A concussion occurs when a person suffers a direct blow to the head or body where the head snaps back and forth. When this happens, the brain may be shaken within the skull. The instability of the brain during that movement causes a mild, traumatic brain injury requiring rest and attention. This results in a temporary impairment of brain functioning and processing.
One of the biggest concerns with concussions is that they may be ignored and go untreated. It is especially problematic for athletes who return to their training too early and risk having a second concussion which may have long-term ramifications.
Risks/Causes
- Sports
- Falls
- Motor Vehicle Accidents
- Bicycling
- Any type of blow or impact that causes the brain to move. This does not need to be a tackle to the ground to cause impact.
Symptoms
Signs and symptoms generally show up after the injury however many times symptoms may not show up until hours or days after the initial injury. Continue to look for signs of a concussion from right after the injury until a few days later.
| Observed Symptoms | Patient Reported Symptoms |
| Loss of consciousness | Drowsiness |
| Memory loss or confusion | Headaches or “pressure” in head |
| Shows Irritability, depression, or a general increase in emotion | Difficulty balancing or dizziness |
| Answers questions slowly | Double or blurry vision |
| Behavior or personality changes | Sensitivity to light or noise |
| Trouble recalling events around time of impact | Nausea or vomiting |
| Moves clumsily | Change in sleep routine |
| Feeling sluggish, hazy, foggy or groggy | |
| Just not “feeling right,” or “feeling down” |
Long Term Effects of Concussions
- Effects on cognitive function
- Effect visual processing
- Can cause functional changes in the brain that persist long after the concussed patient reports recovery from symptoms.
Diagnosis
Because so many of the symptoms of a concussion rely on self report, it is imperative that open, honest communication is fostered between athletes, coaches, and athletic trainers. If an athlete is suspected of having a concussion, it is important to contact a doctor right away. Your physician will take a complete history and do a physical exam.
History
- Number of concussions
- Symptoms
- Loss of consciousness and/or amnesia
- Duration of missed activity
- Number of missed practices and/or games
- Previous concussions
- Recovery time
Physical Exam
- Vital signs
- Speech and gait analysis
- Full musculoskeletal and neurological examination
- Cranial nerve evaluation
- Romberg and Pronator Drift Tests
- Point to Point Discrimination Testing, and Vestibular and Balance Testing, with special consideration given to performing a BESS (Balance Error Scoring System) test
- Neuropsychological testing– ideally comparing to baseline – to check the cognitive function of the athlete’s brain.
- Balance testing is used to measure the brain’s control of movement which is commonly inhibited after a concussion.
- Additional testing may include an eye exam and sleep studies.
What things should you bring to your appointment?
- Any Radiological Studies (CT Scan or MRI)
- Computerized Neurocognitive testing, including both baseline and post-testing (i.e. ImPACT, ect.)
- The Sport Concussion Assessment Tool (SCAT) and Balance Error Scoring System (BESS) scores
- The pre-participation Physical Examination Exam (PPE)
Recovery
- The recovery time for a concussion is normally around seven to ten days, although sometimes symptoms may last for weeks or months depending on the severity.
- Once the symptoms have dissipated, patients may begin to return to normal activities, but should do so gradually. Although symptom-free, the brain may not be entirely recovered and the gradual return to activity gives it the opportunity to continue the recovery process.
Prevention
- Education on concussion protocol for parents and coaches and what signs and symptoms to look for.
- Train athletes on proper techniques and safety measures while playing their sport to decrease the likelihood of a concussion.
- Protective gear unfortunately is not concussion proof. They can help decrease the effect of impact but a concussion can still occur.
- Always use child safety seats and seat belts
- Always wear helmets for activities such as skating, skiing, and bicycle riding
- Encourage children to play safely and avoid unsafe situations in sports, such as striking another child in the head, helmet-to-helmet collisions (in football, for example), or running into unprotected opponents (football, baseball, soccer, basketball). Enforce the rules of safety and good sportsmanship.
- Practice using handrails, especially as you get older in age
If you or your child sustains a concussion, be sure to visit a concussion specialist to ensure you have recovered fully, and have a doctor’s clearance to return to activity. In some cases patients may feel they are fully recovered from their concussion, but are in fact still healing. Visiting a specialist is the best way to ensure you do not engage in activities that could put you at risk for re-injury during your recovery.
