/ by Jenne DeAngelis, ATC
Concussion is defined as a complex process affecting the brain that is induced by traumatic forces. Concussion may be caused by a direct blow to the head, neck, face or elsewhere on the body with a force transmitted to the head. It typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.
Athletes with significant, persistent or worsening signs or symptoms should not return to play the same day. Duration and severity of symptoms are determining factors in return to play. The safest course of action is to hold an athlete out. Full clinical and cognitive recovery should be established before return to play. Athletes should be symptom-free at both rest and exertion. The average recovery time is five to seven days. The athlete should be monitored for any return of symptoms.
When returning athletes to play, they should follow a stepwise symptom-limited program with stages of progression.
- Rest until asymptomatic.
- Light aerobic exercise.
- Sport-specific exercise.
- Non-contact training drills.
- Full contact training after medical clearance.
- Return to competition.
There should be approximately 24 hours or longer for each stage, and the athlete should return to stage one if symptoms recur. Medical clearance should be given before return to play. An athlete may also need cognitive rest, which includes rest from scholastic and cognitive stressors. Teachers and counselors should be made aware of an athlete’s concussion.
If a concussion is suspected, refer to this checklist:
Note: Any item marked with an asterisk requires the athlete be transported immediately to the nearest emergency department.
Day of injury referral
- Loss of consciousness on the field.
- Amnesia lasting longer than 15 minutes.
- Deterioration of neurologic function.*
- Decreasing level of consciousness.*
- Decrease or irregularity of respirations.*
- Decrease or irregularity in pulse.*
- Increase in blood pressure.
- Unequal, dilated or unreactive pupils.*
- Cranial nerve deficits.
- Any signs or symptoms of associated injuries, spine or skull fracture or bleeding.*
- Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation.*
- Seizure activity.*
- Motor deficits subsequent to initial on-field assessment.
- Sensory deficits subsequent to initial on-field assessment.
- Balance deficits subsequent to initial on-field assessment.
- Cranial nerve deficits subsequent to initial on-field assessment.
- Post-concussion symptoms that worsen.
- Additional post-concussion symptoms as compared with those off the field.
- Any of the findings in the day-of-injury referral category.
- Post-concussion symptoms worsen or do not improve over time.
- Increase in the number of post-concussive symptoms reported.
- Post-concussion symptoms begin to interfere with the athlete’s daily activities (i.e., sleep disturbances or cognitive difficulties).
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