Concussion: Wikis

  
  

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Concussion
Classification and external resources

Acceleration (g-forces) can exert rotational forces in the brain, especially the midbrain and diencephalon.
ICD-10 S06.0
ICD-9 850
MedlinePlus 000799
eMedicine aaem/123 sports/27
MeSH D001924
.Concussion, from the Latin concutera ("to shake violently")[1] or the Latin concussus ("action of striking together"),[2] is the most common type of traumatic brain injury.^ Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Echemendia R, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Any head injury is treated very seriously.” Concussions, which account for almost 10 percent of sports injuries, are the most common type of brain injury.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

.The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion may be used interchangeably,[3][4] although the latter is often treated as a narrower category.^ Concussion is a mild traumatic brain injury, usually occurring after a blow to the head.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ A concussion is a brain injury that may result in a bad headache or unconsciousness .

^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[5] .The term "concussion" has been used for centuries and is still commonly used in sports medicine, while 'MTBI' is a technical term used more commonly nowadays in general medical contexts.^ The colloquial term “ding” should not be used to describe a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In many situations, a physician will not be present at the time of the concussion, and the ATC will be forced to act on behalf of the sports medicine team.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Other Sections▼ Abstract METHODS RESULTS DISCUSSION CONCLUSION REFERENCES CONCLUSION The use of standardized measures can improve the accuracy of concussion assessment on the sport sideline.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Frequently defined as a head injury with a transient loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms.^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Listlessness, tiring easily Irritability, crankiness Change in eating or sleeping patterns Lack of interest in favorite toys Loss of balance, unsteady walking When to see a doctor While most concussions get better on their own, some blows to the head can cause more-serious injuries.

.Treatment of concussion involves monitoring and rest.^ In the treatment of concussion, complete bed rest was ineffective in decreasing postconcussion signs and symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur.^ In most people, post-concussion syndrome symptoms occur within the first seven to 10 days and go away within three months, though they can persist for a year or more.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Have your symptoms been constant or do they come and go?
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ We go through our assessment of them and after they experience seven symptom-free days, we’ll take them back to the library and give them the test again.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[6] .Repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.^ Severe or repeated concussions can cause “second-impact syndrome,” in which a subsequent blow before the first heals becomes fatal.
  • SentinelSource.com |More are concerned about brain injuries 10 February 2010 13:40 UTC sentinelsource.com [Source type: News]

^ Cantu RC. Second-impact syndrome.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

.Due to factors such as widely varying definitions and possible underreporting of concussion, the rate at which it occurs annually is not known; however it may be more than 6 per 1,000 people.^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Postconcussion syndrome, however, is a more likely consequence of a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Not every concussion requires a CT scan, but the test is usually done as a precaution if there's a chance your injury is more severe than your immediate condition suggests.

[7] .Common causes include sports injuries, bicycle accidents, car accidents, and falls; the latter two are the most frequent causes among adults.^ Two approaches are most common.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Falls and traffic accidents often involve concussions, with or without other injuries.

^ This type of injury commonly causes adults to be irritable or lethargic, to behave out of character, and to complain of dizziness, nausea, or severe headache.
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

[8] .Concussion may be caused by a blow to the head, or by acceleration forces without a direct impact.^ Risk factors Any blow to the head can cause a concussion.

^ Severe or repeated concussions can cause “second-impact syndrome,” in which a subsequent blow before the first heals becomes fatal.
  • SentinelSource.com |More are concerned about brain injuries 10 February 2010 13:40 UTC sentinelsource.com [Source type: News]

^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

.The forces involved disrupt cellular processes in the brain for days or weeks.^ In its most severe form, DAI can disrupt the brain-stem centers responsible for breathing, heart rate, and wakefulness.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

On the battlefield, MTBI is a potential consequence of nearby explosions.[9]
.It is not known whether the concussed brain is structurally damaged the way it is in other types of brain injury (albeit to a lesser extent) or whether concussion mainly entails a loss of function with physiological but not structural changes.^ Falls and traffic accidents often involve concussions, with or without other injuries.

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Collecting histories on individual athletes is also a vital part of baseline testing, especially in establishing whether the athlete has any history of concussion, neurologic disorder, or other remarkable medical conditions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[10] .Cellular damage has reportedly been found in concussed brains, but it may have been due to artifacts from the studies.^ Doctors once believed that these symptoms, called post-concussion syndrome, were mainly psychological, but we now understand they are caused by subtle damage to the brain.

^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[11] .A debate about whether structural damage exists in concussion has raged for centuries and is ongoing.^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

Contents

Classification

.No single definition of concussion, mild head injury,[12] or mild traumatic brain injury is universally accepted, though a variety of definitions have been offered.^ Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).

^ Concussion is a mild traumatic brain injury, usually occurring after a blow to the head.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[13] .In 2001, the first International Symposium on Concussion in Sport was organized by the International Olympic Committee Medical Commission and other sports federations.^ (They) also consult with area high schools on managing concussions in football and other contact sports.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Further study is required to clarify the relative importance of LOC, PTA, and other factors in predicting recovery after sport-related concussion.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Review Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[14] .A group of experts called the Concussion in Sport Group met there and defined concussion as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces."^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Studies have shown that there is an increased rate of brain injury and occasionally death in people who have had a previous concussion with unconsciousness.

^ But there are too many unanswered questions about the impact a concussion has on the developing brain.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[15] .They agreed that concussion typically involves temporary impairment of neurological function which quickly resolves by itself, and that neuroimaging normally shows no gross structural changes to the brain as the result of the condition.^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Athletes who return on the same day because symptoms resolved quickly ( <20 minutes) should be monitored closely after they return to play.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Sensitivity refers to the probability that a subject with a certain diagnosis (eg, concussion) will be correctly identified by a specific test result (eg, SAC change score).
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6]
.According to the classic definition, no structural brain damage occurs in concussion;[16] it is a functional state, meaning that symptoms are caused primarily by temporary biochemical changes in neurons, taking place for example at their cell membranes and synapses.^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6] .However, in recent years researchers have included injuries in which structural damage does occur under the rubric of concussion.^ Causes Some experts believe post-concussion symptoms are caused by structural damage to the brain or disruption of neurotransmitter systems, resulting from the impact that caused the concussion.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ People who have had a concussion also double their risk of developing epilepsy within the first five years after the injury.

^ Of great concern is a study presented earlier this year by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

.According to the National Institute for Health and Clinical Excellence definition, concussion may involve a physiological or physical disruption in the brain's synapses.^ The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

^ Concussion may cause a gradient of clinical syndromes that may or may not involve LOC. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[17]
.Definitions of mild traumatic brain injury (M.T.B.I) have been inconsistent since the 1970s, but the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) described MTBI-related conditions in 1992, providing a consistent, authoritative definition across specialties.^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Echemendia R, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[4] In 1993, the American Congress of Rehabilitation Medicine defined MTBI as 30 minutes or fewer of loss of consciousness (LOC), 24 hours or fewer of post-traumatic amnesia (PTA), and a Glasgow Coma Scale (GCS) score of at least 13.[18] In 1994, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defined MTBI using PTA and LOC.[4] Other definitions of MTBI incorporate focal neurological deficit and altered mental status, in addition to PTA and GCS.[13]
.Concussion falls under the classification of mild TBI.[19] It is not clear whether concussion is implied in mild brain injury or mild head injury.^ Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).

^ Concussion is a mild traumatic brain injury, usually occurring after a blow to the head.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[20] ."MTBI" and "concussion" are often treated as synonyms in medical literature.^ Cerebral concussion, which is the focus of this position statement, can best be classified as a mild diffuse injury and is often referred to as mild TBI (MTBI).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[18] However, other injuries such as intracranial hemorrhages (e.g. .intra-axial hematoma, epidural hematoma, and subdural hematoma) are not necessarily precluded in MTBI[6] or mild head injury,[21][22] but they are in concussion.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ It is important for concussion victims to seek post concussion medical care to ensure that they are properly assessed and monitored for any complications that may result after the injury.

^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

[23] .MTBI associated with abnormal neuroimaging may be considered "complicated MTBI".[24] "Concussion" can be considered to imply a state in which brain function is temporarily impaired and "MTBI" to imply a pathophysiological state, but in practice few researchers and clinicians distinguish between the terms.^ It is important for concussion victims to seek post concussion medical care to ensure that they are properly assessed and monitored for any complications that may result after the injury.

^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ A number of authors have documented no association between brief ( <1 minute) LOC and abnormalities on neuropsychological testing at 48 hours, raising concern for brief LOC as a predictor of recovery after concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6] .Descriptions of the condition, including the severity and the area of the brain affected, are now used more often than "concussion" in clinical neurology.^ In some cases, when the impact is more extreme, a concussion victim can suffer from bleeding or bruising of the brain, nerve damage, or swelling of the brain due to fluid build-up.

^ More formal neuropsychological testing and postural-stability testing should be viewed as adjuncts to the initial clinical and repeat evaluations (see “ Concussion Assessment Tools ”).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The decision is more difficult if one of the injuries was more severe or was a severe injury resulting from a minimal blow, suggesting that the athlete's brain may be at particular risk for recurrent injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[25]
.Although the term "concussion" is still used in sports literature as interchangeable with "MHI" or "MTBI", the general clinical medical literature now uses "MTBI" instead.^ The colloquial term “ding” should not be used to describe a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Medication Misdiagnosis Medication Errors Contraception Mistakes Medical Mistakes We subscribe to the HONcode principles By using this site you agree to our Terms of Use .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ Despite the increasing body of literature on this topic, debate still surrounds the question of how many concussions are enough to recommend ending the player's career.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[26]
.Controversy exists about whether the definition of concussion should include only those injuries in which loss of consciousness occurs.^ Cognitive impairment can occur for weeks after a concussion injury, making normal functioning difficult for the concussion victim.

^ An athlete with a concussion should be instructed to avoid taking medications except acetaminophen after the injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[1] .Historically, concussion by definition involved a loss of consciousness, but the definition has changed over time to include a change in consciousness, such as amnesia.^ [JAMA. 2003] Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

^ Usually caused by a blow to the head, concussions don't always involve a loss of consciousness.

[27] .The best-known concussion grading scales count head injuries in which loss of consciousness does not occur to be mild concussions and those in which it does to be more severe.^ Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion is a mild traumatic brain injury, usually occurring after a blow to the head.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ How severe is the head injury?

[28]

Grading systems

.At least 41 systems exist to measure the severity, or grade, of a mild head injury,[6] and there is little agreement among professionals about which is the best.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Smith A. Duration of impaired consciousness as an index of severity in closed head injury: a review.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[29] .Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.^ Concussion severity should be determined by paying close attention to the severity and persistence of all signs and symptoms, including the presence of amnesia (retrograde and anterograde) and loss of consciousness (LOC), as well as headache, concentration problems, dizziness, blurred vision, and so on.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ [JAMA. 2003] Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

[29]
.The decision about when to allow athletes to return to contact sports is frequently based on the grade of concussion.^ Cantu RC. Guidelines for return to contact sports after a cerebral concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Before returning to full contact participation, the athlete should be reassessed using neuropsychological and postural-stability tests if available.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ 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 and should be treated for a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Injured athletes are prohibited from returning to play before they are symptom-free during rest and exertion and their neuropsychological tests are normal again, in order to avoid a risk of cumulative effects.^ The presence of self-reported symptoms serves as a major contraindication for RTP, and, based on current recommendations, the athlete should be fully symptom free for at least 7 days at rest and during exertion before returning to play.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In this model, serial testing can be used until neuropsychological testing returns to normal, preinjury levels and the player is completely symptom free.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The combination of brief, standardized measures to quantify the immediate effects and follow-up neuropsychological testing of the injured athlete likely represents the best model for measuring the neurocognitive effects of injury, tracking recovery of function, and assisting the clinician in decision making on the athlete's return to competition.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Three grading systems are followed most widely: one was developed by Robert Cantu, one by the Colorado Medical Society, and a third by the American Academy of Neurology.^ The American Academy of Neurology Concussion Grading Scale (Table 1 ) 6 has been widely used with this approach.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Disqualifying for the Season Guidelines from Cantu 43 and the American Academy of Neurology 6 both recommend termination of the season after the third concussion within the same season.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Denver, CO: Colorado Medical Society; 1990.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[28] Each divides concussion into three grades, as summarized in the following table:[29]
Comparison of concussion grading scales
  Grade I Grade II Grade III
Cantu guidelines Post-traumatic amnesia <30 minutes, no loss of consciousness Loss of consciousness <5 minutes or amnesia lasting 30 minutes–24 hours Loss of consciousness >5 minutes or amnesia >24 hours
Colorado Medical Society guidelines Confusion, no loss of consciousness Confusion, post-traumatic amnesia, no loss of consciousness Any loss of consciousness
American Academy of Neurology guidelines Confusion, symptoms last <15 minutes, no loss of consciousness Symptoms last >15 minutes, no loss of consciousness Loss of consciousness (IIIa, coma lasts seconds, IIIb for minutes)

Signs and symptoms

.Concussion can be associated with a variety of symptoms, which typically occur rapidly after the injury.^ Cognitive impairment can occur for weeks after a concussion injury, making normal functioning difficult for the concussion victim.

^ Review medical complications possibly associated with Concussion: Brain damage Mild traumatic brain injury - see also complications of MTBI Subdural hematoma Cerebral hemorrhage Memory loss more complications...» Concussion Symptoms: Book Excerpts .
  • Symptoms of Concussion - WrongDiagnosis.com 10 February 2010 13:40 UTC www.wrongdiagnosis.com [Source type: General]

^ Post-concussion testing is typically taken within 48 to 72 hours after the injury.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

[14] .Early symptoms usually subside within days or weeks.^ Symptoms can last for days, weeks or even longer.

^ It is strongly recommended that after recurrent injury, especially within-season repeat injuries, the athlete be withheld for an extended period of time (approximately 7 days) after symptoms have resolved.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[11] The number and type of symptoms a person suffers varies widely.[13]

Physical

.Headache is the most common MTBI symptom.^ The most common symptom of concussion is a headache, Cunnane said.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ The two most common concussion symptoms are confusion and amnesia.

[18] .Other symptoms include dizziness, vomiting, nausea, lack of motor coordination, difficulty balancing,[18] or other problems with movement or sensation.^ One side of the card lists the symptoms for athletes (headache, sensitivity to light/noise, sluggish, dizzy, double vision, nausea, memory/concentration problem, change in sleep patterns) and the other displays the warning signs for coaches and parents (forgetful, clumsy, irritability, depression, forgetfulness).
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Other symptoms during the post concussion period may include dizziness, confusion, anxiety, apathy, extreme fatigue, vision problems, headache and vomiting.

^ The injury involves an acceleration-deceleration mechanism in which a blow to the head or the head striking an object results in 1 or more of the following conditions: headache, nausea, vomiting, dizziness, balance problems, feeling “slowed down,” fatigue, trouble sleeping, drowsiness, sensitivity to light or noise, LOC, blurred vision, difficulty remembering, or difficulty concentrating.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Visual symptoms include light sensitivity,[30] seeing bright lights,[29] blurred vision,[11] and double vision.^ One side of the card lists the symptoms for athletes (headache, sensitivity to light/noise, sluggish, dizzy, double vision, nausea, memory/concentration problem, change in sleep patterns) and the other displays the warning signs for coaches and parents (forgetful, clumsy, irritability, depression, forgetfulness).
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Typical self-reported symptoms after a concussion include but are not limited to headache; dizziness; nausea; vomiting; feeling “in a fog”; feeling “slowed down”; trouble falling asleep; sleeping more than usual; fatigue; drowsiness; sensitivity to light or noise; unsteadiness or loss of balance; feeling “dinged,” dazed, or stunned; seeing stars or flashing lights; ringing in the ears; and double vision.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Memory or concentration problems Sensitivity to light and noise Sleep disturbances Irritability Depression Symptoms in children Head trauma is very common in young children.

[31] Tinnitus, or a ringing in the ears, is also commonly reported.[11] .In one in about seventy concussions, concussive convulsions occur, but these are not actual post-traumatic seizures and are not predictive of post-traumatic epilepsy, which results from structural brain damage.^ Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).

^ In some cases, when the impact is more extreme, a concussion victim can suffer from bleeding or bruising of the brain, nerve damage, or swelling of the brain due to fluid build-up.

^ It is important for concussion victims to seek post concussion medical care to ensure that they are properly assessed and monitored for any complications that may result after the injury.

[32] .Concussive convulsions are thought to result from temporary loss of brain function rather than from structural damage and are usually associated with a good outcome.^ Concussion is most often associated with normal results on conventional neuroimaging studies.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Diffuse brain injuries can result in widespread or global disruption of neurologic function and are not usually associated with macroscopically visible brain lesions except in the most severe cases.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Not every concussion requires a CT scan, but the test is usually done as a precaution if there's a chance your injury is more severe than your immediate condition suggests.

[33]

Cognitive and emotional

.Cognitive symptoms include confusion, disorientation, and difficulty focusing attention.^ This plan should include frequent medical evaluations and observations, continued monitoring of postconcussion signs and symptoms, and postinjury cognitive and balance testing.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The concussion assessment battery should include a combination of tests for cognition, postural stability, and self-reported symptoms known to be affected by concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Loss of consciousness may occur but is not necessarily correlated with the severity of the concussion if it is brief.^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ [JAMA. 2003] Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

[15] .Post-traumatic amnesia, in which the person cannot remember events leading up to the injury or after it, or both, is a hallmark of concussion.^ Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).

^ It is important for concussion victims to seek post concussion medical care to ensure that they are properly assessed and monitored for any complications that may result after the injury.

^ Post-concussion testing is typically taken within 48 to 72 hours after the injury.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

[18] .Confusion, another concussion hallmark, may be present immediately or may develop over several minutes.^ One approach is to grade the concussion at the time of the injury on the basis of the signs and symptoms present at the time of the concussion and within the first 15 minutes after injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Not every concussion requires a CT scan, but the test is usually done as a precaution if there's a chance your injury is more severe than your immediate condition suggests.

^ Symptoms The signs and symptoms of a concussion can be subtle and may not be immediately apparent.

[18] .A patient may, for example, repeatedly ask the same questions,[34] be slow to respond to questions or directions, have a vacant stare, or have slurred[18] or incoherent speech.^ Some young players may ask that question, but their situation cannot be compared with that of older, professional athletes, Cunnane said.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[35] .Other MTBI symptoms include changes in sleeping patterns[11] and difficulty with reasoning,[31] concentrating, and performing everyday activities.^ One side of the card lists the symptoms for athletes (headache, sensitivity to light/noise, sluggish, dizzy, double vision, nausea, memory/concentration problem, change in sleep patterns) and the other displays the warning signs for coaches and parents (forgetful, clumsy, irritability, depression, forgetfulness).
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Other symptoms during the post concussion period may include dizziness, confusion, anxiety, apathy, extreme fatigue, vision problems, headache and vomiting.

^ For the basketball player, this may include shooting baskets or participating in walk-throughs, and for the soccer player, this may include dribbling or shooting drills or other sport-specific activities.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[18]
.Affective results of concussion include crankiness, loss of interest in favorite activities or items,[36] tearfulness,[5] and displays of emotion that are inappropriate to the situation.^ Listlessness, tiring easily Irritability, crankiness Change in eating or sleeping patterns Lack of interest in favorite toys Loss of balance, unsteady walking When to see a doctor While most concussions get better on their own, some blows to the head can cause more-serious injuries.

[35] .Common symptoms in concussed children include restlessness, lethargy, and irritability.^ Signs and symptoms of a concussion may include: .

^ Other symptoms during the post concussion period may include dizziness, confusion, anxiety, apathy, extreme fatigue, vision problems, headache and vomiting.

^ The two most common concussion symptoms are confusion and amnesia.

[37]

Mechanism

.
Rotational force is key in concussion.
^ A helmet that protects the head from a skull fracture does not adequately prevent the rotational and shearing forces that lead to many concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Punches in boxing deliver more rotational force to the head than impacts in sports such as American football, and boxing carries a higher risk of concussion than football.^ High schoolers at higher risk for concussions .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ It’s important to have an astute athletic trainer to do observation.” Bloom said concussions are a bigger concern with youth sports than sports with adults because children’s bodies and heads are still developing and growing.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[38]
.The brain is surrounded by cerebrospinal fluid, one of the functions of which is to protect it from light trauma, but more severe impacts or the forces associated with rapid acceleration may not be absorbed by this cushion.^ In some cases, when the impact is more extreme, a concussion victim can suffer from bleeding or bruising of the brain, nerve damage, or swelling of the brain due to fluid build-up.

^ The SAC is also sensitive to detecting more severe neurocognitive changes in injured athletes with LOC or amnesia associated with their concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Diffuse brain injuries can result in widespread or global disruption of neurologic function and are not usually associated with macroscopically visible brain lesions except in the most severe cases.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[10] .Concussion may be caused by impact forces, in which the head strikes or is struck by something, or impulsive forces, in which the head moves without itself being subject to blunt trauma (for example, when the chest hits something and the head snaps forward).^ It is often reported that there is no universal agreement on the standard definition or nature of concussion; however, agreement does exist on several features that incorporate clinical, pathologic, and biomechanical injury constructs associated with head injury: Concussion may be caused by a direct blow to the head or elsewhere on the body from an “impulsive” force transmitted to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ At this time, the ATC should neither endorse nor discourage the use of soccer headgear for protecting against concussion or the consequences of cumulative, subconcussive impacts to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.

[5]
.Forces may cause linear, rotational, or angular movement of the brain, or a combination of these types of motion.^ These types of headgear may reduce the “sting” of a head impact, yet they likely do not meet other sports headgear performance standards.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In these cases, lesions are caused by the brain being shaken within the skull.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Most diffuse injuries involve an acceleration-deceleration motion, either within a linear plane or in a rotational direction or both.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[5] .In rotational movement, the head turns around its center of gravity, and in angular movement it turns on an axis other than its center of gravity.^ Obtaining a baseline symptom score is helpful to establish any preexisting symptoms attributable to factors other than the head injury (eg, illness, fatigue, or somatization).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[5] .The amount of rotational force is thought to be the major type of force to cause concussion[39] and the largest component in its severity.^ A helmet that protects the head from a skull fracture does not adequately prevent the rotational and shearing forces that lead to many concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6] .Studies with athletes have shown that the amount of force and the location of the impact are not necessarily correlated to the severity of the concussion or its symptoms, and have called into question the threshold for concussion previously thought to exist at around 70–75g.^ Symptom-based assessment of the severity of a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ But there are too many unanswered questions about the impact a concussion has on the developing brain.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[40][41]
.The parts of the brain most affected by rotational forces are the midbrain and diencephalon.^ Rotational acceleration-deceleration injuries are believed to be the primary injury mechanism for the most severe diffuse brain injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[1][8] .It is thought that the forces from the injury disrupt the normal cellular activities in the reticular activating system located in these areas, and that this disruption produces the loss of consciousness often seen in concussion.^ Cognitive impairment can occur for weeks after a concussion injury, making normal functioning difficult for the concussion victim.

^ This often causes a brief period of unconsciousness due to a disruption in the brain''s electrical activity.

^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[8] .Other areas of the brain that may be affected include the upper part of the brain stem, the fornix, the corpus callosum, the temporal lobe, and the frontal lobe.^ Other symptoms during the post concussion period may include dizziness, confusion, anxiety, apathy, extreme fatigue, vision problems, headache and vomiting.

^ For the basketball player, this may include shooting baskets or participating in walk-throughs, and for the soccer player, this may include dribbling or shooting drills or other sport-specific activities.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Other substances to avoid during the acute postconcussion period include those that adversely affect central nervous function, in particular alcohol and narcotics.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[42]

Pathophysiology

In both animals and humans, MTBI can alter the brain's physiology for hours to weeks, setting into motion a variety of pathological events.[43] .Though these events are thought to interfere with neuronal and brain function, the metabolic processes that follow concussion are reversed in a large majority of affected brain cells; however a few cells may die after the injury.^ A concussion is a brain injury that may result in a bad headache or unconsciousness .

^ Diagnostic testing, such as an MRI or a CT scan, may be ordered to rule out structural injury to the skull or brain.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

^ It is important for concussion victims to seek post concussion medical care to ensure that they are properly assessed and monitored for any complications that may result after the injury.

[24]
.Included in the cascade of events unleashed in the brain by concussion is impaired neurotransmission, loss of regulation of ions, deregulation of energy use and cellular metabolism, and a reduction in cerebral blood flow.^ See more articles cited in this paragraph Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A cascade of neurochemical, ionic, and metabolic changes occur after brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Furthermore, some areas of the brain demonstrate glycolytic increases and go into a state of metabolic depression as a result of decreases in both glucose and oxidative metabolism with a reduction in cerebral blood flow.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[24] Excitatory neurotransmitters, chemicals such as glutamate that serve to stimulate nerve cells, are released in excessive amounts as the result of the injury.[44] The resulting cellular excitation causes neurons to fire excessively.[45] This creates an imbalance of ions such as potassium and calcium across the cell membranes of neurons (a process like excitotoxicity).[24] Since the neuron firing involves a net influx of positively charged ions into the cell, the ionic imbalance causes cells to have a more positive membrane potential (i.e. it leads to neuronal depolarization). This depolarization in turn causes ion pumps that serve to restore resting potential within cells to work more than they normally do.[24] This increased need for energy leads cells to require greater-than-usual amounts of glucose, which is made into ATP, an important source of energy for cells.[24] The brain may stay in this state of hypermetabolism for days or weeks.[37] .At the same time, cerebral blood flow is relatively reduced for unknown reasons,[30] though the reduction in blood flow is not as severe as it is in ischemia.^ Furthermore, some areas of the brain demonstrate glycolytic increases and go into a state of metabolic depression as a result of decreases in both glucose and oxidative metabolism with a reduction in cerebral blood flow.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[24] Thus cells get less glucose than they normally do, which causes an "energy crisis".[30]
.Concurrently with these processes, the activity of mitochondria may be reduced, which causes cells to rely on anaerobic metabolism to produce energy, which increases levels of the byproduct lactate.^ These types of headgear may reduce the “sting” of a head impact, yet they likely do not meet other sports headgear performance standards.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[24]
.For a period of minutes to days after a concussion, the brain is especially vulnerable to changes in intracranial pressure, blood flow, and anoxia.^ Same-season repeat injuries typically take place within a short window of time, 7 to 10 days after the first concussion, 21 supporting the concept that there may be increased neuronal vulnerability or blood-flow changes during that time, similar to those reported by Giza, Hovda, et al 45 – 47 in animal models.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The greatest deficits were seen 24 hours postinjury, and the athletes with concussion demonstrated a gradual recovery during the 5-day period to within 6% of baseline scores.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ It is strongly recommended that after recurrent injury, especially within-season repeat injuries, the athlete be withheld for an extended period of time (approximately 7 days) after symptoms have resolved.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[30] .According to studies performed on animals (which are not always applicable to humans), large numbers of neurons can die during this period in response to slight, normally innocuous changes in blood flow.^ Same-season repeat injuries typically take place within a short window of time, 7 to 10 days after the first concussion, 21 supporting the concept that there may be increased neuronal vulnerability or blood-flow changes during that time, similar to those reported by Giza, Hovda, et al 45 – 47 in animal models.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[30]
.Concussion involves diffuse (as opposed to focal) brain injury, meaning that the dysfunction occurs over a widespread area of the brain rather than in a particular spot.^ See more articles cited in this paragraph Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Any head injury is treated very seriously.” Concussions, which account for almost 10 percent of sports injuries, are the most common type of brain injury.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

[46] .Concussion is thought to be a milder type of diffuse axonal injury because axons may be injured to a minor extent due to stretching.^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Cerebral concussion, which is the focus of this position statement, can best be classified as a mild diffuse injury and is often referred to as mild TBI (MTBI).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[5] .Animal studies in which primates were concussed have revealed damage to brain tissues such as small petechial hemorrhages and axonal injury.^ Diagnostic testing, such as an MRI or a CT scan, may be ordered to rule out structural injury to the skull or brain.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

^ In some cases, when the impact is more extreme, a concussion victim can suffer from bleeding or bruising of the brain, nerve damage, or swelling of the brain due to fluid build-up.

^ See more articles cited in this paragraph Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[47] .Axonal damage has been found in the brains of concussion sufferers who died from other causes, but inadequate blood flow to the brain due to other injuries may have contributed to the damage.^ A concussion is a brain injury that may result in a bad headache or unconsciousness .

^ Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Diagnostic testing, such as an MRI or a CT scan, may be ordered to rule out structural injury to the skull or brain.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

[11] .Findings from a study of the brains of dead NFL athletes who received concussions suggest there is lasting damage to the brain after experiencing one; this damage can lead to a variety of other health issues.^ But there are too many unanswered questions about the impact a concussion has on the developing brain.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Collecting histories on individual athletes is also a vital part of baseline testing, especially in establishing whether the athlete has any history of concussion, neurologic disorder, or other remarkable medical conditions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The card is available as an educational tool for those who work with young athletes to assist in identifying signs of a concussion or other brain injury and to prevent further harm to the youngster.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[48]

Diagnosis

Unequal pupil size is a sign of a brain injury more serious than concussion.
.Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15).^ Russell WR, Smith A. Post-traumatic amnesia in closed head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ However, more recently, investigations of high school and collegiate athletes with concussion revealed no association between (1) amnesia and duration of symptoms or (2) amnesia and neuropsychological and balance tests at 3, 24, 48, 72, and 96 hours post-injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The greatest deficits were seen 24 hours postinjury, and the athletes with concussion demonstrated a gradual recovery during the 5-day period to within 6% of baseline scores.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[49] .Neuropsychological tests exist to measure cognitive function.^ Later in the year, if the school suspects that a student athlete has suffered a concussion, that student’s cognitive functions will be tested again.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Also, caution should be exercised in neuropsychological test interpretation when pre-injury baseline data do not exist.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ImPACT test assists physicians in evaluating and measuring brain functions, including memory, processing speed, reaction time and symptoms.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

[11] .The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient's condition.^ Diagnostic testing, such as an MRI or a CT scan, may be ordered to rule out structural injury to the skull or brain.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

^ Post-concussion testing is typically taken within 48 to 72 hours after the injury.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

^ After an initial evaluation, the clinician must determine whether the injured athlete requires more advanced medical intervention and eventually grade the injury and make an RTP decision that can occur within minutes, hours, days, or weeks of the injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[50] .Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.^ The program provides a baseline test to athletes at the start of the season, which serves as a basis for comparison following a head injury.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Preseason baseline testing of all athletes is the recommended model for use of concussion screening instruments in sports, because comparison with an athlete's preinjury performance on a given measure provides the most accurate indicator of postinjury recovery.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Before returning to full contact participation, the athlete should be reassessed using neuropsychological and postural-stability tests if available.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[51]
.Health care providers examine head trauma survivors to ensure that the injury is not a more severe medical emergency such as an intracranial hemorrhage.^ How severe is the head injury?

^ Smith A. Duration of impaired consciousness as an index of severity in closed head injury: a review.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting,[52] increasing disorientation or a deteriorating level of consciousness,[53] seizures, and unequal pupil size.^ If symptoms persist or worsen or the level of consciousness deteriorates at all after a concussion, neuroimaging should be performed.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The purpose of the wake-ups is to check for deteriorating signs and symptoms, such as decreased levels of consciousness or increasing headache, which could indicate a more serious head injury or a late-onset complication, such as an intracranial bleed.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ To detect deteriorating signs and symptoms that may indicate a more serious head injury, the ATC should be able to recognize both the obvious signs (eg, fluctuating levels of consciousness, balance problems, and memory and concentration difficulties) and the more common, self-reported symptoms (eg, headache, ringing in the ears, and nausea).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[54] .Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given MRIs or CT scans to detect brain lesions and are observed by medical staff.^ Diagnostic testing, such as an MRI or a CT scan, may be ordered to rule out structural injury to the skull or brain.
  • Sports Concussion Management Program -- 10 February 2010 13:40 UTC www.texashealth.org [Source type: Academic]

^ People who have had a concussion also double their risk of developing epilepsy within the first five years after the injury.

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Health care providers make the decision about whether to give a CT scan using the Glasgow Coma Scale.^ A team approach should be used in making RTP decisions after concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Players care more about health and nutrition — today Bear Bryant could never get away with forbidding them from drinking water during practice.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Balance testing may provide additional information to assist the clinician in the decision-making process of whether to disqualify an individual after a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[8] .In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are intoxicated, at risk for bleeding, older than 60,[8] or younger than 16. Most concussions cannot be detected with MRI or CT scans.^ I would like to read more about it.

^ In addition, because many athletes participate in year-round activities, once they are disqualified for the “season,” it may be difficult to determine at what point they can resume contact play.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Postconcussion syndrome, however, is a more likely consequence of a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[39] .However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans.^ Postconcussion syndrome, however, is a more likely consequence of a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause a gradient of clinical syndromes that may or may not involve LOC. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[24] .Mild head injury may or may not produce abnormal EEG readings.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Bailes JE, Hudson V. Classification of sport-related head trauma: a spectrum of mild to severe injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A moving head hitting an unyielding object usually produces maximum brain injury opposite the site of cranial impact (contrecoup injury) as the brain shifts within the cranium.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[55]
Concussion may be under-diagnosed. .The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries in order to be allowed to remain in the competition.^ Review Head injuries in athletes.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ These methods allow the clinician to quantify the severity of injury and measure the player's progress over the course of postinjury recovery.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Collie A, Darby D, Maruff P. Computerised cognitive assessment of athletes with sports related head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[26] .A retrospective survey in 2005 found that more than 88% of concussions go unrecognized;[56].^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Several former NFL players — and more than one from the Pittsburgh Steelers organization — who have died in recent years have been found with significant brain damage.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ And another study has found former NFL players are far more likely than the general population to suffer from dementia.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

.Diagnosis of concussion can be complicated because it shares symptoms with other conditions.^ Collecting histories on individual athletes is also a vital part of baseline testing, especially in establishing whether the athlete has any history of concussion, neurologic disorder, or other remarkable medical conditions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Because of this, we created an awareness campaign to educate football players, coaches, parents and teachers about the signs and symptoms of a concussion and the importance of “sitting it out.” .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

.For example, post-concussion symptoms such as cognitive problems may be misattributed to brain injury when they are in fact due to post-traumatic stress disorder (PTSD).^ A concussion is a brain injury that may result in a bad headache or unconsciousness .

^ Studies have shown that there is an increased rate of brain injury and occasionally death in people who have had a previous concussion with unconsciousness.

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[57]

Prevention

.Prevention of MTBI involves taking general measures to prevent traumatic brain injury, such as wearing seat belts and using airbags in cars.^ Attention to safety , including the use of appropriate athletic gear, such as bike helmets and seat belts, reduces the risk of head injury.

^ Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Echemendia R, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[18] Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.[36]
.Use of protective equipment such as headgear has been found to reduce the number of concussions in athletes.^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ At this time, the ATC should neither endorse nor discourage the use of soccer headgear for protecting against concussion or the consequences of cumulative, subconcussive impacts to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC should enforce the standard use of mouth guards for protection against dental injuries; however, there is no scientific evidence supporting their use for reducing concussive injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[38] .Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries.^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The decision is more difficult if one of the injuries was more severe or was a severe injury resulting from a minimal blow, suggesting that the athlete's brain may be at particular risk for recurrent injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[58] .New "Head Impact Telemetry System" technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players.^ Review New frontiers in diagnostic imaging in concussive head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Standardized assessment of concussion in football players.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

.Changes to the rules or the practices of enforcing existing rules in sports, such as those against "head-down tackling", or "spearing", which is associated with a high injury rate, may also prevent concussions.^ Tags: concussion , high school sports injuries , sports-related concussion .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Tags: concussion , high school sports injuries .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ It is often reported that there is no universal agreement on the standard definition or nature of concussion; however, agreement does exist on several features that incorporate clinical, pathologic, and biomechanical injury constructs associated with head injury: Concussion may be caused by a direct blow to the head or elsewhere on the body from an “impulsive” force transmitted to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[38]

Treatment

.Usually concussion symptoms go away without treatment,[59] and no specific treatment exists.^ Medications At this time, the clinician has no evidence-based pharmacologic treatment options for an athlete with a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ It is also recommended that acetaminophen (Tylenol, McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, PA) be used sparingly in the treatment of headache-like symptoms in the athlete with a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In the treatment of concussion, complete bed rest was ineffective in decreasing postconcussion signs and symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[60] .About one percent of people who receive treatment for MTBI need surgery for a brain injury.^ The decision is more difficult if one of the injuries was more severe or was a severe injury resulting from a minimal blow, suggesting that the athlete's brain may be at particular risk for recurrent injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Henson MB, De Castro JM, Stringer AY, Johnson C. Food intake by brain-injury humans who are in the chronic phase of recovery.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ One group 91 reported that 15% of the children (mean = 8.34 ± 5.31 years) who were admitted to hospitals after MTBI suffered from a sport-related mechanism of injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[49] .Traditionally, concussion sufferers are prescribed rest,[60] including plenty of sleep at night plus rest during the day.^ The greatest deficits were seen 24 hours postinjury, and the athletes with concussion demonstrated a gradual recovery during the 5-day period to within 6% of baseline scores.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Traditionally, part of these instructions included a recommendation to wake up the athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Therefore, it has been suggested that pediatric athletes suffering a concussion should be restricted from further participation for the day and that additional consideration should be given as to when to return these individuals to activity.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[54] .Health care providers recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen.^ It is recommended that ATCs and physicians consistently use a symptom checklist similar to the one provided in Appendix A .
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The athlete should resume normal activities of daily living as tolerated while avoiding activities that potentially increase symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In this model, serial testing can be used until neuropsychological testing returns to normal, preinjury levels and the player is completely symptom free.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[54] .Education about symptoms, how to manage them, and their normal time course can lead to an improved outcome.^ Because of this, we created an awareness campaign to educate football players, coaches, parents and teachers about the signs and symptoms of a concussion and the importance of “sitting it out.” .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[13]
Medications may be prescribed to treat symptoms such as sleep problems and depression.[13] .Analgesics such as ibuprofen can be taken for the headaches that frequently occur after concussion,[6] but paracetamol (acetaminophen) is preferred to minimize the risk for complications such as intracranial hemorrhage.^ It is also recommended that acetaminophen (Tylenol, McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, PA) be used sparingly in the treatment of headache-like symptoms in the athlete with a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The purpose of the wake-ups is to check for deteriorating signs and symptoms, such as decreased levels of consciousness or increasing headache, which could indicate a more serious head injury or a late-onset complication, such as an intracranial bleed.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[61] Concussed individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor, as they could impede healing.[54]
Observation to monitor for worsening condition is an important part of treatment.[62] .Health care providers recommend that those suffering from concussion return for further medical care and evaluation 24 to 72 hours after the concussive event if the symptoms worsen.^ If there is a suspected concussion, a player should be benched for the game or until fully evaluated by a medical professional; .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ The greatest deficits were seen 24 hours postinjury, and the athletes with concussion demonstrated a gradual recovery during the 5-day period to within 6% of baseline scores.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Traditionally, part of these instructions included a recommendation to wake up the athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Athletes, especially intercollegiate or professional athletes, are typically followed closely by team trainers during this period.^ The greatest deficits were seen 24 hours postinjury, and the athletes with concussion demonstrated a gradual recovery during the 5-day period to within 6% of baseline scores.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Injured subjects identified by the team's certified athletic trainer as having sustained a concussion were tested with the SAC on the sideline immediately following injury and again 48 hours after injury.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ It is strongly recommended that after recurrent injury, especially within-season repeat injuries, the athlete be withheld for an extended period of time (approximately 7 days) after symptoms have resolved.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.But others may not have access to this level of health care and may be sent home with no medical person monitoring them unless the situation gets worse.^ This position statement should provide valuable information and recommendations for certified athletic trainers (ATCs), physicians, and other medical professionals caring for athletes at the youth, high school, collegiate, and elite levels.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Patients may be released from the hospital to the care of a trusted person with orders to return if they display worsening symptoms[8] or those which might indicate an emergent condition, like unconsciousness or altered mental status; convulsions; severe, persistent headache; extremity weakness; vomiting; or new bleeding or deafness in either or both ears.^ Athletes who return on the same day because symptoms resolved quickly ( <20 minutes) should be monitored closely after they return to play.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Signs and symptoms of these focal vascular emergencies can include LOC, cranial nerve deficits, mental status deterioration, and worsening symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Clinicians now have available several brief, standardized methods for assessment of mental status, 6 – 8 postural stability, 9 , 10 and postconcussive symptoms 11 , 12 appropriate for use in a sport setting.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[63] .Repeated observation for the first 24 hours after concussion is recommended; however it is not known whether it is necessary to wake the patient up every few hours.^ Traditionally, part of these instructions included a recommendation to wake up the athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Standardized testing of injured and uninjured control subjects was repeated on the sideline immediately after concussion and 48 hours after injury.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ However, despite these limitations, a concussion instruction form (Appendix C ) should be given to the athlete and a responsible adult who will have direct contact with the athlete for the initial 24 hours after the injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[8]

Prognosis

MTBI has a mortality rate of almost zero.[49] .The symptoms of most concussions resolve within weeks, but problems may persist.^ One approach is to grade the concussion at the time of the injury on the basis of the signs and symptoms present at the time of the concussion and within the first 15 minutes after injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause a gradient of clinical syndromes that may or may not involve LOC. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ This stunned confusional state is a concussion most often reflected by the athlete's initial confusion, which may disappear within minutes, leaving no outwardly observable signs and symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6] It is not common for problems to be permanent, and outcome is usually excellent.[24] .People over age 55 may take longer to heal from MTBI or may heal incompletely.^ Athletic trainers working with younger (pediatric) athletes should be aware that recovery may take longer than in older athletes.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[64] .Similarly, factors such as a previous head injury or a coexisting medical condition have been found to predict longer-lasting post-concussion symptoms.^ An athlete with a concussion should be instructed to avoid taking medications except acetaminophen after the injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Russell WR, Smith A. Post-traumatic amnesia in closed head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ One approach is to grade the concussion at the time of the injury on the basis of the signs and symptoms present at the time of the concussion and within the first 15 minutes after injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[47] .Other factors that may lengthen recovery time after MTBI include psychological problems such as substance abuse or clinical depression, poor health before the injury or additional injuries sustained during it, and life stress.^ For the basketball player, this may include shooting baskets or participating in walk-throughs, and for the soccer player, this may include dribbling or shooting drills or other sport-specific activities.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Obtaining a baseline symptom score is helpful to establish any preexisting symptoms attributable to factors other than the head injury (eg, illness, fatigue, or somatization).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[24] .Longer periods of amnesia or loss of consciousness immediately after the injury may indicate longer recovery times from residual symptoms.^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ One approach is to grade the concussion at the time of the injury on the basis of the signs and symptoms present at the time of the concussion and within the first 15 minutes after injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The athlete should also be monitored over the next few hours and days after the injury for delayed signs and symptoms and to assess recovery.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[65] .For unknown reasons, having had one concussion significantly increases a person's risk of having another.^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ The risk of developing post-concussion syndrome increases with age.
  • Post-concussion syndrome 10 February 2010 13:40 UTC us.cnn.com [Source type: General]

^ To: the long march; Carley Considering I am the only one that mentioned having had a concussion, I would like you to reference my “crude” statements to Carley.
  • Rumors Swirl Around Texas Tech Coaching Scandal 10 February 2010 13:40 UTC www.freerepublic.com [Source type: FILTERED WITH BAYES]

[50] .Having previously sustained a sports concussion has been found to be a strong factor increasing the likelihood of a concussion in the future.^ Injured subjects identified by the team's certified athletic trainer as having sustained a concussion were tested with the SAC on the sideline immediately following injury and again 48 hours after injury.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ CINN applauds the increasing media attention regarding concussions in high school sports.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Further study is required to clarify the relative importance of LOC, PTA, and other factors in predicting recovery after sport-related concussion.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.Other strong factors include participation in a contact sport and body mass size.^ For the basketball player, this may include shooting baskets or participating in walk-throughs, and for the soccer player, this may include dribbling or shooting drills or other sport-specific activities.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ (They) also consult with area high schools on managing concussions in football and other contact sports.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Ideally, preseason baseline testing is conducted before athletes are exposed to the risk of concussion during sport participation (eg, before contact drills during football).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[66] .The prognosis may differ between concussed adults and children; little research has been done on concussion in the pediatric population, but concern exists that severe concussions could interfere with brain development in children.^ But there are too many unanswered questions about the impact a concussion has on the developing brain.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Some research suggests that the magic number may be 3 concussions in a career.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Authors who have tracked symptoms and neuropsychological function after concussion suggest that age-related differences exist between high school and collegiate athletes with regard to recovery.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[50]
.A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years.^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Collecting histories on individual athletes is also a vital part of baseline testing, especially in establishing whether the athlete has any history of concussion, neurologic disorder, or other remarkable medical conditions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Field et al 90 found that high school athletes who sustained a concussion demonstrated prolonged memory dysfunction compared with collegiate athletes who sustained a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects[67]
  • A decrease in episodic memory
  • A decrease in response inhibition
  • Delayed P3a/P3b waves
  • An increase in the cortical silence period
  • Reduced muscle speed otherwise known as bradykinesia

Post-concussion syndrome

.In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent.^ Concussion may cause a gradient of clinical syndromes that may or may not involve LOC. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ His concussion came with two weeks of short-term memory loss, but by the end of the month, he was cleared and back on the field.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[68] .Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability.^ One side of the card lists the symptoms for athletes (headache, sensitivity to light/noise, sluggish, dizzy, double vision, nausea, memory/concentration problem, change in sleep patterns) and the other displays the warning signs for coaches and parents (forgetful, clumsy, irritability, depression, forgetfulness).
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ To detect deteriorating signs and symptoms that may indicate a more serious head injury, the ATC should be able to recognize both the obvious signs (eg, fluctuating levels of consciousness, balance problems, and memory and concentration difficulties) and the more common, self-reported symptoms (eg, headache, ringing in the ears, and nausea).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion severity should be determined by paying close attention to the severity and persistence of all signs and symptoms, including the presence of amnesia (retrograde and anterograde) and loss of consciousness (LOC), as well as headache, concentration problems, dizziness, blurred vision, and so on.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[69] There is no scientifically established treatment, and rest, a recommended recovery technique, has limited effectiveness.[60] Symptoms usually go away on their own within months.[23] .The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.^ These findings also suggest that the decline in SAC score by injured subjects immediately after concussion represents the direct effect of injury on cognitive functioning and is not due to other extraneous factors often encountered on the sport sideline (eg, fatigue, crowd noise, distractibility).
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Although more prospective work is needed in this area, these studies raise questions as to whether the RTP criteria for grade 1 (mild) concussions are conservative enough.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Recent research, however, suggests that these 2 factors, either alone or in combination, are not good predictors of injury severity.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[57]

Cumulative effects

.Cumulative effects of concussions are poorly understood.^ See more articles cited in this paragraph Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The fact that the brain of the young athlete is still developing cannot be ignored, and the effect of concussion on the developing brain is still not entirely understood.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.The severity of concussions and their symptoms may worsen with successive injuries, even if a subsequent injury occurs months or years after an initial one.^ Symptom-based assessment of the severity of a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ For athletes with a history of multiple concussions, it is also important to clarify any apparent pattern of (1) concussions occurring as a result of lighter impacts, (2) concussions occurring closer together in time, (3) a lengthier recovery time with successive concussions, and (4) a less complete recovery with each injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[70] .Symptoms may be more severe and changes in neurophysiology can occur with the third and subsequent concussions.^ Symptom-based assessment of the severity of a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ It has been suggested that athletes with concussion avoid medications containing aspirin or nonsteroidal anti-inflammatories, which decrease platelet function and potentially increase intracranial bleeding, mask the severity and duration of symptoms, and possibly lead to a more severe injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[50] .Studies have had conflicting findings on whether athletes have longer recovery times after repeat concussions and whether cumulative effects such as impairment in cognition and memory occur.^ Duration of cognitive impairment after sports concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Cumulative effects of concussion in high school athletes.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ After the University of North Carolina’s Center for the Study of Retired Athletes published survey-based papers in 2005 through 2007 that found a correlation between N.F.L. football and depression, dementia and other cognitive impairment, a member of the N.F.L. concussion committee called the findings “virtually worthless.” .
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[38]
.Cumulative effects may include psychiatric disorders and loss of long-term memory.^ Up to a million high school and college athletes get them every year, and as more doctors learn about the long-term effects of the injury, the more concern there is about how they may impact the teen athlete’s brain.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ His concussion came with two weeks of short-term memory loss, but by the end of the month, he was cleared and back on the field.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

.For example, the risk of developing clinical depression has been found to be significantly greater for retired football players with a history of three or more concussions than for those with no concussion history.^ Standardized assessment of concussion in football players.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A study from the University of Michigan, released in September, found the rate of dementia symptoms for former football players over age 50 was five times the national average, and for players between 30 and 49 it was 19 times higher than the average.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[71] .Three or more concussions is also associated with a fivefold greater chance of developing Alzheimer's disease earlier and a three-fold greater chance of developing memory deficits.^ See more articles cited in this paragraph Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ See more articles cited in this paragraph Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ More than 3.5 million sports-related concussions occur each year in the United States, according to the U.S. Centers for Disease Control and Prevention and the Brain Injury Association of Washington.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

[71]

Dementia pugilistica

.Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head.^ For athletes with a history of multiple concussions, it is also important to clarify any apparent pattern of (1) concussions occurring as a result of lighter impacts, (2) concussions occurring closer together in time, (3) a lengthier recovery time with successive concussions, and (4) a less complete recovery with each injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The decision is more difficult if one of the injuries was more severe or was a severe injury resulting from a minimal blow, suggesting that the athlete's brain may be at particular risk for recurrent injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.The condition called dementia pugilistica, or "punch drunk" syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior.^ Structural diffuse brain injury (diffuse axonal injury [DAI]) is the most severe type of diffuse injury because axonal disruption occurs, typically resulting in disturbance of cognitive functions, such as concentration and memory.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[72] It shares features with Alzheimer's disease.[73]

Second-impact syndrome

.Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases.^ Cantu RC. Second-impact syndrome.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ [JAMA. 1984] Review Second-impact syndrome.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away.^ More recent studies of high school and collegiate athletes underscore the importance of ensuring that the athlete is symptom free before returning to participation on the same day; even when the player is symptom free within 15 to 20 minutes after the concussive episode, he or she may still demonstrate delayed symptoms or depressed neurocognitive levels.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause a gradient of clinical syndromes that may or may not involve LOC. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ This stunned confusional state is a concussion most often reflected by the athlete's initial confusion, which may disappear within minutes, leaving no outwardly observable signs and symptoms.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[30] .No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain's arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In 1968, 36 brain and cervical spine fatalities occurred in high school and collegiate football.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Determining whether a cervical spine injury has occurred is also of major importance because it is often associated with head injury and should not be missed.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[50] As the brain swells, intracranial pressure rapidly rises.[52] The brain can herniate, and the brain stem can fail within five minutes.[30] .Except in boxing, all cases have occurred in athletes under age 20.[44] Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.^ Because damage to the maturing brain of a young athlete can be catastrophic (ie, almost all reported cases of second-impact syndrome are in young athletes), athletes under age 18 years should be managed more conservatively, using stricter RTP guidelines than those used to manage concussion in the more mature athlete.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ In any case, it is helpful to conduct all modules of baseline testing on players in 1 session to limit the complications of scheduling multiple testing times and to keep testing conditions constant for the athletes.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ All case-matched uninjured control subjects underwent SAC testing on the sideline after their respective matched subjects sustained a concussion and 48 hours after injury under the same conditions as injured athletes.
  • Standardized Mental Status Testing on the Sideline After Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[74]

Epidemiology

Annual incidence of MTBI by age group in Canada[75]
.Most cases of traumatic brain injury are concussions.^ Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Echemendia R, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ See more articles cited in this paragraph Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

.A World Health Organization (WHO) study estimated that between 70 and 90% of head injuries that receive treatment are mild.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Bailes JE, Hudson V. Classification of sport-related head trauma: a spectrum of mild to severe injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The NFL in recent months had to explain to the U.S. Congress its treatment of head injuries with regard to retired players and evidence of long-term effects.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

[7] However, due to underreporting and to the widely varying definitions of concussion and MTBI, it is difficult to estimate how common the condition is.[4] Estimates of the incidence of concussion may be artificially low, for example due to underreporting. At least 25% of MTBI sufferers fail to get assessed by a medical professional.[24] .The WHO group reviewed studies on the epidemiology of MTBI and found a hospital treatment rate of 1–3 per 1000 people, but since not all concussions are treated in hospitals, they estimated that the rate per year in the general population is over 6 per 1000 people.^ With that data being available, if a concussion occurs, the parents have that test data sent to the medical people treating their child and the hospital or neurosurgeon then runs the same test to measure and classify any damage compared to the baseline test given at the school.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ A study conducted by researchers from the University of Illinois published in July found that high school football players are at a greater risk for concussions than college ones.
  • concussion : CINN News & Events 10 February 2010 13:40 UTC cinn.org [Source type: FILTERED WITH BAYES]

^ Additionally, sport-related concussion represented a substantial percentage of all head injuries in children under the age of 10 years (18.2%) and 10- to 14-year-old (53.4%) and 15- to 19-year-old (42.9%) populations.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[7]
.Young children have the highest concussion rate among all age groups.^ Additionally, sport-related concussion represented a substantial percentage of all head injuries in children under the age of 10 years (18.2%) and 10- to 14-year-old (53.4%) and 15- to 19-year-old (42.9%) populations.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Uncertainties about the effects of concussion on young children warrant further study.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[8] .However, most people who suffer concussion are young adults.^ When to disqualify the athlete is one of the most important decisions facing the ATC and team physician when dealing with an athlete suffering from a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ However, despite these limitations, a concussion instruction form (Appendix C ) should be given to the athlete and a responsible adult who will have direct contact with the athlete for the initial 24 hours after the injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[68] A Canadian study found that the yearly incidence of MTBI is lower in older age groups (graph at right).[75] Studies suggest males suffer MTBI at about twice the rate of their female counterparts.[7] .However, female athletes may be at a higher risk for suffering concussion than their male counterparts.^ Mouth Guards The wearing of a mouth guard is thought by some to provide additional protection for the athlete against concussion by either reducing the risk of injury or reducing the severity of the injury itself.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The decision is more difficult if one of the injuries was more severe or was a severe injury resulting from a minimal blow, suggesting that the athlete's brain may be at particular risk for recurrent injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Therefore, it has been suggested that pediatric athletes suffering a concussion should be restricted from further participation for the day and that additional consideration should be given as to when to return these individuals to activity.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[76]
.Up to five percent of sports injuries are concussions.^ Any head injury is treated very seriously.” Concussions, which account for almost 10 percent of sports injuries, are the most common type of brain injury.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ It indicated 40 percent of high school athletes with concussions return to action prematurely and set themselves up for more severe injuries.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ Concussions are the current injury buzz of the sports world.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

[44] .The U.S. Centers for Disease Control and Prevention estimates that 300,000 sports-related concussions occur yearly in the U.S., but that number includes only athletes who lost consciousness.^ Many young athletes experience sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Postconcussion syndrome, however, is a more likely consequence of a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Anyone who is hit by one of those 300 pound athletes is almost certain to be injured, short or long term, including the person doing the hitting.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

[77] .Since loss of consciousness is thought to occur in less than 10% of concussions,[78] the CDC estimate is likely lower than the real number.^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ [JAMA. 2003] Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[77] Sports in which concussion is particularly common include football and boxing (a boxer aims to "knock out", i.e. give a mild traumatic brain injury to, the opponent). The injury is so common in the latter that several medical groups have called for a ban on the sport, including the American Academy of Neurology, the World Medical Association, and the medical associations of the UK, the U.S., Australia, and Canada.[79]
.Due to the lack of a consistent definition, the economic costs of MTBI are not known, but they are estimated to be very high.^ I agree that he is a very talented coach and those that speculate that he will be teaching at some high school due to this “blight” on his record - are surely mistaken!
  • Rumors Swirl Around Texas Tech Coaching Scandal 10 February 2010 13:40 UTC www.freerepublic.com [Source type: FILTERED WITH BAYES]

[80] .These high costs are due in part to the large percentage of hospital admissions for head injury that are due to mild head trauma,[20] but indirect costs such as lost work time and early retirement account for the bulk of the costs.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Bailes JE, Hudson V. Classification of sport-related head trauma: a spectrum of mild to severe injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Any head injury is treated very seriously.” Concussions, which account for almost 10 percent of sports injuries, are the most common type of brain injury.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

[80] .These direct and indirect costs cause the expense of mild brain trauma to rival that of moderate and severe head injuries.^ Review Outcome after mild head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Smith A. Duration of impaired consciousness as an index of severity in closed head injury: a review.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Neuropsychological test performance prior to and following sports-related mild traumatic brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[81]

History and controversy

The Hippocratic Corpus mentioned concussion.[65]
.The Hippocratic Corpus, collection of medical works from ancient Greece, mentions concussion, later translated to commotio cerebri, and discusses loss of speech, hearing and sight that can result from "commotion of the brain".[65] This idea of disruption of mental function by "shaking of the brain" remained the widely accepted understanding of concussion until the 19th century.^ Structural diffuse brain injury (diffuse axonal injury [DAI]) is the most severe type of diffuse injury because axonal disruption occurs, typically resulting in disturbance of cognitive functions, such as concentration and memory.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Collecting histories on individual athletes is also a vital part of baseline testing, especially in establishing whether the athlete has any history of concussion, neurologic disorder, or other remarkable medical conditions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Various methods have been suggested for a systematic survey of mental status and cognitive function in the athlete with a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[65] .The Persian physician Muhammad ibn Zakarīya Rāzi was the first to write about concussion as distinct from other types of head injury in the 10th century AD.[82] He may have been the first to use the term "cerebral concussion", and his definition of the condition, a transient loss of function with no physical damage, set the stage for the medical understanding of the condition for centuries.^ At this time, the ATC should neither endorse nor discourage the use of soccer headgear for protecting against concussion or the consequences of cumulative, subconcussive impacts to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC should enforce the standard use of mouth guards for protection against dental injuries; however, there is no scientific evidence supporting their use for reducing concussive injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ One approach is to grade the concussion at the time of the injury on the basis of the signs and symptoms present at the time of the concussion and within the first 15 minutes after injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[5] .In the 13th century, the physician Lanfranc of Milan's Chiurgia Magna described concussion as brain "commotion", also recognizing a difference between concussion and other types of traumatic brain injury (though many of his contemporaries did not), and discussing the transience of post-concussion symptoms as a result of temporary loss of function from the injury.^ The ATC must recognize that no 2 concussions are identical and that the resulting symptoms can be very different, depending on the force of the blow to the head, the degree of metabolic dysfunction, the tissue damage and duration of time needed to recover, the number of previous concussions, and the time between injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Loss of consciousness, whether it occurs immediately or after an initially lucid interval, is important in that it may signify a more serious vascular brain injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Russell WR, Smith A. Post-traumatic amnesia in closed head injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82] .In the 14th century, the surgeon Guy de Chauliac pointed out the relatively good prognosis of concussion as compared to more severe types of head trauma such as skull fractures and penetrating head trauma.^ The ATC should enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Bailes JE, Hudson V. Classification of sport-related head trauma: a spectrum of mild to severe injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ A helmet that protects the head from a skull fracture does not adequately prevent the rotational and shearing forces that lead to many concussions.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82] .In the 16th century, the term "concussion" came into use, and symptoms such as confusion, lethargy, and memory problems were described.^ The colloquial term “ding” should not be used to describe a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ All signs and symptoms should be evaluated using a graded symptom scale or checklist (described in “ Concussion Assessment Tools ”) when performing follow-up assessments and should be evaluated both at rest and after exertional maneuvers such as biking, jogging, sit-ups, and push-ups.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Several terms are used to describe this injury, the most global being TBI, which can be classified into 2 types: focal and diffuse.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82] The 16th century physician Ambroise Paré used the term commotio cerebri,[5] as well as "shaking of the brain", "commotion", and "concussion".[65]
Guillaume Dupuytren distinguished between concussion and unconsciousness associated with brain contusion.[65]
.Until the 17th century, concussion was usually described by its clinical features, but after the invention of the microscope, more physicians began exploring underlying physical and structural mechanisms.^ More formal neuropsychological testing and postural-stability testing should be viewed as adjuncts to the initial clinical and repeat evaluations (see “ Concussion Assessment Tools ”).
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The ATC or team physician should monitor an athlete with a concussion at 5-minute intervals from the time of the injury until the athlete's condition completely clears or the athlete is referred for further care.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82] However, the prevailing view in the 17th century was that the injury did not result from physical damage, and this view continued to be widely held throughout the 18th century.[82] .The word "concussion" was used at the time to describe the state of unconsciousness and other functional problems that resulted from the impact, rather than a physiological condition.^ For athletes with a history of multiple concussions, it is also important to clarify any apparent pattern of (1) concussions occurring as a result of lighter impacts, (2) concussions occurring closer together in time, (3) a lengthier recovery time with successive concussions, and (4) a less complete recovery with each injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ At this time, the ATC should neither endorse nor discourage the use of soccer headgear for protecting against concussion or the consequences of cumulative, subconcussive impacts to the head.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ The colloquial term “ding” should not be used to describe a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82]
.In 1839, Guillaume Dupuytren described brain contusions, which involve many small hemorrhages, as contusio cerebri and showed the difference between unconsciousness associated with damage to the brain parenchyma and that due to concussion, without such injury.^ Other issues without clear-cut answers in the literature are when to disqualify an athlete who has not been rendered unconscious and whose symptoms cleared rapidly or one who suffered multiple mild to moderate concussions throughout the career and whether youth athletes should be treated differently for initial and recurrent concussive injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Any head injury is treated very seriously.” Concussions, which account for almost 10 percent of sports injuries, are the most common type of brain injury.
  • Concussion trend changing how sports injuries are handled | Grand Rapids Sports - - MLive.com 10 February 2010 13:40 UTC www.mlive.com [Source type: News]

^ The ATC must recognize that no 2 concussions are identical and that the resulting symptoms can be very different, depending on the force of the blow to the head, the degree of metabolic dysfunction, the tissue damage and duration of time needed to recover, the number of previous concussions, and the time between injuries.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[65] .In 1941, animal experiments showed that no macroscopic damage occurs in concussion.^ Presently, no neuroanatomic or physiologic measurements can be used to determine the severity of a concussion or when complete recovery has occurred in an individual athlete after a concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[65][83]
.The debate over whether concussion is a functional or structural phenomenon is ongoing.^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[82] .Structural damage has been found in the mildly traumatically injured brains of animals, but it is not clear whether these changes would be applicable to humans.^ Food intake by brain-injured humans who are in the chronic phase of recovery.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[1] .Such changes in brain structure could be responsible for certain symptoms such as visual disturbances, but other sets of symptoms, especially those of a psychological nature, are more likely to be caused by reversible pathophysiological changes in cellular function that occur after concussion, such as alterations in neurons' biochemistry.^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Structural diffuse brain injury (diffuse axonal injury [DAI]) is the most severe type of diffuse injury because axonal disruption occurs, typically resulting in disturbance of cognitive functions, such as concentration and memory.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Postconcussion syndrome, however, is a more likely consequence of a sport-related concussion.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[6] These reversible changes could also explain why dysfunction is frequently temporary.[82] .A task force of head injury experts called the Concussion In Sport Group met in 2001 and decided that "concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury."^ Jordan B. Head injuries in sports.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

^ Mild head injury in sports: neuropsychological sequelae and recovery of function.
  • National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion 10 February 2010 13:40 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

[14]

See also

References

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Simple English

A concussion is caused by an injury to the head and can cause headache, dizziness, fatigue, etc.



Citable sentences

Up to date as of December 26, 2010

Here are sentences from other pages on Concussion, which are similar to those in the above article.








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