Concussion Education Covers Eight Essential Topics

While virtually every program in contact and collision sports, regardless of level, now routinely offers some basic concussion safety information, much more education than can fit on to an 8 1/2 by 11 sheet of paper is required.

All stakeholders (parents, coaches, players, health care professionals) should receive education on the following:

1. Learning to recognize concussion signs and symptoms, including:

• symptoms (headache, nausea, vomiting, dizziness, visual problems, sensitivity to light/noise, balance problems);
• physical signs (loss of consciousness, unsteady gait/balance problems/dazed facial expression); impaired brain function (confusion, feeling mentally “foggy,” feeling slowed down, difficulty concentrating and remembering a/k/a amnesia);
• behavioral changes (change in personality, irritability, sadness, nervousness, more emotional, depression); and/or
• sleep disturbances (insomnia, drowsiness, sleeping less than usual, sleeping more than usual).

2. The importance of encouraging athletes to honestly self-report concussion symptoms. Athletes who do not immediately report symptoms of concussion and continue to participate in athletic activity take on average five days longer to be cleared for contact than athletes who immediately report symptoms and are removed from play, and at six times the risk of needing 8 or more days to recover.  Stakeholders need to understand the benefits of creating an environment in which athletes feel safe in reporting their concussion symptoms and those of teammates, and of having an athletic trainer or other medical professional, or a trained volunteer, on the sports sideline to watch for signs of concussion and conduct preliminary concussion evaluations.

3. The need to watch for delayed symptoms. It is not uncommon for concussion symptoms or signs, including behavioral changes and concentration and memory problems, to only appear hours or even days after a strong blow to the body or head during practice or game action. Delayed symptoms are especially common among younger athletes. Concussed athletes also need to be closely monitored during the first 24 to 48 hours after injury for signs of deteriorating mental condition suggesting a more serious brain injury requiring an immediate trip to the emergency room;

4. Ways to reduce risk of brain injury. Concussions in contact and collision sports cannot be completely eliminated, but there are proven ways to reduce the risk of concussion and to limit exposure to repetitive impacts to the head, which may be even more dangerous to brain health in the long term than concussions.

5. Why conservative treatment and management of concussions is important. Parents and athletes need to understand the benefits of physical and cognitive rest in the first few days after concussion, and of easing back into a full school day so that symptoms don’t get worse.

6. Why extreme caution is warranted in return-to-play decision-making. The younger the athlete the more caution should be taken in allowing return to play. All athletes should complete a graduated, symptom-limited exercise protocol and receive written approval for RTP from a concussion-trained health care professional;

7. The dangers of continuing to play with concussion symptoms and/or returning to play too soon. A return to sports before the brain has fully healed increases the risk of health problems, both in the short- and long-term, which can include:

• longer recovery time;
• increased likelihood of a second concussion;
• increased risk of injury to another part of the athlete’s body;
• persistent symptoms (i.e. post-concussion syndrome);
• permanent and worsening problems with memory, concentration, and emotions; and
• increased risk of developing devastating degenerative neurological diseases, including early dementia and chronic traumatic encephalopathy.

8. The factors which suggest that retirement from contact and collision sports may be the safest course. Medicine has not yet figured out how many concussions is too many or how much repetitive brain trauma is too much. The amount that leads to permanent deficits in memory, concentration, and other cognitive processes, and/or that increases the risk of early dementia and other problems later in life, is likely different for each athlete.