Team physicians, athletic trainers, and other personnel responsible for the medical care of athletes face no more challenging problem than the recognition, evaluation and management of concussions (generally defined as injury to the brain caused by a sudden acceleration or deceleration of the head that results in any immediate, but temporary, alteration in brain functions, such as loss of consciousness, blurred vision, dizziness, amnesia or loss of memory). No consensus has developed in the medical community on either the definition and grading of concussions or when it is safe for an athlete to return to play, as evidenced by the different guidelines that have been proposed.
It is therefore up to a physician, in the exercise of his or her clinical judgment, to decide when an athlete should be allowed to return to play a contact or collision sport after suffering a concussion. Experts, however, do agree on one thing: that an athlete should never return to contact or collision sports while still suffering post-concussion symptoms [1] at rest and with exertion. To allow such an athlete to return to play risks not only cumulative brain injury, but also Second-Impact Syndrome (SIS) [2], which occurs when an athlete who sustains a head injury - often a concussion or something worse, such as a cerebral contusion (bruised brain) - sustains a second head injury before symptoms associated with the first injury have cleared (i.e. healed). Not surprisingly, it would also be against the recommendations of all current guidelines.
Parents should not be passive bystanders when it comes to the subject of concussions in sports.
Here are some things parents can do to minimize the risks that their child will suffer a concussion while playing sports and, more important, is not allowed to return to play too soon:
Remember: an individual does not have to suffer a loss of consciousness (LOC) to have suffered a concussion. In fact, the vast majority of concussions (more than 90% in one study) did not involve LOC.
Because athletes often feel significant pressure to play through injuries and "tough it out," emphasize to your child the dangers of failing to immediately report or underreporting of concussion symptoms, and that doing so places them at risk for a catastrophic injury.
Insist that all coaches and certified athletic trainers (ATCs) [3] involved in your child's sports program are trained to recognize and manage concussions, and that they, in turn, educate athletes about the signs and symptoms of concussion and the dangers of SIS, which can result from not reporting symptoms to the coach, ATC or team physician.
Make sure that team physicians and ATCs agree on definitions, procedures and referral guidelines for concussions. Clear communication among sports medicine personnel is necessary to provide consistent and proper care to the athlete.
Find out what concussion grading system and return-to-play guidelines [4] if any, are being used at your child's school or by the sports program in which he or she participates. In a 2001 study reported in The Journal of Athletic Training, a surprising majority (63%) of the ATCs surveyed reported that they did not use any scale for evaluating concussions, and nearly a quarter (22%) allowed athletes to return to play in the same game or practice even after LOC, a practice contrary to all of the most frequently followed return-to-play guidelines [4].
If no set of guidelines is being used, demand that the school pick one and use them carefully for several years while the sports medicine team develops its own on-field decision-making skills.
Request that all athletes in contact or collision sports be tested before the start of every season to provide a baseline and individualized normal to be used for comparison purposes should an athlete sustain a concussion.
In an article in the July-September 2001 issue of the Journal Of Athletic Training entirely devoted to concussions in sports, three college ATCs advocated in favor of a more comprehensive approach to evaluating and managing concussions and presented a model for making return-to-play decisions based not solely on a guideline, but also on the athlete's symptoms and performance on objective tests such as the Balance Error Scoring System (BESS) [5]Standardized Assessment of Concussion (SAC) [6]
and theCall for the testing of student-athletes after any concussion to compare against the baseline tests to detect any changes over time.
Links:
[1] https://mail.momsteam.com/node/149
[2] https://mail.momsteam.com/node/205
[3] https://mail.momsteam.com/node/114
[4] https://mail.momsteam.com/node/137
[5] https://mail.momsteam.com/node/221
[6] https://mail.momsteam.com/node/215
[7] https://mail.momsteam.com/forums
[8] https://mail.momsteam.com/users/robert-cantu