Concussion

According to the U.S. Centers for Disease Control and Prevention, about 200,000 people in the United States suffer concussions while playing sports every year. Eighty-five percent go unrecognized. Concussions occur in a wide range of sports and affect athletes of all levels, from professional players to little leaguers.

ImPACT Concussion Testing
To improve the standard of care for athletes suffering concussions, the Sports Medicine Program at Gwinnett Medical Center is leading the way with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) program. Every public high school in Gwinnett County, as well as the Gwinnett Football League, is eligible to participate.

Traumatic Brain Injury
Concussions are mild traumatic brain injuries, and sports concussions have become a significant problem. Recognizing concussions and providing proper treatment is especially important for younger athletes because it typically takes them longer than adults to fully recover.

Derived from the Latin word “concusses,” the term concussion means to shake violently. A concussion happens when force causes the brain to rapidly move back and forth inside the skull. This may be caused by either a direct blow or by a blow to the body that forces the head to quickly rotate. Although some sports have higher instances of concussion, such as football, ice hockey and soccer, concussions can happen in any sport or recreational activity.

Concussion Symptoms
A concussion temporarily impairs how the brain functions and processes information. For example, after a concussion, a patient may have difficulty with balance and coordination, memory, and speech.

A concussion is typically short-lived. Most people recover within seven to 10 days. Unfortunately, once an athlete has sustained a concussion, he or she is at greater risk for additional concussions. Repeat concussions can have long-term consequences, so prevention is essential. Because of the potential long-term consequences of sports concussions, it is important that athletes, coaches and parents know as much as possible about how to recognize them.

Concussion Isn’t Loss of Consciousness
Symptoms are not always obvious. Although it is commonly assumed that concussions cause loss of consciousness, many people with concussions have not been "knocked out." Concussions cause a variety of symptoms. These may appear right away, or may be delayed for several days after the injury. Some symptoms are physical, such as drowsiness. Others are cognitive, like memory loss. In many cases, people with concussions are more emotional than usual.

The Most Common Concussion Symptoms Include:

• Balance problems
• Changes in sleep patterns
• Confusion
• Depression
• Difficulty communicating
• Dizziness
• Drowsiness
• Headache
• Irritability
• Loss of consciousness
• Memory loss
• Nausea and vomiting

Concussion Diagnosis
During the evaluation, your doctor will ask questions about the injury and how it occurred. He or she may ask how severe the force was and whether you lost consciousness or had memory loss after the blow. It is especially important that you tell your doctor about any previous concussions you have had.

Your doctor will most likely perform a neurological examination, which tests coordination, vision, hearing and reflexes. Magnetic resonance imaging (MRI) and computed tomography (CT) scans provide doctors with detailed images of the skull and brain.

The Effects of Concussion
If the neurological examination indicates problems, such as trouble with your vision, your doctor will order imaging scans. Also, if your symptoms worsen over time, CT and MRI scans are important for guiding treatment.

Neuropsychological testing helps to measure the effects concussion has on mental capability. This kind of assessment can be done using computerized tests. The testing provides valuable information on a range of mental functions, such as short-term and long-term memory, attention and concentration, problem solving, and speech.

Treatment of Concussion
The key to healing from a concussion is complete rest. This includes not just physical rest, but mental rest, as well. Reading, computer work, video games and television should be limited until all symptoms have resolved. This typically takes seven to 10 days, although some people have symptoms for weeks or months after the injury.

Once you are free of symptoms, you can gradually return to physical and mental activity. It is important to slowly return to daily activities because being symptom-free does not mean the brain injury has fully healed. Your doctor may recommend a step-by-step program: First add an activity, then, monitor your symptoms. If your symptoms do not return, you can continue increasing the challenges.

This slow, steady approach typically reduces the time spent away from school, work and athletics because it provides enough time for the injury to heal. Diving back into activities as soon as your symptoms have resolved can bring them back and require a return to complete rest.

Returning to Play after a Concussion
Getting back into the game too soon puts you at risk for another concussion. If you suffer a repeat concussion before your first concussion has healed, it may take much longer for your symptoms to resolve and you may develop long-term problems, such as learning difficulties or chronic headaches. Although it rarely happens, repeatedly suffering concussions can cause permanent brain damage and even death.

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, which stressed that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Implications of Concussion
It is difficult to determine when a concussion has fully healed, so baseline neurocognitive evaluation pre-activity, such as ImPACT, is an important tool for health care professionals in assessing whether it is safe for an athlete to return to play. Before the sports season starts, each athlete takes a computerized test that measures brain functions, such as memory and reaction time.

If an athlete later has a concussion, post-injury tests can be compared to the baseline evaluation to measure the severity of the concussion and help doctors monitor healing. In addition, pre-season evaluations can help identify athletes who have had previous, unrecognized concussions and who are at risk for repeat concussions.

If you are suffering from the symptoms of a concussion, let the Gwinnett Medical Center–Duluth help you. For a free physician referral to one of Atlanta’s top sports medicine doctors, please call 678-312-5000.