Concussion

What is a concussion?
A concussion is a complex pathophysiological process affecting the brain, induced by biomechanical forces such as a direct or indirect blow. Concussions can be caused by a blow to the face, neck or elsewhere with transmitted forces to the head. Concussions usually result from a rapid short-lived impairment of neurological function, which resolve spontaneously. The majority (80–90%) of concussions resolve in a short (7–10 day) period, although the recovery time may be longer in children and adolescents. Although no abnormality is seen on standard structural neuro-imaging studies, a head CT or MRI may be considered if there is prolonged loss of consciousness, an abnormal neurologic exam or ongoing symptoms consistent with an intracranial hemorrhage.

Common side effects include:

  • Confusion, feeling spacey or foggy, not able to think straight
  • Feeling drowsy, difficulty waking up
  • Headaches and dizziness
  • Slight memory loss of events occurring right before or right after the injury
  • Nausea and vomiting
  • Sensitivity to light and/or noise
  • Balance problems
  • Loss of consciousness (the duration of the unconsciousness may indicate more severe injury)

Management
The treatment protocol is derived from the most recent 2012 4th International Conference on Concussions in Sports held in Zurich, Switzerland. Neuropsychological test batteries such as the SCAT2 or SCAT3 tests are also used in clinic to evaluate the severity of a concussion and compare baseline or post injury baselines to the recovery period to evaluate for improvement. Regardless of the severity of the injury, an athlete will not be allowed to return to play as long as symptoms are present. For deciding when to return to play, our recommendation and the current standard of care is to follow a supervised, stepwise process.

Concussion symptoms may continue to linger for a period of a few days to a few weeks. Some other symptoms that may present themselves during recovery include feeling withdrawn, irritable, difficulty focusing, feeling tired, intolerance to sound, or persistent headaches. It is usually advisable that patients cease all contact activities or sports for up to one week after all symptoms have passed.

The return to play protocol is as follows:

  • Level 1: No activity, complete rest (no television, computer, texting, or studying). Once asymptomatic for at least 48 hours, the athletes can proceed to level 2.
  • Level 2: Light aerobic exercise such as walking or stationary cycling. Also includes television, computer, texting, and studying. Once asymptomatic for 24-48 hours in this stage, the athlete may proceed to level 3.
  • Level 3: Sports specific training without physical contact (i.e. skating in hockey, running in soccer). Once asymptomatic for 24-48 hours in this stage, the athlete may proceed to level 4.
  • Level 4: More complex, non-contact practice. Once asymptomatic for 24-48 hours in this stage, the athlete may proceed to level 5.
  • Level 5: Full contact training after medical clearance. Once asymptomatic for 24-48 hours in this stage, the athlete may proceed to level 6.
  • Level 6: Game play.

If at any point of the return to play protocol post concussion symptoms occur, the patient should drop back to the previous asymptomatic level and attempt progression of the protocol after a 24 hour symptom free period. Returning too soon can cause adverse effects and may lead to permanent symptoms or other complications.