One of the greatest struggles in concussion management is the initial recognition that something may be wrong with an athlete, and that they require further evaluation. The subject of concussion has been scrutinized recently, and new science is being published almost on a daily basis. In fact, the Google dictionary defines a concussion as a temporary loss of consciousness, which could not be a more limiting and misleading definition!
While the scientific understanding is increasing, it means that there are many layers to dig through when attempting to self-educate on the topic. By Googling concussion, you find conflicting advice, myths and confusion. The purpose of this post is to help take away some of the confusion, and provide you with the simple yes/no questions that I ask myself when identifying a concussion in an athlete.
What is a Concussion?
Parachute Canada defines concussion as a change in brain function, which can be caused by a director or indirect force to the head. This means that a direct hit to the head is not always required; a concussion can result from a blow to the body or a fall on the bottom. Because it is a functional or "invisible" injury, often tests like MIR or CT scans appear normal.
The actual mechanism of injury results when the brain moves in the scull, and makes contact with the inner surface of the bone. This can cause physical damage such as bleeding or trauma to the fibers and tethers that hold the brain in place. More commonly, there is no physical damage, however a chemical cascade and inflammation occur that alter the function of the brain.
What Does a Concussion Look Like?
Since everyone's brain and brain chemistry are very different, each person reacts to a concussion differently.
The Consensus Statement published in 2013 helps to summarize the potential symptoms in different categories:
- Reported Symptoms including headache, dizziness, inability to focus eyes, sensitivity to noise or light
- Physical Signs including loss of consciousness, or difficulty staying awake
- Behavioral Changes such as irritability, personality or emotional changes
- Cognitive impairment such as a slow reaction time, or alterations in short and long term memory
- Sleep disturbances such as insomnia, drowsiness or slowness to wake
That being said, any change to the normal following a mechanism of injury should be viewed as a sign of concussion.
So What to do if an Athlete has Sign or Symptoms?
When an athlete displays signs and symptoms of a concussion, the most important thing to do is to remove the athlete from play until they have received appropriate medical care. The scariest part of concussion is not the initial injury, but rather the risk of Second Impact Syndrome, which occurs when a second impact is sustained before one is completely recovered. Second Impact Syndrome most often results in a critical injury, leading to permanent damage or death.
Athletic Therapists are specialists in field side evaluation of concussions, and in making quick decisions regarding removal from play, and referral to appropriate health care professionals. Sometimes the most important decisions have to be made in the blink of an eye, if a coach or athlete does not notice the most subtle of signs and therefore the athlete is subjected to subsequent contact.
To ensure that the correct decisions are made for your children, players, student, or for yourself, an Athletic Therapist should be present at all high-risk activities to act as a third-party activity for all athletes.
by:Alana GulkaCAT(C), BAHSc-AT, BSc
Certified Athletic Therapist