Orthopedics and Sports Medicine - Concussion Management

What is a Concussion?
A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. A concussion can occur even without the loss of consciousness and those injuries that may seem to be mild can result in serious impairment. It has been reported that U.S. emergency departments treat an estimated 135,000 sports and recreation related head injuries including concussions each year among children ages 5-18 (MMWR July 2007). Concussions can occur in any sport. Children and teens are more likely to sustain concussions and they take longer to recover than adults. A repeat concussion that occurs before the brain recovers from the first concussion—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage and even death. Recognition and proper response to concussions when they first occur can help prevent further injury or even death. Therefore, all coaches, parents and athletes need to learn concussion signs and symptoms as well as what to do if a concussion occurs.


Common Signs Observed:

Common Symptoms Reported by the Athlete:

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall
  • Headache or "pressure" in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Does not "feel right" or is "feeling down"



What to do if you suspect your child/athlete has a concussion?

  • Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.

  • Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion.  Do not try to judge the severity of the injury yourself.  Health care professionals have a number of methods that they can use to assess the severity of concussions.  As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:

      Cause of the injury and force of the hit or blow to the head or body.
      Any loss of consciousness (passed out/knocked out) and if so, for how long
      Any memory loss immediately following the injury
      Any seizures immediately following the injury
      Number of previous concussions

  • Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, determines they are symptom-free and it’s OK to return to play.

  • If you suspect your child or athlete has a concussion, use the above guidelines to help you make your treatment decisions.
  • If your child/athlete is experiencing concussive symptoms, refer the athlete to WHS Washington Hospital Emergency Department for evaluation and treatment.

  • If your child has been diagnosed with a concussion, follow up with a Sports Medicine Specialist to ensure proper care and an appropriate return to play plan.


What is ImPACT Testing?
Along with the signs and symptoms mentioned above, many athletes experience cognitive brain function deficits such as memory loss, difficulty concentrating and decreased reaction time as a result of a concussion. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most-widely used, and most scientifically validated computerized concussion evaluation system. Using ImPACT as part of concussion evaluation can help to objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play. In fact, neurocognitive testing has recently been called the "cornerstone" of proper concussion management by an international panel of sports medicine experts. ImPACT is the most widely used computer-based testing program in the world and is implemented effectively across high school, collegiate, and professional levels of sports participation.

The ImPACT test takes approximately 20 minutes to complete. The program measures multiple aspects of cognitive functioning in athletes, including:

  • Attention span
  • Working memory
  • Sustained and selective attention time
  • Response variability
  • Non-verbal problem solving
  • Reaction time

It is recommended that athletes playing collision sports complete a baseline ImPACT test prior to the start of the season. In the event that the athlete sustains an injury during the following two years of their baseline test, the athlete will repeat the test and the post-injury scores will be compared to baseline scores. If an athlete has already sustained an injury without getting baseline tested, the ImPACT testing can still be given and the scores compared with normal age-matched athletes.

Walk-in baseline ImPACT testing and scheduled appointments are available at WHS Outpatient Rehabilitation Services as well as Primary Care - Lakeside.  WHS Outpatient Rehabilitation Services is located at 240 Wellness Way, Washington, PA 15301 or call (724) 250-6280. Primary Care – Lakeside is located at 1001 Waterdam Plaza Drive, McMurray, PA 15317 or call 724-969-1001.



Content Source:National Center for Injury Prevention and Control, Division of Injury Response Heads Up! Concussion Information for Physicians Centers for Disease Control and Prevention



Frequently Asked Questions

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