1. What is a concussion?
CON-CUS-SION - pronunciation (kn-kshn) n. Latin concussion, concussio, from the concutere to shake violently, from com- + quatere to shake.
A concussion - a type of traumatic brain injury - is recognized as a clinical syndrome of biomechanically induced alteration in brain function. A more appropriate operational definition of concussion is the recognition of two sequential events: traumatic acceleration of the head, followed by presence of signs (observed by someone other than the patient) or symptoms (reported by the patient). As a clinical syndrome the diagnosis of concussion relies on the occurrence of the "event" (i.e., traumatic acceleation) and the association of one or more clinically recongizable features, which are signs and symptoms.
2. What symptoms are associated with concussion?
The reaction to concussion - how an individual may feel - is often unique in terms of the type and intensity of symptoms. The most common symptoms are categorized into four general areas:
- Slurred speech
- Poor coordination/balance
- Low energy
- Feeling tired
- Poor concentration
- Decrease in performance
- Memory difficulty
- Difficulty reading
- Feeling slowed down
- Sleep disturbance
- Difficulty thinking clearly
- Loss/impaired consciousness
- Sensitivity to light
- Sensitivity to noise
- Ringing in the ears
- Double vision
- Personality or behaviour changes
- Feeling depressed
3. What are some of the 'signs' of concussion to keep an eye out for?
The characteristics observed by someone other than the patient are the following:
- Poor coordination or balance
- Loss of consciousness or impaired consciousness
- Poor coordination or easily distracted
- Significantly decreased performance or playing ability
- Slurred speech
- Repetitive questions
- Poor concentration
- Slowness answering questions and following directions
3. What actually happens to the brain when it is concussed?
At this point, it isn't certain what specifically happens. However, if you can imagine that the act of a direct blow to the head causes the brain to shake or shift suddenly within the skull, that action is thought to temporarily disrupt the normal electrical and chemical neural processes. This reaction to direct or indirect contact to the head may then cause some fairly dramatic - but temporary - ‘signs’, such as a loss of consciousness, amnesia or poor balance – or subjective symptoms, such as headache, dizziness, cognitive problems, and so on. Importantly, the range and variety of signs and symptoms differs from person to person and even for each concussive event. It is the experience of clinicians that no two concussions are alike.
4. What do I do if I suspect a player is concussed?
If you are a player, any hit, fall or event that results in you feeling sick, dizzy, “foggy”, or which causes head pain or headache, confusion, memory loss, etc., then you need to be assessed for a concussion. If you see a team mate acting strangely following a collision or hit, report it to the team trainer or coach. If you are a coach and you witness any ‘signs’, or if an athlete reports any symptoms that cause you alarm, immediately remove the person from practice or play. Remember, a concussion is a type of brain injury that requires immediate and appropriate medical evaluation. It’s just a game, after all.
As noted above, the appropriate first action is to remove the player from the practice or game for a sideline evaluation. Typically this is done by a trained first responder such as a team trainer, therapist, team physician or coach – preferably someone who has basic training in concussion evaluation. However, even a knowledgeable, trained parent can ask basic questions of a possibly concussed athlete.
Bottom line: If you suspect a player has been concussed, he or she should be removed and not returned to practice or play until medically cleared to do so. This is the most prudent, safest and selfless action to safeguard the player’s health.
5. When is it safe to return to play?
Not until the player has been medically cleared (see above). The standard, accepted protocol is as follows: A player must be totally symptom free, able to exercise vigorously without symptom exacerbation, be completely free of cognitive symptoms, pass their baseline tests (see below) and essentially (and importantly) be deemed medically back to ‘normal’. Only then may a player return.
6. What happens if the players returns to play too early?
Generally, one or possibly many bad things can happen.
First, an athlete who returns while still symptomatic may be susceptible to a rare (and controversial) medical condition known as Second Impact Syndrome, which can be fatal.
Second, an athlete who returns while symptomatic prolongs his or her recovery period. Students who attempt to “work through” severe symptoms of concussion may do poorly in school, so poorly as to fail exams or assignments – with no recourse once the academic year is finished.
Better to rest, recover and rehabilitate!
7. What is a baseline test and does it actually protect me from a concussion?
A ‘baseline’ test refers to the currently common practice of conducting brief, computerized neuropsychological tests that sample a limited number of functions such as reaction time, problem solving, etc. There are many commercial baseline tests available and all generally follow the same principle: If the athlete suffers a concussion, his or her post-injury scores can be compared to the baseline scores to see if there are changes or relative impairments associated with the concussive event. It sounds simple, but it is rare when the baseline-recovery neuropsychological recovery trajectory is linear or straightforward. This is why a qualified health care professional needs to be involved with both the administration and interpretation of the baseline tests. And no, baseline tests cannot protect you from a concussion.
8. Can I rely on equipment to protect me from concussions?
The short answer is no. There is no such thing as a “concussion-proof” helmet or other equipment. Stop asking stupid questions.
9. Can I do anything to protect myself from concussion?
Yes. If you think you have suffered a concussion, report it to your coach and then remove yourself from the practice or game. Admittedly, this might be easier said than done; but the team culture that promotes injury reporting rather than turning a blind eye is very helpful. Does your sport encourage safety?
Next, if you are sitting out with symptoms of concussion, be hopeful and expect that you will recover, even if the recovery period sometimes seems indeterminate. Many athletes become discouraged if their symptoms last more than a few days, but the literature and our extensive clinical experience indicates that concussion symptoms are time-limited (if somewhat debilitating in the early going).
Our advice is always optimistic: “You will recover!” Medical and rehabilitation advice is crucial to the recovery process.
Ask questions. Follow the advice of your doctor, therapist or neuropsychologist and be compliant with the structure that may be imposed on you.