Concussion

General Information:

A concussion is a brain injury caused by either a direct impact to the head or by any rapid uncontrolled forward, backward or twist movement of the head.  In children and adolescents, concussions often occur while playing sports. If a concussion during sports is suspected it is very important to STOP PLAYING immediately and to be evaluated prior to return. 

What follows are the symptoms and management of a concussion, as well as information on promoting full resolution.

Common Symptoms:

Concussion symptoms may develop immediately after an injury or may slowly evolve over the course of 1-2 days.  The type and severity of symptoms vary by individual but may include:

  • Headache
  • Fatigue
  • Dizziness
  • Nausea
  • Vomiting
  • Difficulty balancing or an unsteady gait
  • Feeling mentally slow or foggy
  • Difficulty remembering the events surrounding a concussion and difficulty remembering additional information in the days after a concussion
  • Difficulty concentrating
  • Sleep changes – increased daytime fatigue, sleeping more than usual, sleeping less than usual, and/or difficulty falling asleep
  • Emotional changes – increased irritability, sadness, anxiety, nervousness or feeling more emotional

Management:

Following a concussion there are 3 primary concerns – avoiding additional head injuries, physical rest and cognitive rest.

Avoid Additional Head Injury
All sports, recreational activities, and other activities that are high risk for a repeat concussion should be avoided until all symptoms resolve and you have been cleared by a provider. The primary reason for this recommendation is to reduce the risk of “second impact syndrome.” Second impact syndrome is the name for potentially severe long term brain injury that can result from getting a second concussion prior to the resolution of the first concussion. 

Physical Rest
All activities that may cause an increase in heart rate should be avoided during a concussion.  Physical exertion of any form may worsen symptoms and slow recovery.  Additionally, increased body rest helps promote concussion recovery.

Cognitive Rest
Cognitive rest involves limiting activities that make symptoms worse, although it is not always possible to eliminate all cognitive activities that produce symptoms.  A child with a concussion may attend school, but may need midday rest to tolerate a full day or shorter days while symptoms are at their worst. Additionally, decreased homework/schoolwork, extensions to complete work and postponing tests helps provide cognitive rest when needed.  The use of computers, cell phones and televisions may exacerbate symptoms also and should be limited when possible.  Your provider can help determine ways to promote cognitive rest especially while attending school.
 

In rare instances initial management requires emergency evaluation and possibly a CT scan of the brain.  These are only suggested for very severe and rare cases.  To determine if your child needs more urgent care please call and speak to our nurses or providers. 

Return to Play:

In order to start the gradual return to play protocol you child must meet certain criteria.  He/she must be participating in school completely, symptom free without medications for 1 week, have a normal neurological exam and have returned to baseline cognitive function.  Some schools provide IMPACT testing or other cognitive baseline testing for athletes.  If this has been completed, a return to baseline testing must be achieved to start the return to play.  Once all school work is completed and you have been approved by your provider you may start the gradual return to play.  This 5 step process includes:

  1. Light aerobic exercise – walk, swim, bike
  2. Sport specific exercise – skate, run
  3. Non-contact drills
  4. Full contact drills
  5. Games

Each stage must be maintained without the return of symptoms for 2-3 days to progress to the following stage. If symptoms develop at any stage your child should return to the earlier stage for a few days while symptoms resolve before starting the 5 step process again.

When to Call:

Concussions can be complex and confusing to manage.  Any child with a suspected concussion should be evaluated in our office.  If a concussion is diagnosed close monitoring and follow up is recommended to promote recovery and reduce the risk of long-term damage. 

Takeaway message:

Concussions are commonly the result of head injuries, often during sports. With the proper management of a concussion full recovery is possible.  All children with a concern of concussion should be evaluated and managed by a provider.

Additional Information:

Information on concussion from the CDC, and on signs and symptoms of concussion return to school from the American Academy of Pediatrics.