How to Reduce Severity of sport-Related Concussion and Imporve Return to Play Decisions

In recent years, new scientific research and clinical-based literature have given the athletic training and medical professions a wealth of updated information on the treatment of sport-related concussion. To provide certified athletic trainers (ATCs), physicians, other medical professionals, parents and coaches, with recommendations based on these latest studies, the National Athletic Trainers’ Association (NATA) issued a new position statement – “Management of Sport-Related Concussion” – in the Fall 2004 issue of The Journal of Athletic Training. The statement will be available online, as of Tuesday, September 28, at http://www.nata.org/publicinformation/files/concussion.pdf. Below are some of the highlights: Defining & Recognizing the Concussion

  • The term “ding” should not be used to describe a sport-related concussion as it generally diminishes the seriousness of the injury. If an athlete shows concussion-like signs and reports symptoms after a contact to the head, the athlete has, at the very least, sustained a mild concussion.
  • Signs of concussion include: fluctuating levels of consciousness, balance problems, memory and concentration difficulties and self-reported symptoms, such as headache, ringing in the ears and nausea.

Evaluating and Making the Return-to-Play Decision

  • For athletes playing sports with a high risk of concussion, baseline cognitive and postural-stability testing should be considered.
  • If an athlete is injured, the time of the initial injury should be recorded. Serial assessments of the athlete should be documented, noting the presence or absence of signs and symptoms of injury. The ATC should monitor vital signs and level of consciousness every 5 minutes after a concussion until the athlete’s condition improves. The athlete should also be monitored over the next few days after the injury for the presence of delayed signs and symptoms and to assess recovery.

Concussion Assessment Tools

  • Formal cognitive and postural-stability testing is recommended to assist in determining injury severity and readiness to return to play (RTP).
  • Once symptom-free, the athlete should be reassessed to establish that cognition and postural stability have returned to normal for that player.

When to Refer to a Physician

  • An athlete with a concussion should be referred to a physician on the day of injury if he or she lost consciousness or experienced amnesia lasting longer than 15 minutes.
  • A team approach should be used in making RTP decisions after concussion. This approach should involve input from the ATC, physician, athlete, and any referral sources.

When to Disqualify

  • Athletes who are symptomatic at rest and after exertion for at least 20 minutes should be disqualified from returning to participation in a sport on the day of the injury.
  • Athletes who experience loss of consciousness or amnesia should be disqualified from participating on the day of the injury.
  • Athletic trainers should be more conservative with athletes who have a history of concussion.

Special Considerations for Young Athletes

  • Because damage to the maturing brain of a young athlete can be catastrophic, athletes under age 18 years should be managed more conservatively.

Home Care

  • An athlete with a concussion should be instructed to avoid taking medications, unless acetaminophen or other medications are prescribed by a physician.
  • Any athlete with a concussion should be instructed to rest, but complete bed rest is not recommended. The athlete should resume normal activities of daily living as tolerated, while avoiding activities that potentially increase symptoms.

Equipment Issues

  • The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions.
  • The ATC should enforce the standard use of mouthguards for protection against dental injuries, even though there is no scientific evidence supporting their use for reducing concussive injury.

The following individuals contributed to conception and design; acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article: Kevin M. Guskiewicz, PhD, ATC – Professor and Director of the Sports Medicine Research Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; Scott L. Bruce, MS, ATC – Certified Athletic Trainer, California State University of PA, California, PA; Robert C. Cantu, MD – Chief of Neurosurgery Service, Emerson Hospital, Concord, MA; Michael S. Ferrara, PhD, ATC – Professor, Exercise and Sport Science, University of Georgia, Athens, GA; James P. Kelly, MD – Associate Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine; Michael McCrea, PhD – Head of Neuropsychology Service/ Neuroscience Program Director, Waukesha Memorial Hospital, Waukesha, WI ; Margot Putukian, MD – Director, Athletic Medicine, Princeton University, Princeton, NJ; Tamara C. Valovich McLeod, PhD, ATC – Assistant Professor, Department of Sport Health Care, Arizona School of Health Sciences, Mesa, AZ. National Athletic Trainers' Association position statement: sport-related concussion. J Athl Train. 2004;39(3).

 
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