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A concussion is a type of traumatic brain injury.
Concussion is caused by a strong impact to the head that leads to problems with thinking or other neurological symptoms. Concussions can occur in any sport when there is a blow to the head, neck, or body that sends a strong force to the head. The symptoms of concussion include headache, cognitive problems such as mental fogginess or changes in memory, problems with balance and coordination, behavioral changes such as irritability, and slowed reaction time. Although most concussions are not associated with loss of consciousness, temporary loss of consciousness can occur.
In cases of suspected sport-related concussion, athletes should immediately be removed from play and assessed by a physician or other licensed health care professional. Assessment begins with evaluation for serious signs of injury such as severe headache, neck pain, double vision, weakness or tingling in the arms or legs, vomiting, seizure, or decreased level of consciousness. If any of these “red flags” are present, emergency transportation to a medical facility may be needed.
If no “red flags” are present, then a more detailed evaluation for concussion may be performed on the sidelines or in the locker room. There is no single test that can definitively diagnose concussion, and various tools are available to aid in diagnosis. One instrument that is commonly used by health care professionals is the Sport Concussion Assessment Tool—5th Edition (SCAT5). The SCAT5 involves questions about symptoms; brief testing of cognitive functions such as memory and concentration; and a screening neurological examination that includes evaluation of eye movements, balance, and coordination.
Head imaging is not needed to diagnose concussion but may be used to rule out other causes of brain injury. Neuropsychological testing may be conducted for more detailed assessment of mental processes such as memory, reaction time, and cognitive processing speed.
Management and Return to Play
New problems can arise during the first 24 to 48 hours after a concussion, so the athlete should not be left alone during this time and medical care should be urgently sought if symptoms worsen. Repeat concussions are most likely to occur in the first several days after a concussion and can cause serious injury, so athletes should not rush to return to play.
The general approach to recovery from concussion involves both physical and mental rest for the first few days after the injury, followed by gradual increases in activity over time (graduated return to activity). If concussion-related symptoms worsen at any point as activity level is being increased, then the athlete should return to the prior level of activity. Typically, after 24 to 48 hours of rest, daily activities should be slowly reintroduced for short periods (ie, 5-15 minutes) and then increased as long as concussion symptoms do not worsen. Mental activities and schoolwork should be gradually resumed as tolerated. Once the athlete is able to complete usual daily activities without concussion-related symptoms, light aerobic activity (such as brisk walking) can be resumed. If this is well tolerated, running or other noncontact training exercises can be added, followed later by light resistance exercises. The decision to ultimately return to play should be individualized, and athletes should be cleared by a health care professional before returning to full contact practice or regular play.
In most cases, concussion-related symptoms usually resolve by 10 to 14 days after the concussion. If symptoms persist for longer, additional evaluation and treatment may be needed. Treatment for prolonged symptoms may include symptom-limited aerobic exercise, physical therapy, balance training, and psychological interventions such as cognitive behavioral therapy.
Centers for Disease Control and Preventionwww.cdc.gov/headsup/index.html
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Published Online: February 1, 2018. doi:10.1001/jama.2018.0436
Sources: American Academy of Neurology
McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838-847.
Sport Concussion Assessment Tool—5th Edition. Br J Sports Med. 2017;51:851-858.
Muth CC. Sport-Related Concussion. JAMA. 2018;319(8):840. doi:10.1001/jama.2018.0436
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