Concussion

Question 1

What is the definition of concussion?

Answer 1

Mild traumatic brain injury

Glascow Coma Scale >/= 13

Question 2

What are the signs and symptoms of concussion?

Answer 2

Headache, usually dull

Poor sleep (not always)

May trigger migraines

Question 3

What diagnostics are performed with suspected concussion and what would they show?

Answer 3

Neuro exam should be normal

No imaging recommended unless neuro exam is abnormal

Question 4

What are the initial treatments for concussion?

Answer 4

Promote sleep

Acetaminophen/ibuprofen PRN headaches

Physical rest for 24-48 hours with gradual return to activities

Minimize cognitive activities until they don’t trigger headaches

Question 5

When should a concussion patient be referred?

Answer 5

Abnormal neuro exam

Glascow Coma Scale < 13

Symptoms for > 21 days

Escalating symptoms

Multiple concussions

Question 6

When may a concussion patient return to work or school?

Answer 6

Able to focus for 30-45 minutes at a time without headache

Accommodations can be made for rest &/or partial days

Question 7

What are the pre-requisites for a concussion patient to return to sports?

Answer 7

Successful return to work or school

Symptom-free without medications

Normal neuro exam

Question 8

What is the progression for returning to sports for an asymptomatic concussion patient?

Answer 8

Light aerobic exercise to increase heart rate

Sports-specific exercises to add movement

Non-contact participation for coordination and increased thinking

Full contact practice to assess status

Normal game/physical activity