BACK TO SCHOOL, FALL 2011 Sports Safety and Concussion
By Wendy Graae MD, FAAP and Karin Sadow MD, FAAP
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Table of Contents
- Diagnosis
- Signs
- Management
- Recuperation
“Your child may have had a concussion.”
Have you done all you can to protect your children from unnecessary injury? Do you know what to do if your child suffers a concussion? If you haven’t done so already, now is the time to check that all protective gear still fits properly and is in good condition. Learn about the potential for various injuries especially head injuries, and learn what to do if your child suffers a concussion. While high school level football carries the greatest risks of head injury for boys, and soccer is the culprit for girls, other sports pose significant risks as well. Concussions are very common at the high school level, and account for almost 9% of all injuries in that age group.
This dreaded phrase may conjure up visions of unconsciousness, but less than 10% of concussions actually occur with loss of consciousness - so what exactly is a concussion?
A concussion is a form of mild traumatic brain injury that results in biochemical abnormalities that cause the brain to function abnormally. It may result from either a direct blow to the head or from impact elsewhere on the body with forces transmitted to the head. For most people, these disturbances in function are temporary and reversible, and recovery is usually complete when managed properly.
How is a concussion diagnosed?
Recognition of the signs and symptoms of concussion is essential and constitutes the first step towards appropriate management. There are four categories of symptoms:
Physical symptoms occur first and may include:
- Loss of consciousness - This makes the diagnosis of a concussion easy, but this occurs
in <10% of concussions - Feeling dizzy or “out of it”
- Headache
- Nausea or vomiting
- Amnesia for the event
Cognitive
- Difficulty concentrating, problem solving or learning new information
Emotional
- Irritability, depression or anxiety
Sleep
- Difficulty falling asleep, or sleeping more, may occur
There is no abnormality in the brain structure itself; therefore imaging studies such as CT or MRI are not useful in the diagnosis of concussion.
What is the management of concussion?
- Do NOT move your child if there is a concern about neck injury.
- Seek immediate medical attention if there is loss of consciousness, a convulsion, slurred speech, numbness or confusion, severe headache or persistent nausea or vomiting.
- Most children will be awake and ambulatory following a concussion, and should immediately be removed from the game.
- There is NO PLACE, ever, for “toughing it out” and returning to play after a possible concussion. Being an informed athlete, parent, or coach will help protect your child from the dangers of a rare but devastating “second impact syndrome.” This can occur if a second head injury occurs before symptoms from the first injury have completely resolved. Second Impact Syndrome causes brain swelling and can result in permanent disability or even death. Numerous patients have shared their experiences with concussion, and you can view one athlete’s story on You Tube: http://www.youtube.com/watch?v=yIqZDbk3M40
- Adequate rest is essential to the brain’s healing process, and this means both physical and cognitive rest, i.e. resting both the body and the brain. Staying focused in school, playing video games, doing homework, or even reading for pleasure may be too taxing for an injured brain, and concussion symptoms may worsen. Work and school schedules may have to be modified. Your primary physician can help guide you.
How long will it take before my child can return to full activity?
Your health care provider may also recommend neuropsychological testing, which can help determine your child’s level of functioning. The ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing) is now required for many high school athletes and measures attention span, working memory, problem solving skills, and reaction time. It is most useful when administered to athletes BEFORE the season begins, so that a true baseline can be obtained. When ImPACT testing is repeated following an injury, it can help determine if an athlete’s cognitive functioning has returned to pre-injury levels. The test only takes 20 minutes and may provide essential information for your child in the months ahead.
Once your child is symptom-free at rest, your healthcare provider will determine how and when your child may start to resume activities. Recovery is a process that takes time - sometimes weeks to months, so be prepared to advocate for your child’s safety and allow the time needed for a full recovery.
Once your child is symptom-free at rest, your healthcare provider will determine how and when your child may start to resume activities. Recovery is a process that takes time - sometimes weeks to months, so be prepared to advocate for your child’s safety and allow the time needed for a full recovery.
Best wishes from PM Pediatrics for a happy and successful 2011-2012 school year!
