Medical Corner: Concussions: What to Do When the Unexpected Occurs

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Medical Corner: Concussions: What to Do When the Unexpected Occurs

Post by Admin on Tue Mar 03, 2015 7:58 pm

Concussions: What to Do When the Unexpected Occurs

By Jim Herlihey: 03/02/15

It can be exhilarating to watch a child compete in school sports. If an injury occurs, however, it can be a game changer for your child and your family. Approximately 15 percent of sports injuries involve a concussion. Parents then ask, “What do we do now?” Since the seriousness of concussions has been underestimated, it is important to know how to respond and what to expect.

Concussion refers to an alteration of mental status due to some kind of head trauma; and even though many people think an affected person must pass out to call the injury a concussion, often there is no loss of consciousness at all. It is estimated that 1.6 to 3.8 million concussions occur per year in U.S. sports with the highest incidences in football, ice hockey, soccer, boxing and rugby. Approximately 85 percent of injuries are mild, and all but 10 percent have symptoms that resolve in 7 to 10 days.

Athletes, parents, trainers and coaches work collectively to prevent concussions by promoting safe game conditions and safe play and by monitoring risks. Many schools even provide prior baseline computerized testing (e.g. Impact Test) for later symptom comparison. If injury occurs, trainers and coaches should perform sideline screenings for concussion symptoms including headache, dizziness, orientation, amnesia, nausea, vomiting and other symptoms. Trainers and coaches play an important role of educating parents and determining whether further medical assessment is needed, such as going to your primary care physician or the emergency room. To ensure a safe response, Pennsylvania passed a youth interscholastic concussion law in 2012 establishing requirements for removal from play, annual coach certification training, criteria for return to play, and the schools’ roles.

When a concussion is suspected, a prompt visit to an emergency room or a licensed medical provider is essential. Some health care providers will also refer patients to see a specialist. If a concussion is determined then complete rest from any potentially aggravating mental and physical activities is required until the symptoms minimize. This may include being removed from school and avoiding all visual or auditory overstimulation (e.g. TVs, computers, smartphones, books, bright lights). Once symptoms are significantly reduced at rest, cognitive/mental and visual activity can be increased over time to just below the symptom threshold. To create a safe progression, it is important for patients and their families to work closely with trained personnel.

If headaches, dizziness or cognitive symptoms continue for more than three or four weeks, post-concussion syndrome (PCS) is likely and a referral to a specialist is recommended. Typically the physician directs the patient appropriately. Physical and speech therapists, neurologists, neuropsychologists, psychologists, optometrists and others often play important roles in recovery. Rehab specialists will assess and improve the capacity for aerobic activities, balance, visual and vestibular (balance) function, and thinking/cognition. The team of experts provides the managing physician information about the patient’s progress to customize an individualized concussion care plan. The doctor then instructs the patient, the parents, and the schools on how he/she can progress to “Return to Learn” or “Return to Play.”

Jim Herlihey, MPT, is a physical therapist at Chester County Hospital.
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