is very important. The athlete will be removed from play and should not be running around or participating in sports. He/she should get lots of sleep and maybe consider drawing the shades so that bright lights don't bother him/her. We are also going to limit their screen time. We don't want to put him/her into hibernation, but we need to give the brain time to reset and recover. We don't want to do something we call "cocooning," meaning we don't want to keep him/her there for much longer than 48 hours. We want to ease him/her back into school and daily activities.
Next, we will determine what accommodations or modifications we need to make to the athletes daily life to provide time to health. Screen time and physical activity will be limited. Sometimes, we need to make some accommodations to their homework and academic schedule. For example, if bright lights bother the athlete, we may allow them to wear sunglasses to school. These accommodations gradually fall away as the athlete starts to feel better.
4. Return to play protocol
After the athlete is symptom-free for 48 hours, we begin a gradual return to play protocol using the ImPact test - a computerized neuro-cognitive test. The post-injury test is compared to the baseline test, which your athlete has already taken. When he/she passes the ImPact test, we gradually increase activity.
Concussions are serious. If you feel your athlete may have a concussion, contact your primary care provider or bring him/her to the ER or Urgent Care. The number one thing to remember when it comes to concussion care is: When in doubt, sit them out.