Not To Be Taken Lightly

One more time, I'm going to write about concussions.

For the past couple of years, concussions have dominated the popular and medical news media.  Several high profile cases have focused a lot of attention on an arena that really deserves a lot of attention.

Not that many years ago, if you could remember what you had for lunch (after a blow to the head, or after you got your "bell rung"), you went right back in the game.

The present state of awareness really started with a study that came out in 1994 that revealed evidence of significant brain trauma in NFL players that did not have a history of concussions.

Since then, lot of research and study has been done on the long term ramifications of concussions.  

And the results are scary. What we do know is that concussions are not to be taken lightly.  We know that there are long term effects even to relatively minor head trauma.

That when you "got your bell rung," actual damage was done, damage that could surface many years down the road.

And lest you think it is just a football thing, let me assure you that it is not. Any active individual can get a concussion.  (Heck, even an inactive individual can trip and fall in the bathroom and get a concussion.)

So, when is it a concussion and when is it just a bump on the head?

Without getting all medical about it (and because there really isn't a single definition of a concussion), a concussion is a blow to the head that disrupts the function of the brain. 

It may manifest itself as a headache, dizziness, nausea, blurred vision, or memory loss.    It can be slight, maybe where a blow to the head leaves you with a mild headache, to severe, in which you lose consciousness.  Either way, we take it seriously. 

In sports, we start our evaluation immediately.   Decisions about how to deal with an unconscious athlete are simple--immobilize them, protect them, and get them transported to the nearest hospital in an ambulance. 

It's all those lesser injuries that take up most of our attention.

We start by administering a standardized set of questions useful in determining cognitive function.  Simple questions, really, but useful in deciding if the brain function has been impaired in any way.  

We perform balance testing , which can provide very important early information.

If symptoms go away quickly, we will just monitor their progress but the game that day at that time is over. 

Lingering symptoms used to mean staying up till quite late, watching for cognitive deterioration.  If there are several hours between injury and bedtime and the symptoms are not getting worse, sleep is generally OK.

Once they have no symptoms and have been cleared by their physician, we administer an ImPACT test, a computerized test of how the brain is functioning.  Along the way, we strongly (in no uncertain terms) insist that the athlete be honest about symptoms.  We don't want them hiding things from us.

If they have medical clearance and a negative ImPACT test, it still isn't over.  Our athletes then have to go through a series of exercises and activities that can take up to two weeks to complete and that's only if they have no recurrence of their symptoms.

This is one arena where we just don't take any chances.