Monitoring an Athlete after a Concussion
Introduction
The correct recognition and management of an athlete with a concussion are critical to the recovery of the athlete. Incorrectly treated, an athlete may continue to suffer from the symptoms of concussion long after the original injury.
There has been a paradigm shift within the sports medicine community on just how to diagnose and manage an athlete who has been diagnosed with a concussion.
Severity of Concussions
In the past, concussions were graded from mild to severe depending on the amount of time that an athlete was unconscious after the initial injury. Researchers have now determined that “level of consciousness” is not a good indicator of concussion.
Rather, the severity of a concussion is dependent upon the length of time that an athlete experiences the signs and symptoms associated with a concussion. With this in mind, the severity of a concussion may not be determined until weeks or months after the initial injury.
Any athlete who receives a blow to the head or a snap of the head needs to be carefully monitored for signs and symptoms of concussion regardless of whether the athlete was rendered unconscious.
If any concussion symptoms are present, the athlete should be immediately pulled from the activity. If medical personnel trained in the recognition of concussion are not available on site, the athlete needs to be referred for immediate medical evaluation.
Symptoms of Concussion
Because there is no physical evidence that can be seen on diagnostic imaging tools (x-ray, MRI, CT scan) when an athlete suffers a concussion, athletes are now asked to keep a concussion symptom checklist to track the number of days that specific symptoms are experienced. Symptoms of concussion may include:
- Fogginess
- Inability to concentrate
- Headache
- Photophobia (sensitive to light)
- Nausea/vomiting
- Confusion
- Disorientation
- Dizziness
- Difficulty in balancing
- Memory deficits
As long as an athlete is experiencing symptoms of a concussion, the athlete needs to be sidelined from all practice, physical activity, and competitions. Athletes who continue to compete while still experiencing symptoms of concussion may increase the length of time of their symptoms and may also be at risk for second impact syndrome, a potentially life-threatening condition.
Treatment for a Concussion
Historically, athletes were withheld from all physical activity until symptoms dissipated. Recent research has shown that the best early treatment for a concussion includes the elimination of all physical activity and cognitive stimulation. Research presented at the Annual National Summit on Concussion and Other Sports Medicine Injuries (Cantu, M., May 15, 2009) revealed that an athlete’s brain recovers faster in a setting with no mental stimulation (including schoolwork, texting, computers, and/or video games).
Just as muscles, ligaments, and bones need rest to heal, studies have shown that the brain also needs rest to heal. Rest is crucial especially within the first 48 hours post injury.
Recovering athletes should be encouraged to lie down in a quiet room void of cognitive stimulation. Movement should also be restricted to only what is necessary as extraneous movement can exacerbate nausea and vomiting.
Because some athletes may be sensitive to light after a concussion, athletes may be more comfortable resting in a quiet, dark environment until this sensitivity subsides.
Most importantly, athletes diagnosed with concussion need to be closely monitored for any decrease in cognitive functioning which may be indicative of a life threatening condition (subdural hematoma). For this reason, athletes with concussion should never be left alone, but should be placed under the supervision of a responsible adult or guardian.
As concussion symptoms begin to dissipate, the athlete can begin to move around and increase cognitive activities. If symptoms worsen with increased activity, the athlete should reduce physical and cognitive activities once again.
Athletes should only begin activity after being cleared by sports medicine personnel trained in the administration of neuropsychological tests. Once the athlete is cleared to begin activity, a gradual and safe progression of activities should be planned with the athlete being closely monitored for any return of symptoms. This type of graduated return will ensure a safe reentry into activity for the athlete.
References
Collins, M. (2009). Evidence-based management of sports-related concussion. Presentation at Annual National Summit on Concussion and Other Sports Medicine Injuries, Los Angeles, California, May 15.
Collins, M. (2009). Management of sports concussion in high school athlete: what are we learning? Presented at Annual National Summit on Concussion and Other Sports Medicine injuries, Los Angeles, California, May 15.
Covassin, T., Elbin III, R., Stiller-Ostrowski, J., Kontos, A. (2009). Immediate post-concussion assessment and cognitive testing (ImPACT) practices of sports medicine professionals. Journal of Athletic Training, 44(6), 639-644.
DiGravio, G. (2009). Center for the study of traumatic encephalopathy announces new findings. Boston University.
Guskiewica, K., Bruce, S., Cantu, R., Ferrara, M., Kelly, J., McCrea, M., et al. (2004). National athletic trainers’ association position statement: management of sport-related concussion. Journal of Athletic Training, 39(3), 280-297.
Guskiewicz, K., McCrea, M., Marshall, S., Cantu, R., Randolph, C., Barr, W., Onate, J., & Kelly, J. (2003). Cumulative effects associated with recurrent concussion in collegiate football players. Journal of the American Medical Association, 290(19), 2549-2555.
Majerske, C., Mihalik, J., Ren, D., Collines, M., & Camiolo Reddy, C. (2008). Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. Journal of Athletic Training, 43(3), 265-274.
McCrory, P., Meeuwisse, W., Johnston, K., & Dvorak, J. (2008). Consensus statement on concussion in sport – the third international conference on concussion in sport held in Zurich. Journal of Science and Medicine in Sport, 12(3), 340-352.
McKee, A., Cantu, R., Nowinski, C., Hedley-Whyte, E., Gavett, B., Budson, A., Santini, V., Lee, H., Kubilus, C., & Stern, R. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. Journal of Neuropathology, June.
Salis, R., (2009). A team physician’s approach to concussion management. Presented at Annual National Summit on Concussion and Other Sports Medicine Injuries, Los Angeles, California, May 15.
Siobounov, S., Siobounov, E., Sebastianelli, W., Cao, C., & Newell, K. (2007). Differential rate of recovery in athletes after first and second concussion episodes. Neurosurgery, 61(2), 338-344.
Smurawa, T., & Congeni, J. (2007). Return-to-play decisions in the adolescent athlete: How to decide. Pediatric Annals, 36(11), 746-751.
Valovich McLeod, T. (2009). The value of various assessment techniques in detecting the effects of concussion on cognition, symptoms, and postural control. Journal of Athletic Training, 44(6), 663-665.
Terry Zeigler, EdD, ATC, Kinesiology Dept. Athletic Training Education Program Director, Vanguard University
http://www.vanguard.edu/athletics/index.aspx?id=403
tzeigler@vanguard.edu
(714) 556-3610 ext 2828