What is concussion management?

What is a concussion?

A concussion is a disturbance in brain function that occurs when the brain is violently rocked back and forth within the skull following a blow to the head or upper body. Concussions not only occur in contact sports such as boxing or rugby but are also prevalent in other sports such as hockey, soccer, waterpolo, cricket and even ballet and gymnastics.

In the sports literature the term ‘concussion’ is used interchangeably with the term mild traumatic brain injury (MTBI) probably due to the fact that most concussions within the sports context do not involve a loss of consciousness (Lovell, Iverson, Collins, McKeag & Maroon, 1999) and have a tendency to fall within the milder rather then the moderate or severe categories.

Is sports concussion a real problem?

Due to the known underreporting of concussions, the true incidence of concussion amongst the contact sports and amongst the different age and gender groups is difficult to ascertain. In the United States it is estimated that 3.8 million sports related concussions occur each season and over 80% of these are amongst high school students (Mihalik et al., 2005; Schatz, Pardini, Lovell, & Collins, 2006). Concussions presented to a United States emergency department between the years of 1990 to 1999 were estimated to be around 4,820 from ice hockey, 21,715 from soccer and 68,861 from American football (Delaney, 2004). The WHO task force review revealed a higher rate of concussion for Rugby Union than Rugby League, American Football and soccer, being up to 8.0 per 1000 game hours, compared with an upper limit 3.0, 3.3 and 1.3 per 1000 game hours respectively for the others (Cassidy, Carrol, Peloso, Borg, von Holst, 2004). In a European study comparing the incidence of soccer injuries relative to Rugby Union, results indicated that Rugby Union was associated with a significantly higher rate of injury than soccer, this was followed by field hockey (Junge, Cheung, Edwards, & Dvorak, 2004). Roy (1974) in his study investigating the frequency and nature of Rugby Union injuries amongst 300 university Rugby Union players in South Africa found that 10% of the all injuries were concussions. Similarly, Nathan, Goedeke, & Noakes (1983) reported that the single most common injury accounting for 21.5% of all injuries in their schoolboy sample was concussion. Recently, The National Sports Concussion Initiative (NSCI) at Rhodes University, South Africa recently conducted a study on the incidence of concussion in South African high school, club and provincial rugby teams (Shuttleworth-Edwards et al., 2008). The results showed that the average seasonal incidence of concussion per team was as high as 23% at an adult level and 14% at a high school level.

According to the Centers for Disease Control and Prevention (Thurman, Branche, & Sniezek, 1998), adolescents represent the highest concussion risk group, with males being at greater risk than females. Adolescent males tend to present with a higher proportion of head injuries owing to the fact that boys are involved in more high-risk collision or contact sports (Baker & Patel, 2000). Studies show that athletes younger than 18 years of age are potentially at risk for concussion due to neurochemical processes which appear to differ from adults in the developing brain (Field, Collins, Lovell & Maroon, 2003). In addition, girls may be more vulnerable than boys to the effects of concussion, and girls competing in sports like soccer and basketball therefore may be particularly susceptible (Bazarian and Atabaki, 2001). A recent study at the University of Stellenbosch also found that concussions can negatively effect academic performance (Health24.com, August 2007). The study found that the academic performance of young rugby players who had suffered concussions, was lower than those of non-players. Functions such as attention and concentration, memory, working speed and reaction time were just some of the areas affected after sustaining a concussion. The performance of the players, measured three years apart, also declined with time. Although the majority of athletes who experience a concussion are likely to recover, an as yet unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury.

A concussed student-athlete may report the following symptoms:

Headache

  • Memory problems

  • Disorientation (unaware of the game period or score)

  • Difficulty in concentrating

  • Visual problems (double or fuzzy vision, seeing stars)

  • Nausea

  • Problems with balance and dizziness

  • Fatigue and drowsiness

  • Sensitivity to light and noise (ringing in the ears)

  • Numbness or tingling sensation

  • Feeling slowed down or mentally foggy

A coach or parent may observe the following signs during a match or practice

  • Slow to follow instructions or to answer questions

  • Impaired balance and poor hand-eye coordination

  • Increased distractibility and problems with following the game

  • Displays of emotion that appear out of place (e.g. irritability, crying and sadness)

  • Poor concentration

  • Slurred speech

  • Vacant stare

  • Unsteady and shaky mobility

  • Inappropriate game-play (e.g. Lingering in the corner of the field, running the wrong way)

  • Loss of insight (e.g. Insisting they are fit to play and refusal to leave the field)

  • Loss of consciousness

  • Seizures or convulsions

Parents may observe the following
signs at home

  • Sleeping difficulties (sleeping more or less then usual, trouble falling asleep)

  • Problems with waking up

  • Regular vomiting

  • Appears confused and disorientated

  • Loses consciousness (passes out)

  • Slurred speech

  • Experiences weakness or numbness in a part of the body

  • Inappropriate emotions such as irritability or crying