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What is a Concussion?

A concussion is a brain injury that is caused by a bump, blow, or jolt to the head or body.  It changes the way a person’s brain functions.  A concussion can occur during athletic practice or game competition as well as with falls or auto accidents, and can occur even if the person does not lose consciousness. A concussion results in the rapid onset of short lived impairments of neurological function due to the disruption of normal brain cellular activity that usually resolves spontaneously over days to weeks. The sudden movement of the brain causes stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain.  Once this injury occurs, the brain is vulnerable to further injury and very sensitive to any increased stress until it fully recovers.

Signs and Symptoms of a Concussion:

  • Dazed, stunned, or disoriented appearance –   Headache or Dizziness
  • Decreased alertness –   Nausea or Vomiting
  • Memory difficulty –   Double vision or changes in vision
  • Speech impairment –   Sensitivity to light or sound
  • Balance or coordination difficulty –   Difficulty with concentration
  • Changes in level of consciousness –   Sleep disturbance
  • Irritability or changes in personality & behavior –   Feeling sluggish, hazy, foggy, or groggy

When To Seek Emergency Care:

  • Headache that gets worse and does not go away.
  • Weakness, numbness or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.
  • Look very drowsy or cannot be awakened.
  • Have one pupil (the black part in the middle of the eye) larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Progressive confusion or agitation.
  • Loss of consciousness.

What Should an Athlete Do If He/She Believes They Have a Concussion?

The athlete should immediately tell the athletic trainer, coach, and parents that he/she has been injured.   The athlete should be removed from practice/competition and not be permitted to return to play that day.   A coach should never allow an athlete to return to participation until cleared by a physician.

It is recommended that the player has mental rest for 2-3 days before seeing a concussion doctor.  Resting for the first few days is critical to allow the brain to begin the healing process.  If the brain is over stimulated during the early phases of recovery, the concussion may take longer to heal.  The good thing is that most concussions heal with rest and time. Physical, cognitive, emotional, and social rest are advised while the athlete is experiencing signs/symptoms of a concussion.  Parents are advised to minimize your child’s mental exertion, limit overstimulation, and limit their cell phone and video game use.

Concussion Facts

  • “Dings” and “bell ringers” are serious brain injuries – you do not have to have loss of consciousness in order to sustain an injury to the brain.
  • The National Institute of Mental Health indicates that each year 1.4 million experience a TBI and 50,000 die from a head injury.
  • Between 1.4 and 3.6 million sports and recreation-related concussions occur each year, with the majority happening at the high school level. Studies estimate 10-19 percent of all athletes involved in contact sport sustain a concussion each season.
  • Second Impact Syndrome occurs when an individual has a second concussion before they are healed from the first concussion and leads to swelling of the brain inside the skull along with increased intracranial pressures.
  • Long term effects of Second Impact Syndrome will be similar to those of a severe traumatic brain injury.

Physical therapy’s Role in Concussion Management

  • Physical therapists at ESSMC are able to evaluate and treat many of the symptoms and problems related to concussions including balance, visual movements, hand-eye coordination, and vestibular function.
  • Vestibular therapy is an important component of recovery from a concussion as the vestibular system is responsible for sensing head movement, maintaining eye focus when you move your head, and balance. Similarly, these head and eye movements will often reproduce or worsen concussion symptoms and therefore must be monitored and treated appropriately.
  • Neck problems such as stiffness, soreness, headaches, and generalized neck pain may result following a concussion. We treat these deficits to further assist in concussion recovery.
  • Our physical therapists become a key component to an athlete’s ability to return to their sport. The therapist in combination with the physician and athletic trainer will progress the athlete through a Return to Play protocol involving a graded exercise approach.

Baseline Concussion Testing

For baseline testing at ESSMC, we use an innovative iPad application (C3 Logix) that was developed by the Cleveland Clinic and used by physicians in the Allegheny Health Network Sports Concussion Clinic. This comprehensive app tests and assesses symptoms, reaction time, memory and processing time, motor function, vision, and balance. This is the only concussion management tool that thoroughly tests all of the areas of the brain that can be affected by a concussion. Contact Michael Tardio, DPT, ATC  for more information by email or phone 412-856-8060 x 113.

Return to Play Protocol (After a Concussion)

The return to play protocol is administered by the athletic trainer and is a six step process that gradually adds higher level activities to the athlete recovering from their concussion.  The athlete will be cleared by their physician to begin the protocol once they are asymptomatic and their C3 Logix tests are back to baseline. The goal of the protocol is to challenge the body and brain and to see if the activity will cause the athlete’s symptoms to return.  Once the athlete can perform all steps of the protocol without symptoms, the physician will take this information and use it to determine their clearance for return to sport.

Risks of Playing with a Concussion:

Continuing to play with concussion signs/symptoms can slow brain recovery and result in permanent injury. Second Impact Syndrome occurs when an athlete sustains an initial concussion and then sustains a second head injury before symptoms from the first have fully resolved.  This can result in a catastrophic injury which is why a player needs to be removed from participation and not returned until released by a physician.

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