9.2 Concussion assessment and management

Concussions are serious brain injuries that can have lasting effects. Proper assessment and management are crucial for recovery. This section covers how to identify concussions, evaluate their severity, and guide athletes through a safe return to play.

Long-term complications like second impact syndrome and chronic traumatic encephalopathy highlight the importance of careful concussion management. Understanding these risks helps emphasize the need for thorough evaluation and gradual return to activities.

Concussion Assessment

Identifying and Evaluating Concussions

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• Concussion is a traumatic brain injury caused by a blow, bump, or jolt to the head that disrupts normal brain function
• Symptoms of concussion can include headache, dizziness, confusion, memory problems, nausea, and sensitivity to light or noise
• SCAT5 (Sport Concussion Assessment Tool) is a standardized tool used to evaluate athletes for concussion
  • Includes symptom checklist, cognitive assessment, and balance testing
  • Helps identify concussion and determine severity
• Cognitive assessment evaluates mental functions such as memory, concentration, and reaction time (Standardized Assessment of Concussion (SAC) test)
• Balance testing assesses vestibular function and coordination (Balance Error Scoring System (BESS) test)

On-Field Assessment and Management

• Immediate removal from play if concussion is suspected based on signs and symptoms
• Sideline assessment using SCAT5 or other concussion assessment tools
• If concussion is confirmed, athlete should not return to play on the same day
• Referral to medical professional for further evaluation and management
• Monitoring for worsening symptoms and signs of more serious brain injury (loss of consciousness, seizures, worsening headache)

Post-Concussion Management

Initial Treatment and Recovery

• Post-concussion syndrome refers to persistent symptoms (headache, dizziness, cognitive problems) lasting weeks to months after concussion
• Initial treatment involves physical and cognitive rest to allow the brain to recover
  • Avoid activities that worsen symptoms (physical exertion, screen time, reading)
  • Gradual return to school and work as tolerated
• Medications may be used to manage specific symptoms (pain relievers for headache, anti-nausea medication)
• Referral to specialists (neurologist, neuropsychologist) for persistent or severe symptoms

Return to Play and Activity

• Return-to-play protocol is a gradual, step-wise process to safely return athletes to sport after concussion
  • Progression from light aerobic activity to sport-specific drills to full contact practice
  • Each step requires 24-48 hours without symptoms before progressing
  • If symptoms return, athlete goes back to previous step
• Gradual return to other activities (school, work, driving) as tolerated
  • May require accommodations or modifications (reduced workload, frequent breaks)
• Importance of not rushing recovery to prevent prolonged symptoms or further injury

Long-Term Complications

Second Impact Syndrome

• Second impact syndrome is a rare but catastrophic condition that occurs when an athlete sustains a second concussion before fully recovering from the first
• Can lead to rapid brain swelling, herniation, and death
• Emphasizes the importance of proper concussion management and not returning to play too soon

Chronic Traumatic Encephalopathy (CTE)

• Chronic Traumatic Encephalopathy (CTE) is a progressive neurodegenerative disease associated with repetitive head impacts
• Symptoms can include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and dementia
• Can only be diagnosed definitively by autopsy
• Has been found in athletes, military veterans, and others with a history of repetitive brain trauma
• Raises concerns about the long-term effects of concussions and the need for prevention and proper management