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Saturday, 21 September 2013

Concussion - Where to Start

Concussions, after staring at my computer screen for about an hour trying to come up with a new and inventive way to talk about concussions and why everyone in sport needs to be educated about them, I realized that their is nothing new to say.  The message is still the same, hopefully you will gain some new knowledge or understanding after spending some time reading this.  That is my hope, that by a coach, parent or athlete reading this, they will learn something about concussions.  We can't necessarily prevent concussions unfortunately it is one of the risks of sport, but we do need to increase the awareness of signs and symptoms and proper management when they do occur.

This may seem like a redundant thing to say but a concussion is a brain injury.  I state this because I have had a coach in the past say a kid could play because the emergency physician said he had a mild brain injury.  He must have been listening to me, he knew that he could not play a kid with a concussion, and obviously I had not educated him enough. As defined from the 4th Concussion Consensus Statement from Zurich November 2012, concussion is a brain injury caused by a direct blow to the head, face, neck or an impulsive force being transmitted to the head from a direct blow to somewhere else in the body that causes a set of physical, cognitive or somatic symptoms.  It is important to say that everyone person will respond differently to a concussion both in the symptoms they show and how they recover.

Every day it seems there is something new coming out about concussions.  For a coach or parent trying to keep up at times seems impossible.  I have found Twitter to be an excellent resource.  Follow health professionals who are known for concussion research to stay up to date and informed.   It is unfortunate that most general practitioners are not up able to stay up to date on the latest concussion research and proper return to play.  When dealing with any health professional ask them questions, if they have never heard of the consensus statements or are still following the earlier versions find someone new.  A great resource is a certified Athletic Therapist in Canada or Athletic Trainer in the States.  Proper concussion management is in their scope of practice and they deal with sport concussions on a regular if not daily basis.

So as a parent or coach what do you need to know.  We are going to break it down into three posts.  First we will focus on the importance of baseline testing, secondly recognizing a concussion, thirdly proper management.

Baseline concussion testing can involve a couple of different aspects.  Depending on your health practitioner they may choose to do a different test.  The most popular and common are the Sport Concussion Assessment Tool 3 (SCAT3), ImPACT and King-Devick.  The SCAT3 has a version designed specifically for athletes aged 5-13 as well as the standard for those 13 and over.  ImPACT should be used along with the SCAT3 or King-Devick.

The importance of having baseline testing done is not to compare to other athletes but to understand the athletes normal state as well as to determine their past concussion history.  Finding out if an athlete has suffered a concussion before and if they have any medical conditions that may effect their recovery from a concussion if one should occur.  Athletes, coaches and parents always ask if the baseline test was passed.  This is where the naming can be deceiving, baseline testing is not a pass or fail, it is to determine how the athlete normally feels to a set of symptoms and to evaluate their memory recall, balance and thinking skills.  It is an evaluation.  How many of us have a headache on a regular basis?  Since headache is the number one symptom of concussion, it is good to know if the athlete regularly has a headache when trying to determine if a concussion has occurred.  When doing baseline evaluations athletes typically tell me they have a hard time with numbers or remembering months.  If we had not done the baseline evaluation I would not have known that and it could effect my evaluation of them post injury.

Education about concussions is always important but that includes the health practitioners education about each individual athlete.  Doing baseline evaluations allows us to get to know the athletes better, which in turn gives us an advantage when an injury does occur.  Have your athletes do baseline evaluations prior to each season as their physical and mental growth and development will change their outcome.  Think of a baseline concussion evaluation as an insurance policy.  We never want to have to use our insurance but are sure glad we have it when it is needed.

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