It seems everywhere we go, sport concussions are a hot topic. If you have kids, or are involved in athletics yourself, it’s likely you know someone who has had a concussion.
And you likely have questions. Here are answers to the six questions I am asked most often:
What is a concussion?
A sport concussion involves an injury to the brain on a cellular level caused by either direct or indirect forces. Concussions can be caused by anything from the “big hit” to head-ground impacts or even repetitive small hits.
How do I know it’s a concussion?
Recognizing a concussed athlete can be challenging. The old adage that you need to be “knocked out” to have a concussion is long gone, nor are we like cartoons that have small tweeting birds circling our head after a big hit. In fact, fewer than 10 percent of sport concussions involve any loss of consciousness. Confused yet? Here are the symptoms to look for:
- Headache
- Dizziness
- Fogginess
- Changes in mood, balance, energy level or appetite
- Sensitivity to light and sound
Unfortunately, diagnosis relies on identifying an athlete with these symptoms through observing, questioning and some physical exam testing. There is no definitive test, such as X-ray, CT, MRI or blood work, to utilize. A head CT is used to identify brain bleeds, not concussions.
What are the consequences of a concussion?
That is the million dollar question. We’ve seen many unfortunate stories about retired NFL athletes who have developed cognitive dysfunction, such as dementia and severe depression, because of multiple concussions they likely experienced during all of their years playing.
Yes, some physical evidence, such as autopsy findings on brains consistent with CTE (chronic traumatic encephalopathy), exists to connect concussions with brain injuries. But, how much, how many, and how severe prior concussions are to blame is still being researched.
During an acute concussion, there are other concerns. It’s extremely rare, but catastrophic events, such as brain swelling that lead to death, can occur from a repeat injury to an already concussed brain. Other dangers from a second impact during concussion can lead to worsening and prolongation of symptoms.
Who’s at risk?
Teens 18 and under are at highest risk for concussions. They, in general, tend to require the longest time to recover. Because of these factors, almost every state in the U.S. has passed laws that require any suspected concussed athlete in a high school or middle school state-sanctioned sport, be immediately taken out of participation and not allowed to return until cleared by medical personal. There has been a significant amount of research and new understandings about sport concussion over the past 10 years, but we still have so much more to go.
How are concussions routinely treated?
This involves a blend of physical and cognitive rest along with academic accommodations for school-aged athletes. Treatment can include:
- Medication in limited cases
- Vestibular retraining ““ an exercise program that helps compensate for inner ear deficiencies ““ and neurocognitive testing
- Sleep
- Hydration
Overall, the brain is amazing and does a lot of the work itself. Our role is to protect and support it during the recovery phase and intervene when complications arise.
When do we know an athlete has recovered?
Just like diagnosis, symptom evaluation is the most important component for this assessment. An athlete can only be considered “recovered” when he or she shows no symptoms. Only after this, should other assessments be utilized to support declaring an athlete recovered. These assessments can include:
- Balance testing, such as BESS testing
- Computer ImPACT ® testing
ImPACT ® testing takes approximately 30 min to complete and assesses areas of visual/verbal memory, cognitive processing speed, and reaction time. Results from the test can be compared to the athlete’s pre-concussion baseline, if they have one, or against other athletes of the same gender and age through a national databank.
All of these assessments help form the medical decision on “clearance” to return to sporting activity. The final step to recovery requires the athlete to gradually return to full participation, through a series of progressive, increasing activity and contact in their sport’s practices/training before they are allowed to return to unrestricted participation in competitions.
