Sports Concussions are a frequent occurrence at all
levels of competition in the
United States
There are 30
million children and adolescents involved in out of school
sports programs and 3.5 million boys and 2 million girls are
involved in interscholastic sports. Furthermore, there
are approximately 715,000 sports and/or recreation-related
injuries that occur each year (Sports Neuropsychology,
2006). According to research from the Centers for
Disease Control and Prevention
there are an estimated 300,000 sports related traumatic brain
injuries (TBIs), of mild to moderate severity, most of
which can be classified as concussions, that
occur in the United States each year. About 10% of all student athletes in
contact sports have concussions each season.
At the high school level
alone at
least 1.25 million athletes compete in contact sports. An
estimated 62,816 cases
of concussion occur annually at the high school level.
It is well known that
many people who sustain concussions experience
post-concussion symptoms and decrements on
neuropsychological
testing during the first week post-injury.
The proportion of
these concussions that are repeat injuries is unknown;
however, there is an increased risk for subsequent TBIs among
persons who have had at least one previous TBI. Repeated
mild brain injuries occurring over an extended period (i.e.,
months or years, can result in cumulative neurologic and
cognitive deficits, but repeated mild brain injuries
occurring within a short period (i.e., hours, days, weeks)
can be catastrophic or fatal. There are an estimated
900 sports related traumatic brain injury deaths per year.
When an individual sustains another concussion before the initial injury has healed,
it is referred to as
"Second Impact Syndrome" (SIS) and has been reported more
frequently since it was first characterized in 1973 by
Schneider. "The syndrome is said to occur when a
second concussion is sustained before the signs and symptoms
of the first have resolved" (Traumatic Brain Injury in
Sports, 2004).
The number of cells damaged will increase and that
damage will progressively occur in deeper structures if
further concussions are sustained.
What is a concussion?
A concussion is a brain injury.
A concussion is any change in mental status that
results when the brain is violently rocked back
and forth inside of the skull due to a blow to
the head, neck, or upper body.
Symptoms
observed by Medical Staff or Athletic
Trainers
may include: athlete
appears dazed, vacant facial expression,
confusion about assignment, athlete forgets
plays, disorientation to game, score, or
opposing team, inappropriate emotional reaction
(laughing, crying), incoordination or clumsiness, slowing
in
answering questions, loss of consciousness (even
for seconds), and any change in typical behavior
or personality.
Symptoms on the sideline reported by athletes
may include a
headache or headachy feeling, dizziness,
poor balance, confusion, lack of feeling or
emotion, anxiety, blurred vision, sensitivity to
light or noise,
feeling
slowed down, change in
sleep pattern, concentration or memory problems,
irritability,
vomiting, and the
inability to remember events prior to the
injury. However, student athletes are
typically poor reporters concerning their
conditions.
WHY WORRY
ABOUT A CONCUSSION? - Any concussion,
regardless of how it may appear at the time of
injury, has the potential for becoming much more
serious over time, particularly if the athlete
returns to play too quickly.
An athlete with a suspected concussion should
never return to play during the practice session
or game at which he or she was injured, no
matter how mild the injury appeared and
regardless of the severity or longevity of
symptoms. Furthermore, a concussed athlete
should never return to practice or play until
all symptoms have disappeared and are not
present during physical exertion or at rest.
Thus, a concussion needs to be managed
properly at the initial onset.
RECOVERY FROM A
CONCUSSION
- The recovery
process can take days, weeks, or even months
depending on the location and impact of the
injury.
"Needed recovery time varies with each
individual. Each concussed athlete should be
evaluated individually rather than with
traditionally used general evaluation and
return-to-play guidelines." As noted in
research, high school student athletes take
longer to recover than college and professional
athletes and
the decision to return to play is a critical
one.
Symptoms that typically persist are
headaches, fatigue, lack of initiation,
sensitivity to light, noise, crowds, slowed
processing, reduced concentration, as well as
feeling like your brain is operating in slow
motion or operating on four cylinders rather
than eight. In addition to these symptoms,
a person may be experiencing difficulties with
anxiety, depression, impulsivity, and agitation.
Furthermore, in the case of the high school or
college student who has
to return to classes, it is critical to know and
understand the recovery process. Thus, a student's academic performance also
needs to be closely monitored.
RECOVERY FROM A BRAIN
INJURY FOR THE STUDENT
ATHLETE
Recovery
from a brain injury is often complicated and
difficult to navigate. For the student who
not only desires to return to the field of
competition but also needs to return to the
classroom, this decision process is just as
complicated. Although the student athlete
appears unchanged, significant changes have been
made on the inside which need attention and, in
turn, require a
significant amount of flexibility and
understanding from his/her teachers,
administrators and counselors. Below is a
listing of possible interventions that if
supported by symptom and/or cognitive data will
assist the athlete in managing her/his academic
demands as well as assist in the recovery
process. These interventions, if needed,
are a critical intervention made by a Neuropsychologist who not only understands sport
concussion management but also the educational
system and learning difficulties.
1.
Team meetings among professionals as well as
with parents are important in designing and
updating treatment, if needed. In addition, regular
meetings to adapt the program due to progress or
regression is an essential piece to managing the
student athlete in his/her academic classes.
2.
Problems with reading comprehension in many
instances need to be addressed, depending on the
grade level of the student and the severity of
the injury.
3. The
following modifications for academic instruction
and evaluation are often recommended during the
recovery process to accommodate, an athlete’s
learning limitations. It is
important to avoid placing the student under too
much academic pressure, while simultaneously having the student meet
requirements that he or she is fully capable of
meeting. Excessive accommodations can be
detrimental to recovery and promote
avoidance defenses. Some of the
accommodations may consist of but are not limited
to:
A.
Additional time on tests.
B. Student
should be provided with a copy of another
student’s class notes.
C. Student
should have access to peer tutoring on an as
needed basis.
D.
Accepting homework papers typed by the student
or dictated by him/her.
E.
Accompany oral directions (verbal) with written
directions (visual) for the student to refer to
given his/her verbal or visual memory
weaknesses.
F.
Interpretation of complex information presented
in classes should be reviewed with the student
in extra help sessions in order to avoid his/her
becoming confused with the material. In
addition, these extra help sessions should
include monitoring the student's performance in
the completion of the outside of class
assignments and to enhance his/her success on the
tests.
G. The
student's level of involvement in Physical
Education class should be limited to activities
where there are no group games or competitions
in order to avoid the possibility of receiving
further blows to the head. Thus, the student
athlete should focus on light cardiovascular
exercise (walking).
4. The student should be required to check in
with the nurse or team physician daily to
evaluate his/her condition and monitor hi,/her for
symptoms of fatigue, pain, headaches, and dizziness.
Education
and the Management of a Sports Concussion starts before
the season
Below is a multi-step system for the
management of concussion based upon
symptoms and cognitive data before the season and
careful management of a concussion after a injury has been
sustained.
I.
Education through seminars and team meetings concerning
concussion for athletic directors, coaches, athletic
trainers, athletes, and parents. This information
includes but is not limited to
Information about concussion,
symptoms, and recovery
III.
When an athlete is thought to
have sustained a concussion during competition and a
sideline evaluation needs to conducted
Coaches, athletic trainers, and team
physicians need to
make quick decisions in order to determine return to
play for a player. Athletes in the heat of
competition are notorious for severe under-reporting of
their symptoms. An effective sideline evaluation
is critical in identifying athletes who need to be
removed from the contest in order to protect them from further injury
or even Second Impact Syndrome.
Athletes, coaches and parents should never self-diagnose
or self-evaluate a concussion, regardless of how mild
the injury or symptoms appeared to be or to have been.
Cognitive testing should occur within 24-72 hours of injury.
Follow-up evaluations
can
occur approximately every
5 days in order to monitor symptoms and to track the athlete’s recovery
and to assist parents and school personnel (i.e.,
teachers and professors) in making accurate decisions.
The best and safest measures to use
in determining whether an athlete should return to play
are that the symptoms have
fully cleared and that an athlete's cognitive
capabilities have returned to baseline (or estimated
pre-injury level of functioning) based upon symptom
and cognitive data.
Once the symptoms and cognitive data
are returned to baseline then the athlete is put under
physical exertion to assess if any symptoms return. This
provides the best
assurance to the coaches and medical staff, as well as
parents and athlete, that he or she is ready to return to
full athletic competition without risk of further injury.
This testing and followed up care
is performed by a credentialed Clinical
Neuropsychologist who works closely with coaches,
trainers, and physicians.
V.
If Symptoms Persist
If symptoms of a concussion persist
for longer than 3 to 4 weeks then the athlete may be
suffering from what is known as Post Concussion
Syndrome. Treatment for this condition may include
the athlete undergoing a Neuropsychological Evaluation
in order to fully delineate the degree of injury as
well as determine the individual's strengths and
weaknesses. Following this extensive evaluation,
an athlete may be advised to enter into cognitive
rehabilitation as well as other treatment modalities in
order to assist him or her in returning to their highest
level of functioning.
Decisions in whether to return to
competitive athletics or retire for an extended period
of time requires careful consideration and can only be
made after the extent of one's recovery is fully
analyzed.
