Recognize the signs of concussion

May 13, 2013
Dr. Mary Parks Lamb

So much media attention is being paid to concussions in sports. When do you need to be concerned for your athlete at home? What can you do to protect your active child? Do you need to look into that ImPACT test that you have heard about?

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way your brain normally works, according to Dr. Mary Parks Lamb, Washington Health System Primary Care - Lakeside. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. A concussion can occur even without the loss of consciousness, and those injuries that may seem to be mild can result in serious injury.

It has been reported that U.S. emergency departments treat an estimated 135,000 sports and recreation-related head injuries including concussions each year among children ages 5 to 18 (MMWR July 2007). Concussion can occur in any sport and children and teens are more likely to get a concussion and take longer to recover than adults. A repeat concussion that occurs before the brain recovers from the first concussion – usually within a short period of time (hours, days, or weeks) – can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.

Recognition and proper response to concussions when they first occur can help prevent further injury or even death. All coaches, parents and athletes need to learn concussion signs and symptoms as well as what to do if a concussion occurs.

How to Recognize Concussion

Common signs observed:

• Appears dazed or stunned

• Is confused about assignment or position

• Forgets an instruction

• Is unsure of game, score, or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness (even briefly)

• Shows mood, behavior, or personality changes

• Can’t recall events prior to hit or fall

• Can’t recall events after hit or fall

Common symptoms reported by the athlete:

• Headache or “pressure” in head

• Nausea or vomiting

• Balance problems or dizziness

• Double or blurry vision

• Sensitivity to light

• Sensitivity to noise

• Feeling sluggish, hazy, foggy, or groggy

• Concentration or memory problems

• Confusion

• Does not “feel right” or is “feeling down”

What to do if you suspect your child/athlete has a concussion?

• Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.

• Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:

− Cause of the injury and force of the hit or blow to the head or body.

− Any loss of consciousness (passed out/knocked out) and if so, for how long

− Any memory loss immediately following the injury

− Any seizures immediately following the injury

− Number of previous concussions

• Keep the athlete out of play the day of the injury and until a health care professional experienced in evaluating for concussion says they are symptom-free and it’s okay to return to play.

What is ImPACT Testing?

Along with the signs and symptoms mentioned, many athletes experience cognitive brain function deficits such as memory loss, difficulty concentrating and increased reaction time as a result of a concussion. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most widely used, and most scientifically validated computerized concussion evaluation system, according to Lamb.

Beginning at age 10, it is recommended that an athlete complete a baseline ImPACT test. In the event of concussion, using ImPACT can help to objectively evaluate the concussed athlete’s post-injury condition and track recovery for safe return to play. In fact, neurocognitive testing has recently been called the “cornerstone” of proper concussion management by an international panel of sports medicine experts. ImPACT is the most widely used computer-based testing program in the world and is implemented effectively across high school, collegiate, and professional levels of sport participation.

ImPACT takes approximately 20 minutes to complete. The program measures multiple aspects of cognitive functioning in athletes, including:

• Attention span

• Working memory

• Sustained and selective attention time

• Response variability

• Non-verbal problem solving

• Reaction time

Lamb said it is also recommended that athletes playing collision sports do a baseline ImPACT test prior to the start of the season. In the event that the athlete sustains an injury during the following two years of their baseline test, the athlete will repeat the test and the post-injury scores will be compared to baseline scores. If an athlete has already sustained an injury without getting baseline tested, the ImPACT testing can still be given and the scores compared with normal age-matched athletes.

If you suspect your child or athlete has a concussion, contact Sports Medicine Specialist, Dr. Todd Franco, at 724-206-0293. Patients at Lakeside Primary Care can also see Dr. Mary Parks Lamb for concussion evaluation and management.

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