Sports Related Concussions, Part 2

By Jean M. Walsh, RN
Trauma Coordinator

As I wrote last time, a concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Quite simply, a concussion alters how the brain normally functions. Concussions can have serious long term health effects and even a subtle “ding” or “bump” can be serious.

According to the Center for Disease Control, it is estimated that nearly 1.6 to 3.8 million sports and recreation concussions occur in the United States each year. Youth 5-18 years of age account for over 2 million sports related emergency room visits per year. Of these visits, nearly 6% or 135,000 involve concussions. Football accounts for nearly 60% of these concussions while bicycling, basketball, soccer and other playground activities round out the top five causes.
If you are a parent or a coach and you believe one of your children or players has suffered a concussion you should:

· Remove the player from the competition immediately.
· Never leave the player alone.
· Get a professional medical evaluation.
· Avoid contact or collision sports for at least 3 weeks.
The 911 system should be activated in the following situations:
· Severe head trauma
· A fall from a height greater than the height of the person
· Prolonged loss of consciousness (greater than 2 minutes)
· Unequal pupils
· Severe Nausea/Vomiting
· Confusion/Perseverating that does not go right away/Restlessness/Agitation
· Extreme drowsiness, weakness or inability to walk
· Severe headache/Slurred speech

A child with a grade III concussion will need to be evaluated by a physician in an emergency setting. A full neurologic exam will be performed to check reflexes, vision, hearing, pupil response, balance, memory, concentration, and coordination. A brain CT scan will be performed to check for any bleeding or bruising in the brain tissue. Admission to the hospital for neurologic observation may also be necessary.

Returning a child to sports after a concussion should be a well defined 4 step process:

1. This should be a gradual process and should be done under the supervision of qualified people. When the player does not have any symptoms, they may be able to do light exercise, stationary cycling or walking.
2. The next step is to do sports specific activity without contact for example running. If there are any symptoms returning then take a step back.
3. Next step is on field practice without contact. Again, any symptoms indicate a return to the previous stage.
4. When a medical doctor has given the go ahead on field practice with contact can begin. The time taken to get to this stage will depend on the severity of the concussion.
Long term consequences of repeated concussions are functional changes that affect thinking, language, emotions, behavior, and sensations. There may be an increased risk of seizure disorders, Alzheimer’s and Parkinson’s disease. Premature return to play can cause permanent neurologic disability from cumulative trauma, death from secondary impact and post concussion syndrome.

Some ways to prevent concussions and their severity are to, wear appropriate headgear at ALL times. Learn proper techniques for tackling opposing players and heading a soccer ball. Understand and recognize the symptoms of a concussion. Never allow an athlete to play if you suspect a concussion. The effects both short and long term are simply not worth it.