Learn more about concussions.
Your Local Health | Written by BJ Towe
You've heard the horror stories: High school cheerleader has learning disability after failed acrobatic stunts. Skateboarder struggles with short-term memory after repeated concussions. NFL player takes own life after multiple hits to the head.
Fortunately, these types of complications are rare — most people recover from a concussion fully within days, weeks, or months. But because repeat concussions can be serious, the healthcare providers at The Iowa Clinic have joined others in the medical and athletic arenas to raise awareness, especially as school athletic programs rev up all across the state.
“Having a concussion doesn't mean you should retire from sports, but because it can be serious it definitely warrants medical attention,” says Michael Nicholson, D.O., a Family Practice physician with The Iowa Clinic.
What is It?
A concussion is a type of traumatic brain injury typically caused by a bump, blow, or jolt to the head. It can occur as the result of virtually any physical activity, from falling off a tricycle to being in a minor fender bender or participating in organized sports.
“In my practice, the greatest number of concussions stem from playing football, hockey, and soccer,” says Dr. Nicholson. “These sports not only have a higher risk of head injury, but they also have the highest participation rates in central Iowa.”
Nicholson believes most coaches and athletic trainers have been well-educated in spotting the signs and symptoms of concussions in their players. However, he adds, “When in doubt, sit them out — and get them evaluated by a physician within 24 to 48 hours.”
What to Look For
“One of the most common misconceptions about concussions is that a loss of consciousness is required, which is absolutely not true,” says Nicholson. “Loss of consciousness occurs only about 10 percent of the time, and symptoms can show up immediately following an injury or days or weeks later.”
Nor can you “see” a concussion, says John Piper, M.D., a Neurosurgeon with The Iowa Clinic.
“A concussion doesn't show up on imaging technology. You can have a normal X-ray, CT scan, or MRI, but you may still have a significant enough injury to qualify as having a concussion.” That's why it's essential that parents, coaches, and athletes know the signs and symptoms of concussions.
Although highly unusual, a concussion can cause a blood clot to form on the brain. Get the injured person to the emergency room right away if they:
- Look very drowsy or cannot be awakened
- Have one pupil larger than the other
- Have convulsions or seizures
- Cannot recognize people or places
- Get increasingly confused, restless, or agitated
- Have unusual behavior
- Lose consciousness
- Have a headache that gets worse and does not go away
- Experience weakness, numbness or decreased coordination
- Repeatedly vomit or have nausea and/or slurred speech.
Infants, toddlers, and preschoolers may not be able to articulate how they are feeling. Call your child's doctor right away if after a fall or bump to the head your child has any of these symptoms or behavioral changes, such as crying more than usual, becoming easily upset or having more temper tantrums, or lack of interest in usual activities or favorite toys.
Concussions in older adults are easily missed or misdiagnosed — yet there's a higher risk of serious complications such a bleeding on the brain.
After falling or hitting the head, an older adult who has worsening headaches, becomes increasingly confused, or takes blood thinners should see their physician immediately – even if they do not have any other symptoms of a concussion.
Road to Recovery
“The good news is that about ninety percent of the time, symptoms are gone within a week to 10 days,” says Piper. After a concussion, the more rest the body and brain receive, the quicker the brain can heal:
Avoid physical activities, including those as light as driving a car or taking the garbage out. Physical activity stimulates the heart, increases blood flow to the brain, and can cause concussion systems to worsen or reoccur.
Avoid cognitive or thinking activities, which require the brain to use energy and can slow recovery, worsen symptoms, or cause them to reoccur. Even everyday activities such as computer use, watching TV, talking on the phone, reading a book, going to school or work, even texting should be avoided.
Only when the symptoms have resolved and in consultation with your doctor should normal activities be resumed. “Returning to play” too soon increases the odds of a repeat concussion, which may lead to more serious issues.
When Symptoms Last for More Than 10 Days
“In and of itself, concussion is usually a non-surgical issue,” Piper says. “But a multi-disciplinary approach to managing and treating symptoms is important in the more severe cases.”
For example, if symptoms include persistent or worsening headaches, the patient may need to see a neurologist. For problems with balance, a physical therapist or occupational therapist may be called in. For issues with cognitive or learning abilities, a neuropsychologist may join the team.
“If there's any suspicion that someone may be having trouble, err on the side of caution. Get them to the doctor,” Piper adds.
School Athletic Program Work to Prevent Long-Term Injuries
“As a parent of a high school football player and as a Neurosurgeon , I am impressed with how vigilant schools have been to proactively watch for and respond to concussions,” says Dr. Piper. “The policies and practices that are being developed for professional sports are being translated to the local school level.”
In addition to having good rules for safety and the sport in place, it's important that athletes follow those rules, practice good sportsmanship, and wear the right protective equipment. After all, wearing a helmet may reduce the risk of serious brain injury or skull fracture, but it won't prevent concussions.
The Centers for Disease Control and Prevention has developed the Heads Up: Concussion in Youth Sports initiative to further educate coaches, parents, and athletes about concussions. To download the toolkit, visit cdc.gov/concussion/HeadsUp/youth.html.
If you spot any of these signs of concussion, seek medical attention immediately
- Difficulty thinking clearly
- Feeling slowed down
- Difficulty concentrating
- Difficulty remembering new information
- Nausea or vomiting (early on)
- Balance problems
- Fuzzy or blurry vision
- Feeling tired, having no energy
- Sensitivity to noise or light
- More emotional
- Nervousness or anxiety
- Sleeping more than usual
- Sleeping less than usual
- Trouble falling asleep
Identifying concussions on the sideline
The news media isn't the only enterprise giving sports-related head injuries a lot of attention: Healthcare organizations, associations, and conferences around the globe have been working to develop tools to identify concussions at the time of injury during sporting events.
Dr. Piper says, “In 2012, the International Summit on Concussion in Zurich released the third edition of the Sports Concussion Assessment Tool — SCAT3 for short. This is the standard by which healthcare providers, coaches, and athletic trainers around the world should use on the sideline to evaluate injured players.”
SCAT3 is used for athletes age 13 and older. It measures symptoms, orientation, memory, recall, balance, and gait.
Child-SCAT3 is designed for use by medical professionals in evaluating children ages 5 to 12.
If you are a medical professional, coach, or athletic trainer, you can find these evaluations on the websites of most athletic associations or by visiting the Brain Injury Associationof America's Website (www.biausa.org) and searching for SCAT3 or Child SCAT3.