This is the time of the year when school starts and with the start of school comes the start of football season. As a concerned football parent myself, this season brings to mind one of the most common problems confronting our young athletes: concussions. A concussion is defined as a traumatic brain injury that alters the way your brain functions. Concussions are not only a common problem seen in football, but also other sports such as hockey, soccer, and cheerleading. Parents need to be familiar with the symptoms of concussions to help diagnose and manage their patients should they have one.
Concussions usually come in three grades. A grade one concussion is defined as transient or short term confusion (inattention, inability to maintain a coherent stream of thought and carry out good-directed movements) and no loss of consciousness, with concussion symptoms or mental status abnormalities on examination resolving in less that 15 minutes. Grade two is defined as transient confusion and no loss of consciousness with concussion symptoms and mental status changes (including amnesia) on examination lasting more than fifteen minutes. Grade three concussions are any loss of consciousness with differentiation between brief (seconds) and prolonged (minutes).
Features of a concussion that are frequently observed include vacant stare, delayed verbal and motor responses, confusion and inability to focus attention, disorientation (including direction, time, date and place), slurred or incoherent proportion to circumstances, memory deficits, and any period of loss of consciousness.
The management of concussions is very important. With a grade one concussion the player should be removed from the contest. The patient should be examined immediately and at five minute intervals for the development of mental status changes or post-concussion symptoms and rest and with exertion. Sideline evaluations include orientation (time, place, person and situation), concentration, repeat digits or months of the year backwards, memory questions, exertion tests (40 yard sprints, push ups, set ups) and neurological tests (strength, coordination, agility, and sensation). If there is no history of previous concussion and the player returns to normal within fifteen minutes they can return to the contest. If there is a history of previous concussion, the player can return to play after being asymptomatic with normal neuralgic assessment, rest and with exercise after one week. With a grade two concussion the player may return to play if asymptomatic after one week. If there has been a previous grade two concussion the player has to be symptom free for two weeks. A grade three concussion with brief loss of consciousness may return to play if asymptomatic for one week. A grade three concussion with prolonged loss of consciousness should stay out of action until symptom free for two weeks. Multiple grade three concussions would warrant being out of play for at least one month.
Concussions are common in sports and need to be taken seriously. Please contact our office if you have any questions.