Assessment and Return to Play Following Sports-Related Concussion

By Frank Ayala & Alex Stepanek

What Exactly is a Concussion?

• Considered a mild traumatic brain injury (MTBI)

• Clinical syndrome with immediate and transient impairment of neural functions.

• No universal agreement on definition of concussion

• 10 % of all athletic injuries are classified as a concussion

What Happens Medically

• Result of a blow to the head or other part of the body causing an acceleration or deceleration of the brain inside the skull

• Stretching, twisting, and separation of dendritic branches

• Neurons temporarily dysfunctional but not destroyed

Symptoms of a Concussion

• Headache, nausea, vomiting, dizziness, balance problems, feeling slowed down, fatigue, trouble sleeping, drowsiness, sensitivity to light or noise, loss of consciousness, blurred vision, amnesia, or difficulty concentrating.

• Symptoms aren't usually evident until several minutes to hours after the blow

Concussion Education

• CDC, NFL, NBA, NHL, NFSA, NCAA all are intent on concussion education

• Some laws establish that athletes, parents, and coaches be informed about concussion information

Assessing Concussions

• Thorough clinical evaluation on the field of play is critical for identification and management

• Include history of concussions, observations, palpation, and special tests like balance

• Goal for on field evaluation is to identify life threatening conditions, if exist treat as a medical emergency

Assessing Concussion cont.

• Evaluation of signs and symptoms, cognitive functinoing, and postural stability is the goal

• Use results from neuropsychological tests, physcial tests, and injurt evaluation to diagnose

• Symptom checklist and symptom scale• ImPACT, CogSport, HeadMinder CRI, ANAM-

SMB are all computerized testing

Multiple Concussions

• Junior Seau• Increased risk after first• 3x greater risk if suffered 3 within last 7 years• Longer recovery time• 3+ concussions, 8x more likely for LOC, 5x for

amnesia• Most take place within 10 days of origional

Resuming Participation

• Take out of play immediately • Should be individualized • Standard is 7 days minimal • Slowly resume participation, 24 hours/level,

72 for multiple concussions• Have evaluation before resuming • Athletes may lie• Consider age, history, sport type, severity

Career Ender

• After suffering 2 concussions in a season, seriously consider ending season

• After 3 in a career, consider ending career in sport

• 3+ concussions had 5x more cognitive impairment, 3x memory problems, association with Alzheimer’s Disease, Dementia, depression

• Parkinson’s Muhammad Ali

Prevention

• Education• Testing, baseline • Technology (UNL)

Citation

• President's Council on Fitness, S. &. (2011). Assessment and Return to Play Following Sports-Related Concussion. President's Council on Fitness, Sports & Nutrition , Vol. 12 (Issue 1), p.g. 1-10.