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January 16, 2015
Concussions or mild traumatic brain injuries (MTBI) affect the metabolic function of the brain. 3.8 million concussions occur every year in athletes. Following a concussion the blood flow is altered to the brain. The brain cells depend upon an adequate blood supply in order to heal form the insult. Football, ice hockey, soccer, and lacrosse have the highest rates of concussive injuries. Injuries occur most often in competition than in practice. Females have a higher rate of concussions for their specific sport.
Signs of a concussion include acute findings and delayed findings. The cognitive, physical, emotional, and sleep are typically affected. Cognitive findings include confusion, amnesia, loss of consciousness, feeling in a “fog”, delayed verbal and motor responses, slurred speech, drowsiness. Physical findings include headache, dizziness, disruption in balance, nausea/vomiting, visual disturbances, and hearing sensitivity. The emotional findings can include emotional fragility, irritability, fatigue, anxiety, and sadness. Sleep disturbances can include too much sleep or inability to sleep.
Concussions can lead to other problems. Depression has been reported. Second Impact syndrome is an injury that occurs to an athlete still recovering from an initial concussion, but has a second concussive episode. Brain damage or death can occur from bleeding around the brain in the syndrome. Except for boxing, second impact syndrome mainly affects adolescents. Post-concussion syndrome is prolonged symptoms of concussion lasting more than three months. Students may perform less than optimal in school with prolonged concussion symptoms.
The management of the injured athlete starts prior to any injury. Coaches, parents, athletes, and medical personnel should be educated towards concussions. Pre-participation exams help to establish a baseline of an athlete that may be used as comparison for the injured athlete. The enforcement of rules helps to decrease rates of injuries. Coaches and parents should teach proper skills of the sport. A culture of intentional acts of unsportsmanlike conduct that lead to injury is unacceptable.
The athlete that is injured on the field of play is initially evaluated on the field for their injury. Any concern by the medical staff or coaches regarding cervical spine injury or a life threatening event would warrant the athlete to be transported to the nearest emergency room for further workup. If a concussion is suspected the evaluation will include any loss of consciousness or concussion symptoms. The patient will also be evaluated on the sideline to help determine the severity of the concussion. The athlete that is diagnosed with a concussion will not be allowed back to play that day. A medical professional should evaluate the concussive athlete.
Return to play is based partly on neuropsychological evaluation. Routine evaluation using X-ray, computed tomography (CT Scan), or MRI (Magnetic Resonance Imaging) is not needed unless the physician is looking for a possibility of intracranial bleeding. The athlete will be evaluated for clearing of symptoms they had following the event. The return to baseline may take a short amount of time to several months. The athlete should gradually acclimate back to their sport.
Concussions can be very alarming to the athlete, parents, coaches, spectators, and physicians. Developing a plan ahead of time to evaluate and treat an injured athlete can be very settling.
Dr. Jeffrey E. Gittins
Orthopedic Sports Medicine
New Albany, OH
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