Concussions

Concussions
Katelyn Mueller, ATC
Hughston Athletic Training Fellowship

What is a concussion?
A concussion is a violent shaking or jarring action of the brain, resulting in immediate or transient impairment of neurological function. Often, a concussion is described as bruising of the brain. Accelerated or decelerated forces can cause a concussion from a blow or jolt to the head. An acceleration force occurs when a person’s head hits an object or another person, resulting in injury at the point of impact, also known as coup. A deceleration force is when the head makes contact with the ground resulting in an injury opposite of the point of impact, also known as contracoup. Anyone can suffer from a concussion; however, some people are more susceptible based on their lifestyle. An athlete, for example, who participates in contact sports such as football or rugby are more likely to suffer from a concussion than a runner or tennis player.

Signs and Symptoms of a Concussion
There are several ways to assess when someone has suffered from a concussion. Usually, the person will know they have been hit in the head or they have hit the ground, or a spectator often sees the injury occur. Some signs and symptoms of a concussion include:
· headache,
· poor concentration,
· loss of consciousness,
· inability to process information,
· dizziness,
· confusion,
· vacant stare,
· memory deficits,
· disorientation,
· blurred vision,
· ringing in the ears.

Concussion Grades
The 3 grades of concussions are based on their severity. A person who suffers from a Grade I (mild) concussion will usually suffer from symptoms for no more than 15 minutes and will not suffer a loss of consciousness or amnesia. If an athlete suffers from a Grade I concussion, he or she will usually be held out of activity for 1 week post concussion.

A Grade II (moderate) concussion has symptoms lasting for more than 15 minutes with no loss of consciousness but the athlete experiences amnesia. The 2 types of amnesia are retrograde and anterograde. Retrograde amnesia occurs when an individual has a loss of memory of things that happened prior to the concussion and anterograde is a loss of memory of events that happened after the concussion. A certified athletic trainer (ATC) or a team physician can refer the athlete for further exam and a computed axial tomography (CT) scan. An athlete should be symptom free after rest and no activity for 1 week, before he or she is cleared to participate in practice or competition.

A Grade III (severe) concussion results in a loss of consciousness for either seconds or minutes. After suffering from a Grade III concussion, the athlete should be referred to a physician and receive a CT scan. Concussions can be assessed by an ATC or diagnosed by a medical doctor. Based on the signs and symptoms, the ATC or physician will determine when the athlete can return to play. To avoid the risk of a more serious injury, an athlete should not return to activity prior to being symptom free.

When an athlete, who has suffered a concussion, returns to activity prior to being asymptomatic he/she is at risk for additional injury. Post-concussion syndrome occurs after a concussion and has signs and symptoms similar to a concussion such as persistent headaches, irritability, inability to concentrate, memory loss and blurred vision. If systems of post-concussion syndrome arise, the athlete should see a physician and be given a CT scan to see if bleeding or other problems are present. Once again, no activity is permitted until the athlete is symptom free.

Secondary impacts of concussions
Second-impact syndrome occurs when an athlete suffers from a concussion and then suffers from a second concussion before the symptoms of the first have totally resolved. Second-impact syndrome can be fatal. An athlete who suffers from second-impact syndrome can experience a blow to the head, appear stunned, but is able to walk off the field. However, intracranial pressures increase rapidly causing the athlete to collapse, and show symptoms of dilated pupils, loss of eye movement, and then, coma, respiratory failure, and finally, death. All of the events can occur within 2 to 5 minutes. The EMS should be activated immediately when second-impact syndrome suspected. It is important that the athlete is not allowed to return to play prematurely after a concussion. Often, an athlete will suffer from more than 1 concussion throughout his or her career or even in 1 season. Once an athlete suffers from 3 concussions in a season the athlete should terminate play for the rest of the season and possibly stop playing contact sports altogether.

Concussion Prevention
A concussion cannot always be prevented, but a good way to help prevent it is to wear the proper safety equipment. Protective equipment can help protect the face and head from accidental or routine injuries. However, the equipment must fit properly, be clean, be kept in good condition and must be used regularly and correctly. Helmets work by absorbing and dispersing impact forces.

Immediately following a concussion, an ATC or physician should examine the athlete. Depending on the symptoms and severity of the concussion, the athlete may have to sit out the game and additional practices and competition. Terminating play for a few weeks to give the athlete a chance to heal is better than allowing him or her to continue playing and risk ending their sports career or causing death.

Katelyn Mueller, ATC, is a first year graduate student and recipient of the Hughston Athletic Training Fellowship in Columbus, Georgia. She earned a Bachelor’s Degree in Athletic Training and Spanish, with a minor in Strength and Conditioning, from the University of Wisconsin – Oshkosh.

Katelyn is a current member of the National Athletic Trainers Association (NATA), the Great Lakes Athletic Trainers Association (GLATA) and the Wisconsin Athletic Trainers Association (WATA).

Currently, she serves as the Head Athletic Trainer at Harris County High School, Hamilton, Georgia.