Concussion

Laura Bhreathnach May 2017

I recently attended the Safe Rugby level 2 first aid course at the Aviva stadium. This updated my knowledge on the management of concussion, spinal injuries and general sports first aid. These skills will help me deliver a high standard of care at Peak physiotherapy. Something that kept coming up on this course was the poor understanding and management of concussion across the country. Therefore I thought it would be helpful to provide some information on the management and symptoms of concussion.

Concussion

Concussion is an issue that affects all sports and it is important that everyone recognises the symptoms of concussion and removes any one from playing or training who has a suspected concussion.

The message is simple – Recognise and remove. Recognise the symptoms of concussion and permanently remove a player displaying any of those symptoms.

Working together with players, coaches, administrators, medics, scientists, the media and supporters, we can ensure the welfare of those who take part in sport at all levels are protected.

What is concussion?

Concussion is a traumatic brain injury resulting in a disturbance of brain function. They can be a result of a direct blow to the head or they can be due to contact to another part of the body resulting in a whiplash type force to the brain. There are many symptoms of concussion, common ones being headache, dizziness, memory disturbance or balance problems. Symptoms of concussion generally appear within the first 24-48hours, however onset of symptoms can be delayed and should be taken just as seriously. Loss of consciousness, being knocked out, occurs in less than 10% of concussions, therefore this is not a requirement for diagnosing concussion. Typically standard brain scans are normal.

Signs and symptoms of concussion

• Any one or more of the following visual clues can indicate a concussion:
• Dazed, blank or vacant look
• Lying motionless on ground / slow to get up
• Unsteady on feet / balance problems or falling over / incoordination
• Loss of consciousness or responsiveness
• Confused / not aware of plays or events
• Grabbing / clutching of head
• Seizure (fits)
• More emotional / irritable than normal for that person
• Headache
• Dizziness
• Mental clouding, confusion, or feeling slowed down
• Visual problems
• Nausea or vomiting
• Fatigue
• Drowsiness / feeling like “in a fog“ / difficulty concentrating
• “Pressure in head”
• Sensitivity to light or noise

What happens if a player has a suspected concussion at training or when playing?

The player MUST be immediately removed from activity and MUST NOT return.

The player MUST NOT be left alone.

The player MUST NOT drive a vehicle.

The player MUST always be in the care of a responsible adult, who is informed of the player’s suspected concussion.

The player MUST NOT consume alcohol in the first 24hours and thereafter should avoid alcohol until provided with a medical or healthcare assessment, or if no one is available they should avoid alcohol until symptom free.

The player should be medically assessed as soon as possible.

If ANY of the following are reported, then the player should be transported for urgent medical assessment at the nearest hospital:

Athlete complains of severe neck pain

Deteriorating consciousness (more drowsy)

Increasing confusion or irritability

Severe or increasing headache

Repeated vomiting

Unusual behavior change

Seizure (fit)

Double vision

Weakness or tingling/burning in arms or legs

Graded Return to play (GRTP)

Athletes with a history of two or more concussions within the past year are at greater risk of further brain injury and slower recovery and should seek medical attention from practitioners experienced in concussion management before return to play.

Usefull tools for recognizing concussion

Useful tools for recognizing a concussion are the pocket scat and this I recommend strongly that this is easily accessible and laminated in ALL first aid bags.

file:///C:/Users/peak%20physio/Downloads/Pocket_CRT_2013_EN%20(1).pdf

Management of concussion is always easier if you know the player and have a baseline scat. This can be difficult if you have different people covering teams. Therefore having a baseline SCAT 5 is really useful to determine the correct management of concussion and return to play.

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097506SCAT5

If you have any questions about concussion, feel free to contact us or book online to see one of our chartered physiotherapists.