The word “concussion” is tossed around casually. Most people think of it as an injury to the head that doesn’t affect the brain, with a very brief loss of consciousness. In fact, any blow that leads to symptoms of concussion should be treated with care. Concussions can even occur when the brain is shaken violently. Your brain may have been injured even if you never lost consciousness. Symptoms include dizziness, nausea, vomiting, balance problems, fatigue, disturbed sleep, sensitivity to light and noise, mood changes, and difficulty with concentration or memory. The medical definition is a head trauma resulting in short-lived impairment of neurologic function. Many different official “scales” are in use to measure severity.
Although we think of concussions as a mild injury, in a study of 434 “traumatic brain injury” (TBI) patients at a Canadian children’s hospital, 23.5 percent of the kids with injuries rated severe were diagnosed as having had a concussion. The researchers titled their study, “My Child Doesn't Have a Brain Injury, He Only Has a Concussion,” arguing that doctors preferred the term “concussion” because it was less alarming to parents.
Concussions are a hazard of football, ice hockey, rugby, soccer, and basketball. The Centers for Disease Control and Prevention estimate that approximately 1.6 million to 3.8 million sports-related concussions occur yearly in the United States. As many as half go unreported, according to the American Medical Society for Sports Medicine. Players and coaches are known to downplay symptoms so players can keep competing.
Immediately after an injury, you should be monitored every 15 to 30 minutes; go to an emergency room if any symptoms worsen. Rest — no sports and no schoolwork — for the next two days, until you are reexamined. Once the symptoms are gone, you can gradually reintroduce activities over the next five days, resting if any symptoms return. Students may need to delay tests and, if symptoms persist, arrange for a lighter workload. Symptoms can sometimes last for weeks, or longer.
Women and younger players are more vulnerable to serious consequences. People who had mood or learning disorders or migraine headaches before their injury may not recognize new symptoms.
Rushing back into sports is taking a big risk. A history of concussion makes it more likely you’ll have another one. Your reaction time may be slower, so you’re less able to protect yourself. If you’re still recovering from the last concussion when your head is slammed again, your brain could swell, leading to permanent damage or even death.
Hospitals may be undertreating people who show up after a TBI, according to several studies. In one study of 395 patients age 14 and older who came to an urban hospital with a “mild traumatic brain injury,” 27 percent who met the usual criteria to be sent home without a follow-up actually turned out to have lasting cognitive problems and needed therapy. This study was alarmingly titled, “You Cannot Go Home: Routine Concussion Evaluation Is Not Enough.”
According to the American Medical Society for Sports Medicine, neither helmets nor mouth guards have been shown to protect players against concussions or make them less severe. The best — though still controversial — answer may be to change the rules of each sport. It may become too expensive to allow professional players to get injured at current rates. The National Football League (NFL), facing a lawsuit on behalf of thousands of former players, agreed to a settlement meant to cover compensation to retirees who develop neurological conditions and pay for testing and medical research about concussions. The NFL has been changing the rules for years. Expect more changes to come — maybe even the end of kickoffs. What will Super Bowls be without kickoffs? Safer.
April 15, 2015
Janet O’Dell, RN