Managing Concussions

By Doug Means, MA, ATC,

            Noah’s head hit the ground pretty hard when he was tackled, and he felt kind of weird afterward. He walked to the sideline shaking his head thinking it was just another hit and that he could shake it off.  He wanted to continue playing.  After the game, though, he sat by his locker and felt sick to his stomach.  Should Noah have kept playing?

Definitely not. Noah may have had a concussion and needed to get checked out instead of returning to the game.

What is a Concussion and What Causes it?

            The brain is made of soft tissue that is cushioned by spinal fluid and encased and protected by the skull.  When a head injury occurs the brain can move around inside the skull and even bang against it causing bruising of the brain and injury to the nerves. When this happens a person sustains a concussion, which is a type of traumatic brain injury, resulting in temporary loss of normal brain function.

According to the CDC, an estimated 136,000 concussions occur each year in high schools alone. Most people that sustain a concussion recover just fine, but parents, coaches and officials need to recognize the signs and symptoms associated with a concussion. Not only is it important to recognize the signs and symptoms, but we have to create an environment where kids feel comfortable and are encouraged to report injuries.

What are the Signs and Symptoms?

            The signs and symptoms of a concussion can be very subtle and may not be immediately apparent.  Because of this, athletes put themselves at risk by returning to a game or practice before they should or before the brain has had time to heal properly.

The most common symptoms after a concussion are headache, amnesia and confusion.  Although we may think of a concussion as someone passing out, a person can have a concussion and never lose consciousness.

Signs and symptoms of a concussion may include:

–          Headache

–          Memory loss, such as remembering things that happened right before the injury

–          “seeing stars”  and feeling dazed, dizzy or lightheaded

–          Nausea or vomiting

–          Blurred vision and sensitivity to light

–          Slurred speech or saying things that don’t make sense

–          Difficulty concentrating

–          Difficulty with balance or coordination

–          Feeling anxious or irritable

–          Feeling overly tired

 

What Should Parents Know?

In many instances a child/athlete who just participated in a practice or game, suffered a suspected concussion, and exhibits one or more of the above symptoms, simply goes home. Here are some the things parents should know and look out for while caring for their child/athlete at home.

1. Monitor the child for the first 24-48 hours.  Because delayed onset of symptoms during the first 24-48 hours is possible, you should closely monitor the athlete during this time.  The rule of thumb is to wake the athlete every 3-4 hours during the night just to check on any changes in symptoms.

2. IMMEDIATELY go to the hospital if the condition deteriorates or the symptoms worsen

– If their headache gets worse

– They can not be woken up

– Vomiting

– Experiences seizures

– Unsteady on their feet or slurred speech

3. NO ASPIRIN. Do not give the athlete Ibuprofen or Advil for their headache. Should over the counter medication be needed for the headache, Tylenol (Acetaminophen) should be given.

4. Physical and “cognitive” rest.  This means that your child should rest and avoid strenuous activities for at least the first 24 hours.  Because activities that require concentration and attention may worsen and delay recovery, daily activities to avoid are: videogames, text messaging and talking on the cell phone.

5. No driving until medically cleared. 

6. Normal diet. Limited information is available regarding the recommended diet for your child suffering from a concussion.  A normal well balanced diet should be maintained while avoiding spicy foods.

7. TRUST YOUR INSTINCTS!! You know your child better than anyone. Don’t be afraid to ask them how they are feeling and take them to the doctor if you suspect something is wrong.

KORT’s Role in Concussion Management

KORT Physical Therapy has implemented a Comprehensive Concussion Management Program for all of their athletic trainers that work at 30 high schools and small colleges throughout Kentucky and Southern Indiana.

The program consists of the following 5 phases:

–          Baseline Testing

–          Education

–          On-Field Management

–          Referral to a Medical Specialist

–          Post Injury Testing and Rehabilitation

Baseline testing is available to all athletes.  KORT utilizes the ImPACT Baseline Testing (http://impacttest.com) which is a computerized neurocognitive evaluation system.   By using this system, KORT is able to manage concussions on an individualized basis.  Utilization of this system helps to objectively evaluate the concussed athlete’s post-injury condition and track recovery for a safe return to play. This test can be administered at the school by the athletic trainer or in one of our KORT clinics. To inquire about having a baseline test administered, contact Doug Means at dmeans@kort.com

Making sure parents, athletes and coaches are educated about concussions is the second phase of KORT’s program.  Knowing the signs and symptoms are one thing, but what should a parent look for when the athlete is at home?  What are some things to avoid while the athlete is recovering? What if my son/daughter gets another concussion?

Answers to these questions are provided on KORT’s web site at:

http://kort.com/services/Sports-Medicine/Educational-Resources.aspx

KORT provides medical on field coverage at over 30 high schools and small colleges throughout Kentucky and Southern Indiana.  The athletic trainers, working with their team physicians at these schools are Nationally Certified and trained to manage all traumatic brain injuries.

Should an athlete sustain a concussion, the athletic trainers are able to make the proper referral to a Neurological Specialist, many times getting them in within 24 hours.  Should the physician order follow up ImPACT testing, this can be completed at a KORT facility or administered by the athletic trainer at the school. The results can be compiled producing a report that can be sent to the physician immediately.

Return to Play

Athletes who are not fully recovered from the initial concussion are significantly more susceptible to recurrent concussions.  Once the athlete has been cleared by the physician to return to sports, it is important to integrate them safely back into their sport.  The athletic trainers with KORT have established a return to play protocol as part of their concussion management plan to gradually return an athlete to play while controlling their activity level and monitoring their symptoms.

The protocol begins on Day 1, once the athlete is symptom free for 24 hours.

Day 2, the athlete will perform light aerobic activity for 20-30 minutes for two days.  If the athlete continues to be symptom free, they will progress to:

Day 3, where the athlete will be put through another two days of interval training with the introduction of weight exercises.

On Day 4, the athlete starts to practice without risk of contact. The athlete will return to full practice on Day 5 if they are still symptom free.  At any point during this rehabilitation, should the athlete have a recurrence of symptoms, the physician is notified and the protocol begins again starting with day 1.

KORT, through its Comprehensive Concussion Program, hopes to create a “team” approach when helping an athlete recover from a concussion.  This “team” consists of: the physician to guide the care of the athlete, the coaches to recognize the signs and symptoms, the teachers working with the athletic trainer and coaching staff to monitor athlete’s demeanor and disposition in the classroom setting while informing and educating parents on how to care for and monitor them at home.  By creating this system the athlete is able to be monitored while creating a safe environment for them. With the ultimate goal being the safe and effective return of the athlete back to full play, KORT is making sure that happens.

 

Doug Means, MA, ATC, is the Director of Sports Medicine for the Kentucky Orthopedic Rehab Team (KORT).  He is Nationally Certified by the National Athletic Trainers Association and has over 20 years of athletic training experience.  He has worked with athletes at all levels from High School, College, NFL and with the USOC.   

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