The American College of Sports Medicine (ACSM) released the following information on sports concussions. I appreciate them raising awareness of brian injury. With all due respect to my colleagues, their advice on "brain rest" is neither biologically possible nor data based. They write "
Like any other injured body
part, the concussed brain should be
rested in order to recover. D
uring recovery, athletes should have no physical exertion that will raise the heart rate, and they should also perform no mental work, such as school or other tasks, that require concentration. Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games." If you or your child get a prescription for total "brain rest", you should ask why.
I still recommend that people with a brain injury should seek a BRAIN specialist. JR
WHAT IS A CONCUSSION?
A concussion is an injury to the brain caused by a sudden acceleration or deceleration force, and concussions occur in many different sports. While an athlete does not need to hit his or her head to suffer a concussion, hits to the head— against another person, a ball, or the ground—are a common cause. The brain moves inside the skull, and the sudden movement can cause the brain to swell. Helmets protect against more serious head injuries, but they do not necessarily prevent concussions. It may not be obvious to parents, coaches, trainers and athletes immediately how bad the head injury is, so if a concussion is at all suspected, the athlete needs to stop with the practice or the game.
SYMPTOMS OF CONCUSSION
The most serious concussion symptoms could be associated with a more severe head injury, such as bleeding into the brain. People with the following “red flag” symptoms need emergency care:
• Increasing confusion or headaches;
• Vomiting, double vision or unequal pupils;
• Irritability or behavior change; and
• Drowsiness or fading in and out of consciousness.
Other concussion symptoms are less obvious and are split among four categories:
• Physical symptoms—headache; nausea; dizziness; vision or balance problems; sensitivity to light or noise.
• Cognitive symptoms—feeling mentally slow or foggy; trouble concentrating; trouble remembering.
• Emotional symptoms—irritability; sadness; nervousness; feeling more emotional than usual.
• Sleep-related symptoms—sleeping more or less than usual; drowsiness; trouble falling asleep.
CONCUSSION DIAGNOSIS
Assuming the injured athlete does not have any of the most serious symptoms, he or she will not need a head CT scan or MRI. There is currently no imaging test that can diagnose a concussion. The doctor will ask about symptoms, complete a neurological physical exam and possibly balance testing, and may opt to perform mental agility testing known as neuropsychological testing. These tests are best if there is a pre-injury baseline for comparison, and this may be a service offered by your local school, club or hospital.
CONCUSSION TREATMENT
Unfortunately, people with a concussion usually look and act normally, so it is difficult for them and their family, teachers and coaches to tell they’ve suffered a concussion. Like any other injured body part, the concussed brain should be rested in order to recover. During recovery, athletes should have no physical exertion that will raise the heart rate, and theyshould also perform no mental work, such
as school or other tasks, that require concentration.
Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games. As the brain recovers, cognitive activity can be gradually returned. Only when the brain is working normally at rest, with no recurrence of the symptoms listed above, is the athlete ready to return to play.
Most people with concussions recover in 7-14 days. Some individuals require significantly longer times, and some are never quite back to normal. Repeated concussions can be associated with more
severe injury and longer recovery. A repeated concussion before the brain is fully recovered can be fatal, causing rapid brain swelling and second impact syndrome.
RETURNING TO PLAY
A progression of return-to-play after a concussion begins only after all symptoms have cleared at rest and with mental exertion. Then an athlete can begin a five-day gradual return, stopping and waiting
at any point when exertion causes symptoms to return.
• Day 1: Low-level activity, such as walking or slow jogging.
• Day 2: Increased intensity of jogging, running or biking.
• Day 3: Heavy non-contact activity, including sprinting.
• Day 4: Contact activity in controlled practice situation.
• Day 5: Full participation.
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