Medical research about sport-related concussion has provided sports medicine clinicians with a great deal of new information in recent years. This has resulted in improved recognition of concussion, also called mild traumatic brain injury (MTBI), reduction in the incidence and severity of concussion and better-informed decisions regarding return to play. Sport-related concussion is often poorly understood by the general population, and by athletes themselves. The intent of this information sheet is to provide some general information about sport-related concussion.
An athlete who exhibits or reports symptoms including: headaches, dizziness, nausea, vomiting, drowsiness, blurred or altered vision, disorientation, mental confusion, or memory impairment is exhibiting symptoms of concussion. This may occur after a direct blow to the head, as well as, after collisions in which there was no direct blow to the head. Concussions may occur with or without the loss of consciousness. In the past, the terms "bell run" and "ding" were used to describe what are now understood to be concussions. The seriousness of these seemingly minor injuries is better understood now and it is important to treat these injuries appropriately and to not minimize the potential long-term effects that can result.
Research indicates that athletes who return to activity before completely recovering from a concussion have a higher risk of sustaining a second concussion. This re-injury often results from a seemingly insignificant blow or contact and usually results in a longer recovery period. These athletes are also at risk for "Second Impact Syndrome". "Second Impact Syndrome" results in rapid brain swelling, brain damage and in some cases death.
Post-concussion syndrome (PCS) refers to symptoms that persist over a longer period of time after the initial injury. Common symptoms include: sleep disturbances, concentration problems, fatigue, anxiety, irritability, short-term memory impairment, "fogginess", and academic difficulties. PCS may persist for days, weeks, months or indefinitely.
Medical management of sport-related concussion continues to evolve. The most recent medical practice standards regarding management of sport-related concussion were published in early 2005. "The Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004" introduces new classifications for concussion severity and makes clear that recovery time is a marker for determining the severity of a concussion. The Prague Statement further clarifies these points:
1. No athlete should return to play if symptomatic.
2. Physical and cognitive rest is required during the recover period.
3. Return to play following a concussion should follow a stepwise process.
Neuropsychological testing, such as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) has become widely accepted as a standard of care following sports-related concussion. such testing has proved to be extremely reliable in determining recovery after a concussion and is far more reliable than the athlete's self-reported recovery from symptoms. ImPACT is one of the tools utilized at Wesleyan University to determine when it is safe to allow an athlete to return to play.
Both the Prague Statement and the National Athletic Trainers' Association (NATA) Position Statement on Management of Sport-Related Concussion address the importance of neuropsychological testing to aid in determining recovery from concussion and recommend baseline testing of athletes.
Revised January 2007