PRORehab Library

Concussion Evaluation and Treatment

It is estimated that over 60,000 high school athletes will suffer from a concussion while playing sports this year. Many people know that a concussion involves trauma to the brain, but are unfamiliar with the proper evaluation and care of this type of injury. Recognition and follow-up care by a physician are the two most important steps a parent or coach can make.
A concussion is the result of a direct hit to the head that causes transient impairment of neural function of the brain. Signs and symptoms include headache, ringing in the ears, dizziness, nausea, difficulty concentrating, memory loss, or a loss of consciousness. It is often believed that in order to sustain a concussion, an individual, must lose consciousness. The truth is, a person can maintain consciousness and still have a mild concussion. Your next question may be: “As a parent, how do I know if my child has a concussion?” The easiest way is to simply observe the individual and listen to any complaints he/she might have. Changes in personality and physical feeling of the athlete are both indicators that a head injury has occurred.
In 1997 the Quality Standards Subcommittee of the American Academy of Neurology published concussion parameters and guidelines for return to competition. Severity of the concussion was divided into three grades: 1, 2, and 3. Grade one was defined as transient confusion, no loss of consciousness, and duration of all signs and symptoms less than 15 minutes. The second grade was defined as transient confusion, no loss of consciousness, and the duration of signs and symptoms that were greater than 15 minutes. Grade three is defined as any loss of consciousness, either brief or prolonged.
Once a concussion is suspected the athlete should be constantly monitored so that any changes in their condition can be addressed immediately. Signs and symptoms of a concussion are: headache, dizziness, confusion, poor balance, ringing in the ears, blurry vision, loss of memory, and unequal pupil size. It should be noted, not all of these signs and symptoms need to be present for an individual to be suffering from a head injury. Should these problems persist for more than 15 minutes or increase in intensity, the athlete should be referred to a physician for further evaluation.
Even after being checked out by a physician, the athlete may complain of some cognitive difficulties for a period of time. This is called postconcussional syndrome. It is typically characterized with difficulty concentrating, decreased attention, irritability, or impaired memory. Exercise may contribute to headaches, early fatigue, or dizziness. If these symptoms are persistent, the athlete should be held out of activity and a follow up visit with a physician scheduled.
Return to play is best determined by the severity and number of concussions sustained. The American Academy of Neurology reports that an athlete with a grade-one may return to play the same day if his/her symptoms resolve within 15 minutes and it is their first concussion. However, if this is the second or third, grade-one, the athlete should not return for one week from the time symptoms have resolved. The first grade- two concussion is an automatic one-week suspension of play and a second or third is a two-week wait. As you can see, as the grade and number of concussions increases, so does return time. Grade three concussions and return time should always be evaluated by a physician. Multiple grade-three concussions, as recommended by the American Academy of Neurology, is a minimum of one month from sports participation and possibly no participation in contact sports.
As a certified athletic trainer working with hundreds of athletes each year, I use the saying: “When in doubt, have a physician check it out.” Unlike a fractured finger, a severe concussion is not something that can wait until the morning. An untreated head injury can cause paralysis or even death. As a parent or coach you should note any uncharacteristic behaviors, complaints of severe headache, increase in nausea, vomiting, dizziness, or mood swings. Should any of these things become severe, please take your child to the hospital.

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