Assessment and Return to Play Following Sports-Related Concussion
By Frank Ayala & Alex Stepanek
What Exactly is a Concussion?
• Considered a mild traumatic brain injury (MTBI)
• Clinical syndrome with immediate and transient impairment of neural functions.
• No universal agreement on definition of concussion
• 10 % of all athletic injuries are classified as a concussion
What Happens Medically
• Result of a blow to the head or other part of the body causing an acceleration or deceleration of the brain inside the skull
• Stretching, twisting, and separation of dendritic branches
• Neurons temporarily dysfunctional but not destroyed
Symptoms of a Concussion
• Headache, nausea, vomiting, dizziness, balance problems, feeling slowed down, fatigue, trouble sleeping, drowsiness, sensitivity to light or noise, loss of consciousness, blurred vision, amnesia, or difficulty concentrating.
• Symptoms aren't usually evident until several minutes to hours after the blow
Concussion Education
• CDC, NFL, NBA, NHL, NFSA, NCAA all are intent on concussion education
• Some laws establish that athletes, parents, and coaches be informed about concussion information
Assessing Concussions
• Thorough clinical evaluation on the field of play is critical for identification and management
• Include history of concussions, observations, palpation, and special tests like balance
• Goal for on field evaluation is to identify life threatening conditions, if exist treat as a medical emergency
Assessing Concussion cont.
• Evaluation of signs and symptoms, cognitive functinoing, and postural stability is the goal
• Use results from neuropsychological tests, physcial tests, and injurt evaluation to diagnose
• Symptom checklist and symptom scale• ImPACT, CogSport, HeadMinder CRI, ANAM-
SMB are all computerized testing
Multiple Concussions
• Junior Seau• Increased risk after first• 3x greater risk if suffered 3 within last 7 years• Longer recovery time• 3+ concussions, 8x more likely for LOC, 5x for
amnesia• Most take place within 10 days of origional
Resuming Participation
• Take out of play immediately • Should be individualized • Standard is 7 days minimal • Slowly resume participation, 24 hours/level,
72 for multiple concussions• Have evaluation before resuming • Athletes may lie• Consider age, history, sport type, severity
Career Ender
• After suffering 2 concussions in a season, seriously consider ending season
• After 3 in a career, consider ending career in sport
• 3+ concussions had 5x more cognitive impairment, 3x memory problems, association with Alzheimer’s Disease, Dementia, depression
• Parkinson’s Muhammad Ali
Prevention
• Education• Testing, baseline • Technology (UNL)
Citation
• President's Council on Fitness, S. &. (2011). Assessment and Return to Play Following Sports-Related Concussion. President's Council on Fitness, Sports & Nutrition , Vol. 12 (Issue 1), p.g. 1-10.