A concussion is the most common type of traumatic brain injury in both adults and children, and can occur when an athlete receives a traumatic force to the head or upper body that causes the brain to shake inside of the skull.
Concussions range from minor to major and are usually diagnosed based on symptoms and severity of head trauma. The injury is defined as a concussion when it causes a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess.
Causes of Concussion
Causes of concussion can include any number of activities resulting in trauma to the head. Most often seen in children are sports injuries and bicycle accidents while adults are more likely to suffer from a concussion as the result of a car accident or fall.
Between 1.4 and 3.6 million sports and recreation-related concussions occur each year, with the majority happening at the high school level, according to the Center for Disease Control and Prevention. Because many mild concussions go undiagnosed and unreported, it is difficult to estimate the rate of concussion in any sport, but studies estimate that at least 10 to 20 percent of all athletes involved in contact sports have a concussion each season.
Risks of Concussion
In recent years, research has shown that even seemingly mild concussions can have serious consequences in young athletes if they are not properly managed. Loss of consciousness is not an indicator of injury severity. Traditional imaging techniques such as MRI and CT may be helpful in severe injury cases, but cannot identify subtle effects believed to occur in mild concussion.
Diagnosing a Concussion
Because no two concussions are exactly alike and symptoms are not always definite, the injury’s severity, effects and recovery are sometimes difficult to determine. The decision to allow the athlete to return to the game is not always straightforward, although research has shown that until a concussed brain is completely healed, the brain is likely vulnerable to further injury. Thus, the critical importance of properly managing the injury.
Everyone can and should take certain practical steps to help minimize the risk of concussions, especially wearing seatbelts.
For children playing sports, there are other considerations, including:
- Appropriate use of helmets, mouth guards and padding, which should be worn consistently
- Following all safety rules for a sport
- Learning the concussion symptoms in children so prompt medical attention is sought for your child
- Taking the recommended amount of time off from sport
- Only allowing your child to return once they have been cleared by a doctor familiar with concussion
For older adults, important factors to keep in mind are:
Help prevent falls by keeping floors clutter-free
Wear thin, flat shoes with hard soles that do not interfere with balance
Concussion and Children
What should I do if I think my child has had a concussion?
If an athlete is suspected of having a concussion, he or she must be immediately removed from play, be it a game or practice. Continuing to participate in physical activity after a concussion can lead to worsening concussion symptoms, increased risk for further injury, and even death. Parents and coaches are not expected to be able to “diagnose” a concussion, as that is the job of a medical professional. However, you must be aware of the signs and symptoms of a concussion and if you are suspicious, then your child must stop playing.
When in doubt, sit them out!
All athletes who sustain a concussion need to be evaluated by a health care professional who is familiar with sports concussions. You should call your child’s physician and explain what has happened and follow your physician’s instructions. If your child is vomiting, has a severe headache, is having difficulty staying awake or answering simple questions he or she should be taken to the emergency department immediately.
Allowing enough healing and recovery time following a concussion is crucial in preventing any further damage. Research shows that the effects of repeated concussion in young athletes are cumulative. Most athletes who experience an initial concussion can recover completely as long as they are not returned to contact sports too soon. Following a concussion, there is a period of change in brain function that varies in severity and length with each individual. During this time, the brain is vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of more serious brain injury increases.
When can an athlete return to play following a concussion?
After suffering a concussion, no athlete should return to play or practice on that same day. Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury. Studies have shown us that the young brain does not recover quickly enough for an athlete to return to activity in such a short time.
Concerns over athletes returning to play too quickly have led state lawmakers in both Oregon and Washington to pass laws stating that no player shall return to play following a concussion on that same day and the athlete must be cleared by an appropriate health-care professional before he or she are allowed to return to play in games or practices.
The laws also mandate that coaches receive education on recognizing the signs and symptoms of concussion.
Once an athlete no longer has symptoms of a concussion and is cleared to return to play by health care professional knowledgeable in the care of sports concussions he or she should proceed with activity in a step-wise fashion to allow the brain to re-adjust to exertion.
An explosion of scientific research over the past decade has taught doctors more about the proper management of sports-related concussion than was ever known before, and has raised public awareness and significantly changed the way sports concussions are managed.
How can a concussion affect schoolwork?
Following a concussion, many athletes will have difficulty in school. These problems may last from days to months and often involve difficulties with short and long-term memory, concentration, and organization. In many cases it is best to lessen the athlete’s class load early on after the injury. This may include staying home from school for a few days, followed by a lightened schedule for a few days, or perhaps a longer period of time, if needed. Decreasing the stress on the brain early on after a concussion may lessen symptoms and shorten the recovery time.
Much of the recently published research includes data proving the usefulness of objective neuropsychological testing, such as ImPACT™, as part of the comprehensive clinical evaluation to determine recovery following concussion. Recent international sports injury management guidelines have emphasized player symptoms and neuropsychological test results as “cornerstones” of the evaluation and management process.