Concussions have received a significant amount of media attention lately, especially those sustained in sporting activities. This renewed interest in concussive brain injury stems from four relatively recent medical findings:
1. Concussion results in temporary, but measurable, brain dysfunction.
2. This brain dysfunction may last, even after a person reports being symptom free.
3. Athletes who return to sports while suffering from symptoms of their concussion are at risk for catastrophic outcomes, such as “second-impact syndrome.”
4. Some people, mostly athletes, who sustain multiple concussions over their lifetime, may be at risk for dementia and other problems later in life known as “chronic traumatic encephalopathy.”

Incidence
Concussion doesn’t just happen to professional athletes. In fact, concussion is a common injury among children. One out of every 220 pediatric patients seen in U.S. emergency departments is diagnosed with a concussion. Concussion is an especially common injury in young athletes. It is estimated that between 1.6 and 3.8 million concussions occur each year in high school sports alone. Yet less than half of all high school athletes who sustain a concussion report it to anyone. So the true number of concussions that occur in sports is likely even higher. Because the signs and symptoms of concussion can be subtle, it is important to understand the nature, extent and prognosis for this common yet underreported injury.

Definition
A concussion results from a rapid, rotational acceleration, or spinning of the brain. Contrary to popular belief, a concussion is not a bruise on the brain. In fact, modern images of the brain, such as “CT scans” and “MRIs” show no bruising, no bleeding and no swelling after a concussion. The brain is not structurally damaged; it is simply not working properly. As a result, people who suffer from a concussion have poorer memory. They have slower reaction times. They take longer to process information. These effects give rise to symptoms such as headaches, nausea, dizziness, insomnia and sensitivity to light, among others. With time, brain function returns to normal, and symptoms resolve. However, given the potential consequences of returning to play too soon, it is imperative that all athletes be managed appropriately after sustaining a sport-related concussion.

The first thing you should do if you suspect your child has a concussion is to take him to a medical professional to help ensure there is not another injury to the brain, such as swelling or bleeding. Once it has been established that your child has a concussion and no other associated injuries, treatment may begin. Concussion will resolve over time, but you can help your child recover from a concussion by simply allowing him to rest.

Recovery
There are two different types of rest used to help recover from a concussion. The first type is physical
rest. This is well understood by most parents and patients. Concussed athletes should refrain from vigorous exercise by avoiding running, cycling, ice skating, weightlifting, etc. Such exercise can make an athlete’s symptoms worse, as well as prolong recovery.

The second type of rest is known as cognitive rest. “Cognitive” is a term used to describe certain aspects of brain function, and cognitive processes are those that involve thinking, reasoning, memory and concentration. After injury, cognitive activities will exacerbate concussion symptoms.

Therefore, it is recommended that athletes recovering from a concussion avoid reading, playing video games, texting, working online, and playing games like chess or scrabble. It is also recommended that concussed athletes minimize their homework until they are recovered.

Fortunately, most high school athletes will recover quickly from their concussions. In fact, a recent study in The American Journal of Sports Medicine revealed that nearly 85% of high school athletes who sustained a concussion in sports were symptom free within a week. Only 1.5% had symptoms that lasted longer than a month.

Risks
One of the most serious risks of returning to play prior to resolution of symptoms is “second-impact syndrome.” Athletes that play contact or collision sports may sustain blows to the body or head, causing the brain to spin. In some athletes who are still experiencing symptoms from a prior concussion, most often adolescent males, this can lead to significant swelling of the brain, causing the brain to expand beyond the volume of the skull. When this happens, the brain can be forced through the hole in the bottom of the skull, and become compressed. This leads to devastating neurologic injury, coma and often death and is one of the main reasons that athletic trainers and doctors recommend that athletes refrain from contact and collision sports until their concussionsymptoms have fully resolved.

Diagnostic Tools
In order to help doctors and other clinicians diagnose and manage concussions, many athletic programs
have started to measure each athlete’s brain function prior to the start of the season, using what are known as computerized neuropsychological tests. Then, if a suspected concussion occurs, brain function can be re-measured and compared to the athlete’s pre-injury function and can help clinicians diagnose a concussion, as well as monitor recovery. This pre-season test is most often used in collision sports, such as rugby, boys’ ice hockey, football, and boys’ lacrosse, and contact sports such as girls’ ice hockey, soccer, basketball, girls’ lacrosse, and baseball/softball. If your child plays collision or contact sports, then we recommend she undergo baseline computerized neuropsychological testing, especially if she has already suffered a concussion during her lifetime.

While it is important that concussions are recognized and managed appropriately, there are some reassuring points to keep in mind. First, most athletes who sustain a sport-related concussion will recover quickly, within days to weeks. Second, if concussions are diagnosed and managed properly, then most athletes can return to their sports safely, and enjoy long careers, even lifetime participation. Only those rare athletes who suffer prolonged recoveries or sustain multiple concussions need to consider retiring from their sports. In this age of sedentary lifestyles and childhood obesity, the benefits of exercise, both physical and mental, far outweigh the risks associated with sports participation.

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From issue: 27/05-06