So we have all seen vision of athletes being knocked out during a game and being either carted or walked off the pitch looking dazed and confused. But how can we be more vigilant at looking after the non professional population when it comes to concussions. That is what this months newsletter is about.
So what is Sports Related Concussion (SRC)?
“Sport related concussion is a traumatic brain injury induced by biomechanical forces”
Several common features include:
- SRC may be caused either by a direct or indirect blow resulting in a sudden force being transmitted to the head.
- SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
- SRC may or may not involve loss of consciousness.
- Recovery time varies greatly between individuals but in adults >18 years old most will recover within 10-14 days and in children <18 years old within 4 weeks. In some cases symptoms can be significantly prolonged.
Identifying Sports Related Concussion:
Ideally any suspected concussion needs to be assessed by a doctor with an interest in the area, initial assessments can also be performed by another qualified health professional (eg your physiotherapist). Barring this anyone can use the Concussion Recognition Tool (CRT5) attached at the bottom of this post to identify concussion. Anyone diagnosed with concussion then needs to be followed up by a doctor, or in severe cases the emergency department.
For the purpose of this newsletter I will skip over the health professionals role in concussion, and instead I will focus on what you need to know if you suspect someone may be concussed and there is not an appropriately trained person nearby to assess them.
STEP 1: Know your red flags:
If there is concern after an injury including whether ANY of the following signs are observed or complaints are reported then the player should be safely and immediately removed from play/game/activity. If no licensed healthcare professional is available, call an ambulance for urgent medical assessment:
• Neck pain or tenderness
• Severe or increasing headache
• Deteriorating conscious state
• “Who scored last in this game?”
• Double vision
• Seizure or convulsion • Loss of consciousness
• Vomiting
• Weakness or tingling/ burning in arms or legs
• Increasingly restless, agitated or combative
Remember:
• In all cases, the basic principles of first aid (DR ABCD – danger, response, airway, breathing, circulation) should be followed.
• Do not attempt to move the player (other than required for airway support) unless trained to so do.
• Assessment for a spinal cord injury is critical. If the injured person is unconscious, assume they have a neck injury until proven otherwise. DO NOT MOVE THEM
• Do not remove a helmet or any other equipment unless trained to do so safely.
If there are no Red Flags, identification of possible concussion should proceed to the following steps:
STEP 2: OBSERVABLE SIGNS
Visual clues that suggest possible concussion include:
• Lying motionless on the playing surface
• Disorientation or confusion, or an inability to respond appropriately to questions
• Balance, gait difficulties, motor incoordination, stumbling, slow laboured movements
• Slow to get up after a direct or indirect hit to the head
• Blank or vacant look
• Facial injury after head trauma
STEP 3: SYMPTOMS
Common symptoms that injured persons will report are:
• Headache
• Blurred vision
• More emotional
• Difficulty concentrating
• “Pressure in head”
• Sensitivity to light
• More Irritable
• Difficulty remembering
• Balance problems
• Sensitivity to noise
• Sadness
• Nausea or vomiting
• Fatigue or low energy
• Nervous or anxious
• Feeling slowed down
• Drowsiness
• Dizziness
• Neck Pain
• Feeling like “in a fog“
• “Don’t feel right”
STEP 4: MEMORY ASSESSMENT
(IN ATHLETES OLDER THAN 12 YEARS)
Failure to answer any of these questions (modified appropriately for each sport) correctly may suggest a concussion:
• “What venue are we at today?”
•“What team did you play last week/game?”
• “Which half is it now?”
• “Did your team win the last game?”
• “Who scored last in this game?”
Athletes with Concussion Should:
• Not be left alone initially (at least for the first 1-2 hours).
• Not drink alcohol.
• Not use recreational/ prescription drugs.
• Not be sent home by themselves. They need to be with a responsible adult.
• Not drive a motor vehicle until cleared to do so by a healthcare professional.
ANY ATHLETE WITH A SUSPECTED CONCUSSION SHOULD BE IMMEDIATELY REMOVED FROM PRACTICE OR PLAY AND SHOULD NOT RETURN TO ACTIVITY UNTIL ASSESSED MEDICALLY, EVEN IF THE SYMPTOMS RESOLVE
Returning to School following Concussion
Something you may not have considered is how to reintroduce school to children with concussion. Although there is a sparsity of research into concussions in children, we do know that concentrating can be difficult folliowing SRC, and even aggravate concussion symptoms.
The above image details a step by step process to return to school but the principles are simple.
- Slowly increase the mental load on a child with concussion. This may mean having shorter days of school initially, or even time off all together. They may need a period of time off homework or just frequent breaks.
- Do not return to sport until the child has returned back to normal school.
Return to Sport Following Concussion
Returning to sport now has some strict guidelines to follow. These should be followed in conjunction with your GP.
The basic principles are:
- 1-2 days complete rest
- Then progress through the 6 steps of increasing intensity to return to sport. Each step should be completed individually over 24 hours (don’t skip multiple steps in a day).
- Return to sport should be at the quickest a full week from the initial concussion.
Apolagies for the small images, if you zoom in the quality should be good enough to make out the protocol.
The Main message:
Medicine around concussion is progressing quickly, but in general they are still relatively poorly understood. Always involve your doctor with diagnosing, treating and clearing concussions for a return to sport!
Resources:
