EDUCATION

• Frequently Asked Questions
• Concussion Resources

 

Frequently Asked Questions

1. What should you do if a student athlete may have a concussion?
2. What are the preseason concussion assessments an athlete should complete and why?
3. When should an athlete be pulled from play due to a possible head injury?
4. How much rest is needed after a concussion?
5. When can an athlete return to competition after a concussion?
6. In what sports do most head injuries occur?
7. Can equipment such as headgear and sensors help prevent concussions?
8. Can concussion be prevented?
9. Should I play or not?
10. What is a concussion?
11. What are the signs and symptoms of a concussion and what should you do?
12. What are the short and long term effects of a concussion?
13. What is Post Concussion Syndrome?
14. What is Chronic Traumatic Encephalopathy (CTE)?

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What are the preseason concussion assessments an athlete should complete and why?

Mayo Clinic believes preseason concussion assessments should be incorporated into the annual sports participation physicals at all levels of play. - David Dodick, MD

Most preseason concussion assessment programs only include a single computerized cognitive test. These assessments are commonly referred to as "Concussion baseline tests". They are tools used by a health professional to help care for and return a patient back to his/her normal cognitive functioning after a concussion/head injury has occurred. The Mayo Clinic's preseason concussion assessment includes multiple tests to assist in removing an injured athlete from competition and returning that athlete back to learning and activity when appropriate. Baseline neurologic evaluations should be performed on a yearly basis in school-aged athletes due to significant developmental changes that occur in this age group. Mayo Clinic's annual pre-participation concussion baseline assessment program provides safety personal and physicians necessary information to assess head injuries and assist in making a return to play determination. Our pre-participation assessment includes the completion of the:

1. Relevant background information
2. SCAT5 Symptom Evaluation
3. Eye movement tracking (KD Test in association with Mayo Clinic)
4. Computerized cognitive testing (Cognigram, or ImPact)
5. Balance Testing (Timed Tandem Gait)

Pre-Season Neurologic Evaluation results need to be accessible at all times, including practices and games, to sideline medical staff.

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When should an athlete be pulled from play due to a possible head injury?

All 50 states have laws governing the diagnosis and management of concussion. See your local or state bodies for further details. An athlete should be pulled from competition when he or she fails any ONE or more of the following Steps;

• Step 1: Recognize and Remove - If signs of a concussion are observed or symptoms are reported, the athlete must be removed from the play until cleared by a medical professional.
• Step 2: Orientation Questions - If the athlete incorrectly answers a basic orientation question, the athlete must be removed from the play until cleared by a medical professional.
• Step 3: Eye-movement testing (King-Devick Test in association with Mayo Clinic*) - If the athlete has a prolonged test time compared to baseline or any uncorrected errors, the athlete must be removed from play until cleared by a medical professional.
• Step 4: Balance testing, to be completed by a medical professional.
• Step 5: Additional tools used by an experienced concussion specialist to evaluate an injury.

*When no baseline data is available, results should be interpreted by the clinician using best clinical judgment.

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How much rest is needed after a concussion?

Total rest,  or "cocooning" is not ideal for an injured brain. In fact, prolonged rest can impeded the recovery of the brain. Telling an active youth to completely remove themselves from social and physical activity can lead to further symptoms thus prolonging or preventing recovery. Mayo Clinic recommends a graduated return to activity program overseen and directed by a medical provider specializing in concussion.

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When can an athlete return to competition after a concussion?

All 50 states have laws governing the diagnosis and management of concussion. See your local or state bodies for further details. Never return to play or vigorous activity while signs or symptoms of a concussion are present. An athlete with a suspected concussion should not return to play until he or she has been medically evaluated by a health care professional trained in evaluating and managing concussions. While appropriate management of concussion is highly individualized, athletes are typically seen every one-to-two weeks until they are fully cleared to return to play. The majority of athletes are gradually returned to learn and play over the course of 3 weeks following the injury. For those patients with a slower recover time, Mayo Clinic will refer the athlete to the appropriate rehabilitative therapies. Mayo Clinic concussion specialists work with student athletes and their school to design individually tailored return to learn and school accommodation plans. Mayo Clinic provides a comprehensive evaluation for diagnosis and management of concussions that includes includes assessment of neurologic function, cognitive (thinking) skills, balance, oculomotor function, and emotion. Together, the health providers establish a diagnosis, develop a treatment plan and provide recommendations for return-to-learn and return-to-play. If you do not have access to a Mayo Clinic facility, it is highly recommended that any return-to-play protocol be overseen by a physician.

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In what sports do most head injuries occur?

A concussion can occur in any sport or any activity. Certain sports such as football, rugby, hockey, soccer, lacrosse, and cheer have a higher incidence of concussion than others. Sports with more potential for contact or collision obviously have a higher rate of concussion than other sports such as swimming or golf where no contact is to made with other individuals. Regardless of sport, coaches should be alert to the signs and symptoms of concussion and be mindful or injuries of all types.

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Can equipment such as headgear and sensors help prevent concussions?

Helmets do a great job of preventing skull fractures and catastrophic brain injuries but they do not prevent concussions. There has been no equipment that has been developed or scientifically proven that prevents concussions.

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Can concussions be prevented?

Concussions cannot be completely prevented but the risk of any injury can be minimized by using the proper protective gear, complete preseason baseline testing, and be physically prepared to play your sport. Some tips that may help you minimize your risk of head injury in any sport include:

• Knowing your alignment, assignment and technique. Knowing where you are supposed to be, what you are supposed to do and doing it with sound fundamentals not only help you become a better player, it minimizes the opportunities for injury. Know your sport and be coachable.
• Wearing protective gear during sports and other recreational activities. Make sure the equipment fits properly, is well-maintained and worn correctly. Follow the rules of the game and practice good sportsmanship. When bicycling, motorcycling, snowboarding or engaging in any recreational activity that may result in head injury, wear protective headgear.
• Educating others about concussions. Educating coaches, athletes, parents and others about concussions can help spread awareness. Coaches and parents can also help encourage good sportsmanship.

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Should I play or not?

There are so many great mental and psychical benefits that are instilled through sports that positively impact an individuals life. The decision to begin playing a particular sport or continue playing that sport after a head injury is very personal to the athlete and family. Following any injury, the most important thing to an athlete is returning to play the sport they love. The tough thing about concussions is that most times the athlete can continue to perform athletically. There is not a sprain or broken bone preventing them from playing. This is why it is critical to educate the athlete and family on the risks and effects of subsequent head injuries. The duration of the recovery time following a concussion is important to consider in returning to play. Most athletes recover within a month or less. If the recovery time exceeds a month, more consideration should be taken on returning to play after a full recovery. The number of past concussions and the forces in which causes those concussions are also important factors to consider. If the force required to cause subsequent concussions continues to decrease, the athlete and family need to seriously consider pausing sport participation. If an individual tries to hide an injury, not report symptoms or return to the sport too early, that athlete is at risk of multiple concussions that may result in long term symptoms and retirement from all contact sports. A major consideration that needs to be discussed, is if the benefits of participation in a certain sport outweigh the potential risks.

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What is a concussion?

A concussion is a traumatic brain injury that affects your brain function. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Concussions are usually caused by a blow to the head. Violently shaking the head and upper body also can cause concussions. Some concussions cause you to lose consciousness, but most do not. It's possible to have a concussion and not realize it. Most people usually recover fully after a concussion.

A violent blow to your head and neck or upper body can cause your brain to slide back and forth forcefully against the inner walls of your skull.

Sudden acceleration or deceleration of the head, caused by events such as a car crash or being violently shaken, also can cause brain injury.

These injuries affect brain function, usually for a brief period, resulting in signs and symptoms of concussion. This type of brain injury may lead to bleeding in or around your brain, causing symptoms such as prolonged drowsiness and confusion. These symptoms may develop immediately or later. Such bleeding in your brain can be fatal. That's why anyone who experiences a brain injury needs monitoring in the hours afterward and emergency care if symptoms worsen. Risk factors Activities and factors that may increase your risk of a concussion include:

• Falling, especially in young children and older adults
• Participating in a high-risk sport, such as football, hockey, soccer, rugby, boxing or other contact sport
• Participating in high-risk sports without proper safety equipment and supervision
• Being involved in a motor vehicle collision
• Being involved in a pedestrian or bicycle accident
• Being a soldier involved in combat
• Being a victim of physical abuse
• Having had a previous concussion

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What are the signs and symptoms of a concussion and what should you do?

The signs and symptoms of a concussion can be subtle and may not show up immediately. Symptoms can last for days, weeks or even longer. Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia usually involves forgetting the event that caused the concussion. Signs and symptoms of a concussion may include:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea
• Vomiting
• Slurred speech
• Delayed response to questions
• Appearing dazed
• Fatigue
• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

You may have some symptoms of concussions immediately. Others may not be apparent for hours or days after injury, such as:

Symptoms in children Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can't describe how they feel. Concussion clues may include:

• Appearing dazed
• Listlessness and tiring easily
• Irritability and crankiness
• Loss of balance and unsteady walking
• Crying excessively
• Change in eating or sleeping patterns
• Lack of interest in favorite toys

Other symptoms include:

• Seizures
• Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
• Lasting or recurrent dizziness
• Obvious difficulty with mental function or physical coordination
• Symptoms that worsen over time
• Large head bumps or bruises on areas other than the forehead in children, especially in infants under 12 months of age

When to see a doctor

• See a doctor within 1 to 2 days if You or your child experiences a head injury, even if emergency care isn't required.
• The American Academy of Pediatrics recommends that you call your child's doctor for anything more than a light bump on your child's head.
• If your child doesn't have signs of a serious head injury, remains alert, moves normally and responds to you, the injury is probably mild and usually doesn't need further testing.
• In this case, if your child wants to nap, it's OK to let him or her sleep. If worrisome signs develop later, seek emergency care.

Seek emergency care for an adult or child who experiences a head injury and symptoms such as:

• Repeated vomiting
• A loss of consciousness lasting longer than 30 seconds
• A headache that gets worse over time
• Changes in his or her behavior, such as irritability
• Changes in physical coordination, such as stumbling or clumsiness
• Confusion or disorientation, such as difficulty recognizing people or places
• Slurred speech or other changes in speech

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What are the short and long term effects of a concussion?

Potential complications of concussion include:

• Post-traumatic headaches. Some people experience headaches within a week to a few months after a brain injury.
• Post-traumatic vertigo. Some people experience a sense of spinning or dizziness for days, week or months after a brain injury.
• Post-concussion syndrome. Some people have symptoms — such as headaches, dizziness and thinking difficulties — a few days after a concussion. Symptoms may continue for weeks or months.
• Cumulative effects of multiple brain injuries. It's possible that some people who have had one or more traumatic brain injuries over the course of their lives are at greater risk of developing lasting, possibly progressive, impairment that limits function. This is an area of active research.
• Second impact syndrome. Rarely, experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and usually fatal brain swelling. Concussion changes the levels of brain chemicals. It usually takes about a week for these levels to stabilize again, but recovery time varies. It's important for athletes never to return to sports while they're still experiencing signs and symptoms of concussion.

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What is post concussion syndrome?

Post-concussion syndrome is a complex disorder in which various symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion. For the minority of student athletes that do not recover within 3 weeks, they can expect to recover within 3 months. Should all conditions not be resolved under 3 months, the patient will continue additional rehabilitation, assessments and care as directed by the concussion team. Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of the messaging system within the nerves, caused by the impact that caused the concussion. Others believe post-concussion symptoms are related to psychological factors, especially since the most common symptoms — headache, dizziness and sleep problems — are similar to those often experienced by people diagnosed with depression, anxiety or post-traumatic stress disorder. In many cases, both physiological effects of brain trauma and emotional reactions to these effects play a role in the development of symptoms. Researchers haven't determined why some people who've had concussions develop persistent post-concussion symptoms while others do not. There's no proven connection between the severity of the injury and the likelihood of developing persistent post-concussion symptoms. However, some research shows that certain factors are more common in people who develop post-concussion syndrome compared with those who don't develop the syndrome. These factors include a history of depression, anxiety, post-traumatic stress disorder, significant life stressors, a poor social support system and lack of coping skills. More research is still needed to better understand how and why post-concussion syndrome happens after some injuries and not others. Risk factors for developing post-concussion syndrome include:

• Age. Studies have found increasing age to be a risk factor for post-concussion syndrome.
• Sex. Women are more likely to be diagnosed with post-concussion syndrome, but this may be because women are generally more likely to seek medical care

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What is Chronic Traumatic Encephalopathy (CTE)?

Chronic traumatic encephalopathy (CTE) is the term used to describe brain degeneration likely caused by repeated head traumas. CTE is a diagnosis only made at autopsy by studying sections of the brain. CTE is a very rare condition. It has been found in the brains of people who played contact sports, such as football, as well as others. Some symptoms of CTE are thought to include difficulties with thinking (cognition), physical problems, emotions and other behaviors. CTE is a very controversial condition that is still not well-understood. Researchers do not yet know the frequency of CTE in the population and do not understand the causes. There is no cure for CTE.

• Difficulty thinking (cognitive impairment)
• Impulsive behavior
• Depression or apathy
• Short-term memory loss
• Difficulty planning and carrying out tasks (executive function)
• Emotional instability
• Substance abuse
• Suicidal thoughts or behavior

Other suspected symptoms may include:

• Irritability
• Aggression
• Speech and language difficulties
• Motor impairment, such as difficulty walking, tremor, loss of muscle movement, weakness or rigidity
• Trouble swallowing (dysphagia)
• Vision and focusing problems
• Trouble with sense of smell (olfactory abnormalities)
• Dementia

The full list of symptoms of people with CTE at autopsy is still unknown. It is unclear what kind of symptoms, if any, it may cause. Little is known right now about how CTE progresses.

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Concussion Resources

A number of good concussion resources for parents, coaches and student athletes have been developed by the:

• Center for Disease Control and Prevention and are available online at CDC Concussion Resources.
• International Concussion Society at www.concussion.org
• American Academy of Neurology at AAN Concussion.

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