Who is administering the Youth Sports Concussion Program?
The program is being administered by Primary Health Care Services of Peterborough, representing the Peterborough Networked Family Health Team. The Peterborough Networked Family Health Team consists of family doctors, nurse practitioners, registered dietitians, mental health clinicians, pharmacists, registered nurses, an occupational therapist and medical secretaries across the City and County of Peterborough and provides care for over 117,000 patients.
What is a concussion?
A concussion is a common form of brain injury, and can be caused by a direct or indirect hit to the head or body (for example, a car crash, fall or sport injury). This causes a change in brain function, which results in a variety of symptoms. With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal.
What actually happens?
When a person suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull’s bony surface. A hard hit to the body can result in an acceleration/deceleration injury when the brain brushes against bony protuberances inside the skull. Such force can also result in a rotational injury in which the brain twists, potentially causing shearing of the brain nerve fibres. It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. In the minutes to days following a concussion, brain cells remain in a vulnerable state. New research emphasizes that the problem may not be the structure of the brain tissue itself, but how the brain is working. The exact length of this change is unclear. During this time period, the brain does not function normally on a temporary basis, and is more vulnerable to a second head injury.
How do concussions occur?
Most concussions occur as a result of a collision with another object while the object or person is moving at a high rate of speed. Forces such as these (and others) can result in deceleration and rotational concussive injuries.
Who to tell?
It is extremely important to seek medical advice immediately upon receiving a blow to the head or body that results in signs or symptoms of a concussion. Often, concussions can go untreated (and even unnoticed by others) because few symptoms are visible to casual observers. Many times, the symptoms of a concussion may not be identified until the person recovers to the point where increased exertion causes symptoms to worsen. In fact, 4 out of 5 professional athletes do not even know that they have been concussed (Delaney et al, CJSM 2001).
Although symptoms may not be immediately apparent, it is important to be aware of possible physical, cognitive and emotional changes. You can never be too careful! Symptoms may actually worsen throughout the day of the injury or even the next day. Without proper management, a concussion can result in permanent problems and seriously affect one’s quality of life.
It is important to tell a family member, friend, co-worker, teammate, employer, trainer or coach if you think you have had a concussion. Memory loss or amnesia associated with the trauma is one hallmark of a concussion and some people may forget that they were injured until after the diagnosis is established. However, if the person is aware of the signs of concussion, informing someone will help assure proper medical care. If you think you have had a concussion, you should immediately remove yourself from the current activity whether it is sports, work or school.
What are the symptoms of a concussion?
You can’t see a concussion. Signs and symptoms of a concussion can show up right after the injury or may not appear or be noticed until days after the injury. If your child reports one or more symptoms of concussion listed below, or if you notice the symptoms yourself, keep your child out of play and seek medical attention right away.
|Loss of Consciousness (LOC)||Disequilibrium|
|Confusion||Feeling “in a fog”, “zoned out”|
|Post-Traumatic Amnesia (PTA)||Vacant stare, “glassy eyed”|
|Retrograde Amnesia (RGA)||Emotional Liability|
|Delayed Verbal or motor responses||Slurred/incoherent speech|
|Inability to Focus||Visual disturbances, including light sensitivity, blurry vision, or double vision|
Are there screening and diagnosis options?
Concussions are a common occurrence and most resolve uneventfully. A concussion always has the potential to cause serious harm and needs to be checked by your health care provider as soon as possible.
Diagnosing a concussion may take several steps. Your health care provider may ask questions about your concussion and work/ sport history, the most recent injury, and will conduct a neurological exam. This can include checking your memory and concentration, vision, coordination, reflexes and balance. Your doctor may request further tests that include:
- Computerized Tomography (CT scan) – CT is fast, patient friendly and has the ability to image a combination of soft tissue, bone, and blood vessels. It is a sophisticated X-ray machine linked to a computer to produce detailed, two-dimensional images of the patient’s brain. The patient lies still on a movable table that is guided into a large X-ray machine where the images are taken. A CT scan is painless and usually takes around 10 minutes.
- Magnetic Resonance Imaging (MRI) – An MRI uses magnetic fields and radio waves to generate images of the brain. The patient lies inside a cylindrical machine for 15-60 minutes while images are made. This technique is also painless, but noisy. In the majority of concussions there will not be any obvious damage found on these tests.
At times they can be important to assess for other skull or brain injury but in general, they currently have little to add to concussion management.
- Neuropsychological testing – Sometimes the role of neuropsychological testing is important in identifying subtle cognitive (i.e. memory, concentration) problems caused by the concussion and may at times help to plan to return to pre-injury activity. In addition, balance testing may be required. Usually these are arranged by the concussion expert.
When should I return to activity?
A concussed person should be removed from activity immediately and should be assessed by their health care provider. Given that symptoms may worsen later that night and the next day, you should not return to your current activity. When concussed, your ability to assess your situation may be impaired. Post-concussive symptoms may intensify with an increase in activity, so it is important that return to activity is gradual and monitored/supervised by your family doctor or nurse practitioner.
How do I cope with symptoms?
The best medical management for a concussion is rest, both physical and mental. A person who has suffered a concussion may often feel lethargic and tired. It is important to admit this fatigue to yourself. Your brain is telling you that you need rest and it is extremely important that you listen to it. If you continue pushing yourself and struggling on, it is likely you will make the symptoms worse.
The first thing to fail when you get tired is your concentration. If there is something important to get done, it is best to complete it when you are fresh after resting. When your attention starts to fade you may need to stop, rest again and write down the important things for later. Many patients who have suffered a concussion often complain of being very irritable. You may find that things that would not normally annoy you suddenly do. Patients sometimes find themselves losing their temper, snapping at family members or friends and being very annoyed over things. This may be because one’s own self-control needs a fresh, working brain as well. In order to cope with this you need to be aware of emotions. Some patients have learned personal relaxation methods such as imagery and progressive relaxation methods to optimize their coping skills.
Other symptoms such as dizziness and clumsiness appear because the brain is reacting slowly and less efficiently. Concussions can upset balance organs in the ear, resulting in vertigo. One way to deal with these types of symptoms is to take special care in actions and movements, which means walking slowly and being aware of your surroundings.
Other problems such as noise sensitivity and visual changes are also the result of a concussion. Putting up with noise and bright lights needs brain energy and you may find that you do not have the energy level to do so. You may be around a loud radio, bright lights or a stimulating environment and find yourself suffering from bad headaches. One answer to coping with this is to avoid loud noise and bright lights as much as possible. Many people find it helpful to wear sunglasses everywhere, even indoors.
When dealing with other symptoms it is crucial to only take medications that your health care provider has prescribed or approved of. Also, do not drink alcohol or take any drugs not prescribed by your health care provider, as it may hinder recovery and can put you at risk for further injury. Remember, although in most cases symptoms resolve spontaneously, usually in a couple of weeks, the process of healing from a concussion may take considerably more time. It is important to pace yourself and increase activity gradually as well as consult with your family or friends before making any important decisions.
How do I cope with emotions?
When coping with a concussion, it is not uncommon for the person to become overwhelmed by a variety of emotions. Often times the patient feels concerned, anxious and sometimes depressed. The first part of the healing process is to understand that these emotions are normal. After an injury, most people go through an initial stage of denial. You may refuse to believe that you are injured or unable to participate in your selected work, activity or sport. It is extremely tough to realize that after sustaining a concussion, your body may not be able to respond as it did before.
Other emotions such as anger and depression are also common when suffering a concussion. You may find yourself being angry, displaced, and blaming others for your injury. It is quite common to become very angry at your co-workers, family and friends. As you continue to become more aware about the extent of your injury, depression may set in. This may include self-pity, crying, insomnia, etc. When you are unable to work, play and participate in your normal life, you may become doubtful of your personal abilities and struggle with your personal worth. You may worry that if you are out of the “loop”, somebody will take your spot or permanent position. You may suffer a blow to your ego and it is not uncommon to isolate or alienate yourself.
With time, most patients learn to accept the injury. It is important to allow yourself to mourn, be sad and then move on. Attempting to be mad or tough and find blame for your injury is a waste of time. It is important to leave the “should haves” or “would haves” out of the picture and focus on the future. The reality is that you have suffered a concussion and you have to deal with it. This may include setting goals for yourself and maintaining a positive attitude. You may find yourself weighing the pros and cons of your future. Dealing with a serious concussion is very demanding and can result in economic loss and emotional burden for you and your family. A positive, optimistic outlook can help to speed up the healing process and lessen the emotional pain, while thinking negatively discourages everyone around you. It is also important to take an active role in your recovery and seek out the resources available to you. Continue to participate in daily functions and activities, as your step-wise recovery allows(see details provided in accompanying handout). Do not isolate yourself.
Lastly, it is important to be patient. Concussion can result in permanent damage and seriously affect your quality of life. Do not rush your recovery because it will only lead to negative results. Follow the advice of your health care provider and trust in the healing process.
How can concussions be prevented?
It is important to take a preventative approach when dealing with concussions. This is especially true with recent concussions as the brain is still very vulnerable at that time. Prevention of concussion and head injury is most successful when workers and athletes are properly educated and the safety rules of the working and sporting environment are enforced. Concussions are an invisible injury, making it important to share information with the people surrounding you. This will help them understand your own situation and educate them for the future.
Protective equipment can reduce the risk and severity of head injury. It is important that hard hats/helmets are of high quality and properly fitted, for work environments and collision sports. Workers should follow safety procedures mandated on work sites and all protective equipment should be certified and well maintained.
Baseline and After Injury Tests
What is a Baseline test?
A baseline test is a term for any test used before a treatment or activity. It is one tool in an effective concussion management program because it measures what we can’t see – cognitive (brain) function. Baseline testing is a best practice and is recommended by both the National Collegiate Athletic Association (NCAA) and the American Academy of Pediatrics (AAP).
It is recommended that an Athlete take a Baseline test at the start of the school year or before the first contact practice of a sport season. It is also recommended that every Athlete take a Baseline test every year.
What is an After Injury test?
An After Injury test is taken after a suspected head injury occurs and once physical, sleep and mood symptoms are gone. This test is identical to the Baseline test because repeating the same tasks after the injury identifies any cognitive changes from the Baseline test performance. This ability to compare results helps indicate whether the brain has fully recovered. Health care providers use the test results (comparing Baseline to After Injury Test results) in making decisions about when it is safe for Athletes to return to play or to the classroom.
Is there any difference between the Baseline and After Injury tests?
Baseline and After Injury tests are the same test. The reason they are the same test is that the Baseline performance serves as the benchmark for the After Injury test results.
However, the results are computed differently for Baseline and After Injury tests. Baseline reports show whether the performance of the Athlete was acceptable for future comparisons and likely to be their best effort. After Injury reports show whether there was significant decline in test performance in comparison to the most recent valid Baseline test.