The term “concussion” is confusing, even for some health professionals. Many people believe that a brief loss of consciousness after a blow to the head equals a concussion. Not true.

According to the latest criteria, there are two definitions of concussion:

1. Altered mental status with a brief alteration in the level of consciousness following blunt head trauma

2. Within four hours of head trauma, any one of the following symptoms:

  • Headache

  • Fatigue
  • Dizziness
  • Nausea
  • Vomiting
  • Blurred vision
  • Difficulty in memory
  • Trouble concentrating
  • Altered gait or behavior

Of all these post-head trauma symptoms, the three most common are headache, dizziness and fatigue.

In recent years, increasingly more evidence has been accumulating that demonstrates that a second or repeated concussion that occurs shortly after the first one can be very dangerous and may lead to severe permanent brain damage. Therefore, our approach to a concussion is much more careful and cautious, not only in recognizing that a concussion has occurred but also in protecting the child from the possibility of suffering another concussion soon afterward. It is important to note that loss of consciousness after the head trauma is not a factor in managing concussion.

A concussion occurs most often during contact sports, such as football, hockey and lacrosse. The message about the possible serious consequences of repeated concussions has gotten through to most trainers and coaches, who now understand the need to move more slowly than in the past in allowing the child to resume the contact sport. Nevertheless, if you have a son or daughter participating in any contact sport, I would strongly advise you to always carefully check for any possible head injury after each practice or game. Even what seems like a slight blow to the head can cause a concussion. Some of the signs and symptoms following a concussion may be minor, and a change of behavior of any kind should raise your index of suspicion and requires an evaluation by a physician.

Children and teenagers take longer to recover from a second concussion that occurs within one year of the first. A large-scale recent study showed that on average it took 12 days to recover from the first concussion but 24 days to become symptom free after the second. Further, in the group with two concussions, one-third still had signs or symptoms after one month and 15% still had symptoms after three months. Of interest is that one of the common signs lasting over three months was poor school performance. This has lead to the concept of “cognitive rest.” The group of children who suffer from poor school performance following a concussion may require academic adjustments such as frequent breaks from study.

The old theory that 90% of concussion patients recover within one week is incorrect. It takes a lot longer than anybody expected in the past. We cannot allow the child or teenager to decide when he is fully recovered and able to resume full activity, including the contact sport.

The bottom line is that any head trauma that causes a possible concussion must be carefully evaluated, looking for any post-concussion signs and symptoms. If in doubt, it is better to be on the safe side and not allow the child to get back in the game. A physician must clear the child before she resumes the contact sport; all the signs and symptoms of the concussion must be completely resolved. Doing otherwise puts the child at risk for permanent brain damage.

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From issue: 29/05-06