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

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)

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.