Concussion

What is a concussion?

A concussion is categorized as a type of traumatic brain injury, or TBI, caused by a blow, bump or jolt to the head and/or body causing the head and brain to move quickly back and forth. Concussions can typically occur from a fall or blow to the body.

Many people believe that you must experience loss of consciousness or be “knocked out” to have sustained a concussion; however, that is not accurate. The majority of concussions do not involve any loss of consciousness. In fact, less than 90 percent of all concussions sustained in sports are considered to be mild and may be characterized by transient confusion, or a brief duration of post-traumatic amnesia, or PTA, but result in no loss of consciousness (LOC).

Every year there are about 300,000 cases of traumatic brain injury (TBI) that occur in a sports and/or recreation setting. About 90 percent of sports-related TBIs are mild (mTBI) and may go unreported. Concussions are extremely common in U.S. football, resulting in nearly 250,000 concussions per year. Additionally, this type of injury is most common at the high school level where it is estimated that 20 percent of high school football players will sustain a concussion every season as compared to the 10 percent of college football players and 13 percent of NFL players.

It is believe that the higher rates of incidence in the younger athletes are due to smaller neck sizes and poor tackling technique. Although, concussions can also occur in any contact sport including soccer, hockey, rugby and several others.

If you suspect someone has suffered a concussion, please consider if the following has occured:

A direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head.
A rapid onset of short-lived impairment of neurological function that resolves spontaneously.
An onset of europathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
A graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
Association with grossly normal structural neuroimaging studies such as an MRI scan or CT scan; however, it is important to note that since a concussion does NOT show up on an MRI or CT scan, these tests may came back as normal, but does not indicate that the athlete didn’t suffer a concussion. A clear MRI or CT scan does not mean that the athlete is clear of a concussion injury.

For more information regarding concussions and their impact on sports, please watch the following video of Dr. Andrew Blecher, sports medicine doctor and concussion expert at Southern California Orthopedic Institute. To find out more about the signs, symptoms and evaluation of concussions, please click the links below.

The Signs and Symptoms of Concussions

he Signs and Symptoms of a Concussion

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If you suspect someone has suffered a concussion, please consider if the following has occured:

A direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head.
A rapid onset of short-lived impairment of neurological function that resolves spontaneously.
An onset of europathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
A graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
Association with grossly normal structural neuroimaging studies such as an MRI scan or CT scan; however, it is important to note that since a concussion does NOT show up on an MRI or CT scan, these tests may came back as normal, but does not indicate that the athlete didn’t suffer a concussion. A clear MRI or CT scan does not mean that the athlete is clear of a concussion injury.

Signs & Symptoms of a Concussion

Signs are indicators that a coach, athletic trainer, parent or fellow team member may notice:

Any period of loss of consciousness
Disorientation or confusion
Slurred or incoherent speech
Difficulty paying attention
Delayed verbal and motor response
Vacant stare
Emotionality out of proportion to circumstance
Memory deficits

Symptoms of a concussion are what an athlete may report experiencing:

Early symptoms (minutes to hours):

Headache
Dizziness
Confusion
Tinnitus
Nausea
Vomiting
Visual changes

Late symptoms (days to weeks):

Memory disturbances
Poor attention and concentration
Irritability
Sleep disturbances
Personality changes such as becoming easily frustrated
Fatigue
Persistent low-grade headache

If an athlete has ANY symptoms or signs of concussion, the athlete:

Should NOT be allowed to return to play in the current game or practice
Should not be left alone (regular monitoring for deterioration over next several hours)
Should be medically evaluated by a medical doctor (not a chiropractor or nurse)
Should follow a medically supervised stepwise process for returning to play

If you suspect that you, or an athlete you know, has suffered a concussion, please read more about how a concussion is evaluted by clicking here.

How a Concussion is Evaluated and Treated

How Concussions are Evaluated and Treated

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Concussion Evaulations

There are a number of assessment tools and tests that can be utilized to assess and evaulate a concussion injury, however, the most important tool is a baseline test.

Often times baseline testing is part of the pre-participation physical examination. Baseline formal neuropsychological testing should be considered in organized high risk sports such as football, hockey and motocross, and in athletes with a previous history of concussions, who may at increased risk for developing further complex concussions.

In addition to a mental status exam, a balance test, a full neurological physical exam, the concussion doctors at SCOI also use the ImPACT system of computerized neuropsychological testing to evaluate for memory, concentration, attention, visual-motor and reaction time deficits. Currently, the Concussion Center at Southern California Orthopedic Institute is one of only three centers in the greater Los Angeles area with Certified ImPACT Consultants (CIC).

At SCOI, baseline testing with ImPACT is offered at an extremely low cost, or as part of our recent partnership with Well’s Fargo “Play It Safe” concussion care insurance program. For more information on “Play It Safe” concussion program, click here.

Concussion Treatment

The most important and successful treatment for a concussion injury is physical and cognitive rest.

Activities requiring physical exertion, concentration, or attention may exacerbate symptoms and delay recovery and therefore should be avoided. This means that the concussed athlete should avoid sports, exercise, video games, computer use and, in some instances, should be held out of school or have academic accommodations made. Once the symptoms have resolved then a standard stepwise return to play protocol may look like:

No activity – Complete rest until asymptomatic, or symptoms resolve
Light aerobic exercise such as walking or riding a stationary bike
Sport specific exercise. For example, skating for hockey; or running for soccer; start light resistance training
Non-contact training drills and increased resistance training
After medical clearance: Full contact training
Game play

If you think you, your child or your athlete has sustained a concussion, please contact Southern California Orthopedic Institute for a concussion assessment or treatment by calling (818) 901-6600.