Concussions: Proactive Parents Needed

Evolving science

Team physicians, athletic trainers, and other personnel responsible for the medical care of athletes face no more challenging problem than the recognition, evaluation and management of a concussion. 

Diagnosis of concussion usually involves the assessment of a range of domains, including:

• clinical symptoms - somatic (headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. laughing uncontrollably);
• physical signs (e.g. loss of conciousness, amnesia);
• Behavioral changes (e.g. irritability);
• Cognitive impairment (e.g. slowed reaction times)
• Sleep disturbance (e.g. drowsiness).

Concussion experts acknowledge, however, that the science of concussion is evolving and that management and return to play decisions remain a matter of clinical judgment on a case-by-case basis.¹

Where experts agree

Experts, however, agree on a number of important points:

1. An athlete with a suspected concussion should not be left alone following the injury and should be monitored over the course of the next 24 to 48 hours for signs indicating a more serious brain injury.
2. Except for some adult athletes, in some circumstances, an athlete with diagnosed concussion, including any athlete under 18, should not be allowed to return to play on the day of injury. 
3. Children and adolescents should not be returned to practice or game play until completely free of symptoms.
4. Children and adolescents need to limit exertion with activities of daily living and to limit scholastic and other cognitive stressors.  This means no text messaging or videogames while still experiencing symptoms.  It may also mean modifying school attendance and activities to avoid making symptoms worse.

Advice for parents

• Become educated about the signs and symptoms of a concussion and the dangers of returning to sports too soon after a concussion, including second impact syndrome (SIS).   Remember: an individual does not have to suffer a loss of consciousness (LOC) to have suffered a concussion. In fact, the vast majority of concussions (more than 90% in one study) did not involve LOC.
• Emphasize to your child the dangers of failing to immediately report or underreporting of concussion symptoms, and that doing so places them at risk for a catastrophic injury.
• Insist that all coaches and certified athletic trainers (ATs) involved in your child's sports program be trained to recognize and manage concussions, and that they, in turn, educate athletes about the signs and symptoms of concussion and the dangers of SIS, which can result from not reporting symptoms to the coach, AT or team physician.
• Make sure that team physicians and ATs agree on definitions, procedures and referral guidelines for concussions. Clear communication among sports medicine personnel is necessary to provide consistent and proper care to the athlete.
• Request that all athletes in contact or collision sports undergo neuropsychological testing before the start of every season to provide a baseline and individualized normal to be used for comparison purposes should an athlete sustain a concussion.
• Call for the testing of student-athletes after any concussion to compare against the baseline tests to detect any changes over time.
• Insist that NO athlete ever be allowed to return to the same contest or practice after experiencing any post-concussion signs or symptoms.  [Note: a 2001 study reported in The Journal of Athletic Training, nearly a quarter (22%) of the ATCs surveyed allowed athletes to return to play in the same game or practice after suffering a suspected concussion.]