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Concussion Concerns from the Athlete’s Perspective

What is a concussion?

A concussion is a brain injury that causes changes in the way the brain functions.  It can occur from a direct blow to the head, face or neck or a jolt to the body.

Can I still have a concussion if I did not lose consciousness?

Although a concussion may involve a loss in consciousness, approximately 90 percent of concussions do not.

How do I know if I have a concussion?

Concussions affect everyone differently.   You may have one or a combination of the following symptoms:

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What if I think I may have a concussion but don’t feel anything?

Symptoms may occur immediately following the injury or may take up to 48 hours to appear.  In some cases, there are no symptoms at all.

Bottom line… WHEN IN DOUBT SIT IT OUT

What should I do if I think I have a concussion?

Tell your coach immediately.  Do not wait for the next stoppage of play or line change.  Removing yourself from play immediately will eliminate the chance of further injury.

Why can’t I return to play if I am feeling better?

If you return to play too soon after a concussion, you risk the chance of sustaining a second concussion otherwise known as “second impact syndrome” or SIS.   SIS describes the situation where an individual sustains a second head injury before the first concussion has healed.   If you get a second hit before your brain has had the chance to recover, the consequences of SIS could be severe.  You should also know that the second hit does not need to be a major one for you to suffer from SIS.

IT’S BETTER TO MISS ONE OR TWO GAMES THAN AN ENTIRE SEASON

Athlete Resources:

concussion team approach

Concussion FACTS for the Athlete

Concussion Concerns from the Parents Perspective

What is a concussion?

A concussion is a brain injury that causes changes in the way the brain functions.  It can occur from a direct blow to the head, face or neck or a jolt to the body.

How can I tell if my child has a concussion?

Although a concussion may involve a loss in consciousness, most concussions do not.  It is sometimes referred to a “stealth injury” as it does not appear in a x-ray or MRI.  Symptoms may occur immediately following the injury or may take up to 48 hours to appear.  In some cases, there are no symptoms at all.

Concussions affect everyone differently.   Your child may have one or a combination of the following symptoms:

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What do I do if I suspect my child has a concussion?

If there is a suspected concussion, your child should be removed from play immediately and a medical doctor should be contacted for proper diagnosis.  It is also important that you supervise your child in the hours following a concussion.

You should seek immediate medical attention if you observe any of the following signs or symptoms:

  • Loss of consciousness

  • Headache worsening

  • Neck pain

  • Drowsiness

  • Vomiting

  • Seizures

  • Weakness, numbness or tingling in the arms, legs, or face

  • Slurred speech

  • Cannot recognize people or places

  • Unusual behaviour, confusion or irritability

  • Unsteady walking or standing

 

 

 

What should I do if my child is experiencing post concussive symptoms?

The child should rest at home until the symptoms subside. During that time they should not be allowed to watch TV or to use a computer/tablet/cell phone. The child should avoid bright lights and loud noises.  Sleep hygiene is crucial to the child’s recovery.  If the symptoms get worse, you should contact a medical doctor immediately.

 

When can my child return to school?

Once your child is symptom free for 24 hours they can return to school. You should use the NC “Return to School” protocol as a guide.  Parents and educators should continue to monitor symptoms throughout the process. Stages can take as little as 24 hours or as long as a few weeks to complete. Parents must work closely with educators to ensure management strategies are being implemented.  Educators may not be familiar the “Return to play protocol” in these cases parents must advocate on their child’s behalf.

When can my child return to play?

Your child should rest a minimum of 7 – 10 days after the injury.  If symptoms last more than 10 days, your child should wait 24 hours after symptoms have subsided before commencing “Return to play” protocol.  If your child returns to play too soon after a concussion, he risks the chance of sustaining a second concussion otherwise known as “second impact syndrome” or SIS.   SIS describes the situation where an individual sustains a second head injury before the first concussion has healed.   If you get a second hit before your brain has had the chance to recover, the consequences of SIS could be severe.  You should also know that the second hit does not need to be a major one for you to suffer from SIS.

IT’S BETTER TO MISS ONE OR TWO GAMES THAN AN ENTIRE SEASON

concussion team approach

Concussion concerns from the coach’s

perspective

What can coaches do before the season to ensure their teams are prepared to handle any potential concussions?

Education- It has been shown that the more athletes know about concussions the more likely they are to report them. Make sure that your players and coaching staff know what symptoms to look for and that they understand the danger of second impact syndrome (SIS).

Baseline Testing- All your players should undergo comprehensive baseline testing prior to the start of the competitive season. The test should include cognitive, visual and vestibular components.

Plan- All your athletes should know what to do in the event they suspect they may have sustained a concussion. This plan should involve removing themselves from the play immediately. Players should also know to notify the coaching staff or referee if they think one of their teammates is concussed.

What do I do if I think one of my players has a concussion?

If you suspect one of your players may have a concussion they should be removed from play immediately. Do not wait for a stoppage of play or a line change. The concussed player should be assessed immediately.  If during your evaluation you notice any of the following signs or symptoms the athlete should seek immediate medical care:

  • Loss of consciousness

  • Headache worsening

  • Neck pain

  • Drowsiness

  • Vomiting

  • Seizures

  • Weakness, numbness or tingling in the arms, legs, or face

  • Slurred speech

  • Cannot recognize people or places

  • Unusual behaviour, confusion or irritability

  • Unsteady walking or standing

 

Is there are sideline test that can help me determine if my athlete can return to play?

A concussion can affect either the visual, vestibular or congitive systems. Testing these systems is a good way to show your athlete that they may be concussed. That being said, there is currently no test that can safely clear the athlete to return to play. The athlete must be evaluated and cleared by a medical doctor.

What should I do if I suspect my player may have concussion but appears to be symptom free?

Symptoms may occur immediately following the injury or may take up to 48 hours to appear.  In some cases, there are no symptoms at all.  If you suspect the athlete may have a concussion, they should be removed from the game until they can be properly evaluated by a physician.  Parents should be contacted and told to look for any symptoms that may present themselves while the child is at home.

How long can I expect the athlete to be sidelined for?

The athlete will need to rest a minimum of 7 – 10 days after the injury.  If symptoms last more than 10 days, the athlete should wait 24 hours after symptoms have subsided before commencing “Return to play” protocol.  If your child returns to play too soon after a concussion, he risks the chance of sustaining a second concussion and in extreme cases may develop “second impact syndrome” or SIS.   SIS describes the situation where an individual sustains a second head injury before the first concussion has healed.   Before returning to play the athlete must receive clearance from a medical doctor.

Resources: 

concussion team approach

Concussion Facts for Coaches (CDC)

Concussion Concerns from the Educator’s Perspective.

What is a concussion?

A concussion is a brain injury that causes changes in the way the brain functions.  It can occur from a direct blow to the head, face or neck or a jolt to the body.

How will a concussion affect the child’s academic performance?

The signs and symptoms will depend on the location and severity of the injury. The accommodations required will depend on the symptoms. Below is a list of common symptoms:

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How long can I expect a child will be out of school?

Children can only return to school once they have been symptom free for twenty four hours. Returning to school should be a graduated process as outlined in the “Return to School protocol (insert hyperlink here). Parents and educators should continue to monitor symptoms throughout the process. Stages can take as little as 24 hours or as long as a few weeks to complete.

How can I help my student “Return to School successfully”?

While the student is still symptomatic, it is important to continue to rest physically and cognitively.  Once symptom- free, the student can return to school with certain accommodations. Individuals will experience various degrees of symptoms and therefore the return to learn steps will be tailored to their needs.

The NC team will provide recommendations to help facilitate this process. Understanding symptoms will help guide accommodation strategies.
The employer or educator can play an important role in recovery by providing accommodations.

The chart below lists different management strategies that may be useful:

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concussion team approach

Should one still use a grading system to help manage patients who have or are suspected of having a concussion?

Extensive research on concussions has provided medical professionals with a much better understanding of the symptomatic course and risk of potential long-term complications. Clinicians involved in the assessment and management of sport-related concussions began to notice that patients who lost consciousness for brief periods of time often recovered more quickly than those who did not lose consciousness at all. This led to the realization that diagnosing those who did not lose consciousness with a lower grade of concussion was inaccurate. As a result of this understanding, and other realizations, grading systems have been replaced with more individualized concussion management.

Does the force of impact have to be of a particular magnitude to cause a concussion?

No, concussions occur from blows to different parts of the body of varying magnitude. A relatively minor impact may result in a concussion while a high-magnitude hit may not. There is therefore no way to know for certain whether a particular blow will lead to a concussion.

What neuro-imaging should one order for my patients who have been diagnosed with a concussion?

Conventional structural neuro-imaging is normal in concussive injury and so in most cases unnecessary. The following suggestions were made by the panel at the 4th International Conference on Concussion in Sport held in Zurich November 2012: brain CT scans (or where available, brain MRI) contribute little to concussion evaluation but should be employed whenever suspicion of an intracerebral structural lesion exists. Examples of such situations may include a prolonged disturbance of the conscious state, a focal neurological deficit or worsening symptoms.

For what period of time should one recommend full visual, cognitive and physical rest?

Physical and cognitive rest are the cornerstones of concussion management. More clinical studies are needed to better determine the ideal duration of the rest period. It is our general recommendation that full rest not be longer than 3-5 days. Rest is most useful immediately after the suspected concussion, not as beneficial if started weeks after a concussion occurred.

What is the best approach to investigation and management of persistent (>10 days) post-concussive symptoms?

Persistent symptoms (>10 days) are generally reported in 10-15% of concussions. This may be higher in certain sports (eg, elite ice hockey) and populations (eg, children). In general, symptoms are not specific to concussion and it is important to consider and manage co-existent pathologies. Cases where clinical recovery falls outside the expected window (ie, 10 days) should be managed in an interdisciplinary manner by healthcare providers with experience in sports-related concussion. Important components of management after the initial period of physical and cognitive rest include associated therapies such as cognitive, vestibular, physical and psychological therapy, consideration of assessment of other causes of prolonged symptoms and consideration of commencement of a graded exercise program at a level that does not exacerbate symptoms.

 

What are the benefits of using Neurocognitive testing when assessing a possible concussion?

Neurocognitive Testing Recent advancements in concussion management have resulted in the widespread use of computer-based Neurocognitive testing protocols, and evidence now shows that concussed athletes demonstrate subtle cognitive deficits that may persist beyond symptom resolution – emphasizing the fact that return to play once “symptom-free” is no longer an accurate measure of readiness. For this reason, Neurociruict employs computerized Neurocognitive testing as part of all baseline and post-injury assessment protocols. This type of testing provides us with a snapshot of how an athlete’s brain is functioning by measuring things like reaction time, processing speed, memory, and attention/concentration.

What role does manual therapy play in relieving post concussion symptoms?

It is widely accepted that patients should not receive any manual therapy in the 10 days following the suspected concussion. Should the symptoms last beyond that point there is a lot of research showing that a high proportion of post-concussion headache sufferers have physical signs of cervical musculoskeletal dysfunction, particularly in the upper three cervical joints, and support the need for a precise and sensitive physical examination of the cervical spine in patients complaining of persisting post-concussion headaches.

When should and how should exercise be reintroduced?

The consensus is that a child should be symptom free for 5-7 days prior to starting their return to play protocol. The protocol is most effective when guided and supervised by a trained professional with experience in concussion management. It should also be noted that recent research indicates that prolonged bed rest should not be recommended for concussed individuals. Prolonged rest can result can result in significant de-conditioning, increased fatigue and depression. The Buffalo Concussion Treadmill Test (BCTT) has been utilized to establish a safe and effective exercise program for individuals who remain symptomatic for longer than 3 weeks. At Neurocircuit the BCTT is introduced at 3 weeks to identify the patient’s threshold (based on symptoms and heart rate) and used to prescribe aerobic exercise.

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