Lecture 18 - Sport Related Concussions

Question 1

what is the definition of a concussion?

Answer 1

• sport-related concussion is a traumatic head injury induced by biomechanical forces
• may be linear or rotational

Question 2

what is a linear concussion?

Answer 2

• injury at the impact site
• brain strikes skull on the opposite side

Question 3

what is a rotational concussion?

Answer 3

• brain strikes skull on the other side
• brain rotates - stretches or tears structures/vessels as it shears itself
• CSF is not helpful here

Question 4

what are common symptoms of a concussion in teenagers/adults?

Answer 4

• headache
• fatigue
• feeling slowed down
• difficulty concentrating
• fogginess
• dizziness
• light sensitivity
• visual blurring or double vision

Question 5

what are the common symptoms of a concussion in children (ages 7-13)

Answer 5

• headaches
• fatigue
• dizziness

Question 6

what are the 6 clinical domains of SRC?

Answer 6

1. symptoms
2. physical signs
3. balance impairment (unsteadiness)
4. behavioural changes (irritability)
5. cognitive impairment (slowed reaction time)
6. sleep/wake disturbances (somnolence)

Question 7

what are the types of symptoms of a concussion?

Answer 7

1. somatic (headache)
2. cognitive (fog)
3. emotional (mood swings)

Question 8

what are the physical signs of a concussion?

Answer 8

• loss of consciousness
• amnesia
• neurological deficits

Question 9

true or false: concussions only occur if someone hits their head

Answer 9

• false
• can be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head

Question 10

true or false: concussions only occur if the head is hit hard

Answer 10

• false
• no agreed upon biomechanical threshold (60-168g)
• force does not factor in on symptom severity

Question 11

true or false: you just need better equipment (and why?)

Answer 11

• false
• helmets reduce catastrophic head injuries (high energy impact forces) but not rotational forces (which usually cause concussions)
• limited evidence for most sports

Question 12

true or false: concussions are getting worse

Answer 12

• false
• no scientifically validated concussion severity scales
• no such thing as a minor/severe concussion (until recovery is done, you can not say how bad it was)
• time missed is getting longer because we are getting better/smarter at dealing with concussions

Question 13

what is the acute medical management for concussions?

Answer 13

• check ABC’s, consciousness, and C-spine/significant injury
• memory assessment (or other sideline tests) in combination with symptom report can lead to the diagnosis of a concussion
• these tests alone are not reliable (clinical examination is required)

Question 14

What is the best test for the acute evaluation of SRCs?

Answer 14

• SCAT-5 (tests all 4 domains)
• tests postural stability, neurocognitive functions, and symptoms
• slightly tests oculomotor functions
• HAS A SCRIPT (easy to use and consistent)
• has a 10-word option (instead of just memorizing 5 words)

Question 15

what should you do when sending a potentially concussed athlete home?

Answer 15

• re-evaluate
• send with someone (responsible adult)
• serial monitoring for deterioration (initial few hours)
• look for red flags (such as neck pain, unconscious, confusion, vomiting, seizure, double vision, weakness/tingling)

Question 16

why is re-evaluation necessary?

Answer 16

• evolving and delayed-onset symptoms are common
• multidimensional testing is best (SCAT-5)

Question 17

What is the timeline for return to play? (by age)

Answer 17

• teens = much longer than 10 days
• children = up to 4 weeks
• adults = as low as 6 days

Question 18

why is recovery time longer for children under 13?

Answer 18

• developing brain is more vulnerable
• need to be clinically completely symptom-free before returning (never on the same day)

Question 19

how long is recovery for a “very mild” concussion when on-field symptoms last >15 minutes?

Answer 19

• at least 7 days before full neurocognitive and symptom recovery
• short-term symptoms still need to be removed from play

Question 20

how long does it take for the brain to metabolically return to normal?

Answer 20

• ~2 weeks
• period of vulnerability
• glucose, blood flow and metabolic rate for oxygen are not normal

Question 21

what happens if another concussion occurs within 2 weeks of the first one?

Answer 21

• second impact syndrome
• up to 14 days post-injury
• occurs when athletes return to sport before the resolution of symptoms
• catastrophic increase in intracranial pressure (despite minor second impact)
• leads to much longer recovery time (if not death)
• common under the age of 21

Question 22

how to check for concussions on the sideline

Answer 22

• know your athletes
• be prepared (educate, assess, communicate, idealize the environment (aka is it concussion or hunger/dehydration)
• re-evaluate!!! –> delayed or evolved symptoms are common

Question 23

What is needed for a safe and effective return to play?

Answer 23

• athlete must be honest in subjective reports
• parent will be a liaison
• medical team must be a voice of reason (critical eye, communicate stages)
• coach must practice planning and team culture
• must work together to idealize environment

Question 24

what are the 6 stages of return to play?

Answer 24

1. symptom-limited activity (school/work)
2. light aerobic exercise
3. sport-specific exercise
4. non-contact training drills
5. full-contact practice
6. return to sport

Question 25

when do you transition through stages of RTP?

Answer 25

• once 24 hours symptom-free in one stage, can move up to the next stage
• if symptoms arise, move back a stage and wait until 24 hours symptom free again