Sports Concussion: Not Just Football Players
As fall arrives students to return to the football field – and to the possibility of getting a concussion. A concussion is a mild blow to the head that can cause damage to brain cells at a level not detected on MRI or CT scan.
This damage is most often temporary, but the brain does need time to heal, and a too-soon return to active sports participation may lead to permanent brain damage. Most athletes with a concussion will no longer have symptoms within a week of the injury, but studies have shown that younger athletes may require up to 10 days or longer.
As part of his practice as a neuropsychologist at Raffle Brain Institute in Carmel, Dr. Raffle often begins the school year by meeting with high school coaches to talk about concussion. Not just football coaches, but all coaches whose students are engaged in sports – especially sports where the players don’t wear helmets. Concussions happen in all sports, both fall and winter sports (basketball, soccer, cross-country, volleyball, ice skating, ice hockey – and cheerleading) and spring sports (baseball, track, tennis, lacrosse – and cheerleading). Coaches, teachers, and parents must keep a careful eye out for noticeable changes in the athlete’s functioning following a concussion – if they notice anything unusual, they should contact Dr. Raffle immediately, and if symptoms appear serious, take the student to the emergency room.
Concussion Management Protocol for Coaches
Immediately Following a Head Injury:
STEP 1: Rule out neck or back injury – If suspected, DO NOT MOVE PLAYER and Call 911 for an ambulance
STEP 2: If the player can walk, move to sideline or other safe location
STEP 3: DO NOT let player return to play, and expect that the player will miss the next game – The risk of brain damage from a second concussion is increased dramatically
“It’s better to miss the next game than the whole season.”
Following the Game:
Inform parents/guardians and classroom teachers about the athlete’s concussion
Refer athlete to Raffle Brain Institute for neuropsychological testing
Following signed permission from Dr. Raffle, allow athlete to return to play gradually, watching carefully and slowing down if symptoms (listed below) return
Recognizing the Signs and Symptoms of Concussion
NOT EVERY HIT OR FALL IS SEEN BY A COACH. Therefore, all coaches, teachers, and parents should be aware of the signs and symptoms of concussion. If any of the following symptoms are noticed, Raffle Brain Institute should be contacted immediately:
Athletes Should Suspect a Concussion When They:
Have a Sudden Headache or Nausea
Have Balance Problems or Dizziness
Have Double or Blurred Vision
Have Ringing in Ears (Tinnitus)
Become Sensitive to Light or Noise
Feel Sluggish, Groggy, or Sleepy
Can’t Concentrate or Remember Things
Feel Confused or Disoriented
Feel “Not Right” or “Not Myself”
Coaches Should Suspect a Concussion When Athletes:
Lose Consciousness, However Briefly
Appear Dazed or Stunned
Speak in a Slurred or “Drunk” Voice
Forget Planned Plays
Move or Walk Clumsily
Answer Questions Slowly
Want to Fall Asleep
Vomit or Feel Like Vomiting
Act Confused About Assigned Position
Are Unsure of Score or Name of Opposing Team
Complain of Weakness/Numbness in Arms or Legs
Can’t Recognize People or Their Location
Become Increasingly Irritable or Angry
Show Changes in Behavior or Personality
Have Episodes of “Stopping and Staring” (Seizures)
Can't Recall Events Prior to Fall or Hit (Retrograde Amnesia)
Can't Recall Events After Fall or Hit (Anterograde Amnesia)
“It’s better to miss the next game than live a lifetime with a severe brain injury.”
Image by Vince Fleming
Parents Should Suspect a Concussion When Athletes Complain – More than Usual – of:
Fatigue
Vomiting
Headache
Irritability
Visual Problems
Hearing Changes
Slurring of Speech
Memory Problems
Sleep Disturbances
Dizziness or Vertigo
Decreased Attention
Changes in Personality
Problems with Balance
Altered Taste and Smell
Depression and Anxiety
Decreased Concentration
Difficulty in Problem Solving
Sensitivity to Light and Sound
Sudden Problems with Reading
Difficulty Understanding What is Said
Difficulty Locating Familiar Objects
Teachers Should Expect Concussion when Athletes Shows Sudden Changes in:
Cognitive Effects:
Inability to Recall Previously Learned Information
Inability to Remember 2- to 3-Step Directions
Inability to Grasp New Concepts Without Repeated Exposures
Difficulty Recalling the Day’s Schedule or Assignments
Higher-Level Problem Solving:
Difficulty Organizing and Completing Long-Term Projects
Inability to Sequence Steps Necessary to Plan Activity
Inability to Find Solutions to Problem Situations (e.g., Lost Book)
Difficulty Drawing Conclusions from Presented Facts
Attention and Concentration:
Distraction by Normal Classroom Activity
Difficulty Staying on Topic During Class Discussion
Inability to Complete a Task Without Prompting
Blurting Out Answers at Inappropriate Times
Fixed Staring (Possible Seizure)
Becoming Fatigued by Mid-Afternoon
Sensorimotor:
Taking an Inordinate Amount of Time to Produce Written Material
Inability to Take Notes During Class Lecture
Difficulty Copying Information from Board or Overhead Projector
Difficulty Completing Simple Math Problems on Worksheet
Completing One-Half of Paper that is Inside Visual Field
Disorientation in Hallway and/or Difficulty Finding Classrooms
Language:
Difficulty Taking Turns in Conversation
Inability to Summarize and Articulate Thoughts
Using Indefinite Words or Talking Around a Subject
Inability to Understand the Meaning of a Conversation
Inability to Understand Figures of Speech or Metaphors
Behavioral/Emotional:
Speaking or Performing Socially Inappropriate Actions
Sudden Difficulty Fitting In with Peers
Easily Misled by Peers into Making Poor Choices
Inability to Start/Stop Activity Without Assistance
Impulsively Leaving Seat or Classroom
Becoming Easily Frustrated
Unawareness or Denial that Injury Has Taken Place (Anosognosia)
Physical:
Headaches
Lack of Endurance
Changes in Body Temperature
Motor Coordination Problems
Muscle Rigidity, Spasticity, or Tremors
Problems Carrying Out Movements Purposefully on Command (Apraxia)
Final Thoughts
Physical exercise through sports is extremely important for a young person’s health. With proper management, safe practices, and proper follow-up, concussions do not have to result in long-term consequences. The more coaches, teachers, parents, and the athletes themselves understand about concussion, the more these athletes can enjoy many years of safe and enjoyable play.