Maura Palumbo

Ms.Lewis (Period 2B)

Health Occupations

Concussion Management in Student Athletes

Every year more then 300,000 athletes suffer concussions. However, twenty-five
percent do not receive proper care after sustaining a concussion.[1] Concussions in
student athletes need to be treated swiftly to ensure a full recovery and a quick return to
the classroom and the court or field. A concussion is caused by bleeding or bruising from
a blow or trauma to the head or upper body. Something as simple as a quick acceleration
or deceleration of the head can cause a concussion. Concussion symptoms can last less
than a week to over a year or even be permanent with repeated concussions. With limited
standardized protocols doctors do not yet have a firm answer for youth about when they
can return to school and sports. Each concussion victim will take a different amount of
time to return back to normal activities, especially youth athletes who face stressful
situations.
Although high school athletes may not think twice about the hard hit they had in
practice two days before a game another strike to the head could be the difference
between leaving the game on their feet or in an ambulance. Concussions are diagnosed by
symptoms. Scans such as MRIs may not be useful unless Post-traumatic Amnesia (PTA)
is present for 30 minutes or more [2]. Some of the symptoms of concussions are:
headaches, confusion, loss of consciousness, dizziness, ringing in the ears, nausea,

vomiting, slurred speech, delayed response to questions, amnesia surrounding the event,
and fatigue. However there are also some delayed symptoms to be aware of such as
irritability, personality changes, sleep disturbances, sensitivity to light and noise, vertigo,
depression and change in smell and taste. A light shined into the patient's eyes tests for
pupil reaction and if the pupils are of unequal sizes then a concussion may be diagnosed.
These issues may show up within the first few minutes after impact or a few days later. It
is extremely important to monitor any youth with a suspected head injury for any of these
signs [4].
Each concussion sustained is put into a category or grade. A grade 1 concussion is
described as transient confusion, no loss of consciousness and concussion symptoms
lasting less then 15 minutes. Next are grade 2 concussions with some or all of these
symptoms: transient confusion, no loss of consciousness, and concussion symptoms
lasting over 15 minutes. Lastly is a grade 3 concussion which is loss of consciousness for
any length of time.
The Sport Concussion Assessment Tool (SCAT) tests is used to gather
information regarding healing but is most accurate if a baseline test was administered to
the athlete prior to a concussion. Today many schools and sports teams test athletes at
the beginning of a sports season. For concussion injuries rest is the only way to fully
heal the damaged brain. However students often have to meet educational requirements
without accommodations for cognitive impairment which can be hard for students with
a high grade of concussion or multiple concussions. [5] Prolonged recovery due to lack of
proper care can cause serious issues.

Post-concussion syndrome (PCS) can be characterized as prolonged symptoms

and prolonged recovery. 80% of concussion patients have symptoms that last less then 7
days. 20% of concussion sufferers have symptoms lasting weeks, months and even years.
Although no firm evidence has been to found support an answer as to how fast an
individual recovers, there are a few warning signs. A history of concussions increases the
risk of PCS. [6] Another factor is four or more concussion symptoms over a week long
period. Correlations have been found between people who have a history of depression
or markers making them prone to concussions. [6] PCS is not associated with how hard
you are hit. Symptoms of PCS can be one or more of the following: headaches, dizziness,
fatigue, irritability, anxiety, insomnia, loss of concentration and memory, and sensitivity
to noise and light. [6] Students who suffer from PCS should not return to sports or
mentally challenging actives such as school until symptoms subside. Traumas such as
car collisions, falls, assaults, and sport injuries are commonly associated with PCS.
Luckily there are tests for youth in high risk sports to take before a concussion occurs that
will provide a baseline to determine when the concussed brain has returned back to
normal.
Baseline and imPACT tests are both ways to ensure students are cognitively
healed before returning to normal activities. These tests are typically taken by high school
and college teams in impact sports. They must be taken before practice begins for that
season because the risk of compromised tests is high. This is because any impact to the
head or shoulder could compromise the honesty of the test. Elementary students take less
time to heal then college and high school students. [7] ImPACT testing costs as little as

$10 per test and the results can be accessed by doctors around the world. After a
concussion is suspected the athlete can be tested and after 24-72 hours after being pulled
from sports can be retested. [8] ImPACT testing is fast, cheap and easy to find with more
then 10,000 professionals trained to administer the test. This test can help establish when
it is safe for a student to return to school and sports. However this is not a cure or
prevention for concussions.
Preventing concussions is not as clear as it may seem. While helmets may lessen
the effects of a concussion they can not fully protect the brain from impact. Because the
brain moves around inside the skull it is impossible to protect it from all trauma. Always
wear a seat belt in a car that is moving to keep the head from hitting any objects such as a
steering wheel or window. Use helmets that are to the standards of the sport they are
intended to be used for. Bike helmets should be used with bikes and horseback riding
helmets should be used around horses. Each helmet is designed to fit snuggly around the
head. Now a company called Riddle is designing helmets to alert coaches when a
concussion blow is detected. These helmets are also designed to take blows in a similar
way that an airbag absorbs shock. [10] After a blow is taken to a helmet they must be
replaced. Neglecting this can cause serious problems later on as internal damage to the
helmet may have occurred and it's efficacy may be significantly reduced. During games,
when a students receives any type of head or neck injury, they should be pulled out and
examined. [7] Because some symptoms do not show until at least an hour or more after a
fall or blow to the head these students should be closely monitored for the next 48 hours.
[5]

In conclusion, the information provided above is given in the hope that every
student who has suffered a possible concussive event is monitored closely for quick
diagnosis and that those suffering a concussion are diagnosed quickly and treated
accordingly. Concussions in adolescents can be unpredictable and school and a quick
return to sports can worsen the effects of healing. Testing such as imPACT or SCAT can
help ensure the student is fully recovered before returning to stressful activities. However
the first step is to prevent concussions using proper safety equipment and being aware of
the signs of a concussion so that multiple concussions do not occur. It is also important to
understand that PCS can effect anyone no matter the grade of the concussion or
symptoms experienced by the individual and proper diagnoses can prevent further
problems by ensuring the student takes proper steps to rest and recover. Multiple
concussions can have serious impacts on youth and should be taken very seriously.
Concussions are diagnosed by symptoms. Tests such as brain scans can not tell if some
patients have concussions. Beware, report and protect yourself and others from
concussions. Medication can be taken to take away headaches and nausea and to help
individuals sleep but these are not a solution to a brain trauma. Currently only time and
rest can heal the brain. Full restrictions should be imposed to keep students from
returning to school or sports before they are ready. Rest in the form of sleeping in a dark
room with no sound as well as a reduced work program can help students heal faster. [4]
PCS support groups are available to help students talk with others about what they are
going through. Students who have a hard time with headaches have found sunglasses and
staying away from noisy areas such as lunch rooms helpful. A doctor can provide

documentation recommending a reduced work load to the school of the student.

However with all of this being said concussion management in student athletes needs to
be taken seriously and all risks must be discussed. Because each injury and each brain is
different they will take different amounts of time to heal. The real answer is there no set
rules but rather recommended guidelines to reintegrate each individual back to school and
sports.
I chose this topic because on January 14th, 2014 I suffered a concussion in a fall
off a horse. I did not receive the diagnoses until a week after the fall. I did not hit my
head but suffered a whiplash injury so I did not know I could have a concussion. A full
year later I still suffer from PCS. School is more difficult and stress is harder to handle.
My eyes are more sensitive to light which makes me wear glasses with a tint called
BluTech that reduces the glare on surfaces. It is hard to fall asleep and even harder to
wake up. Chronic headaches have become a part of my life. Depression seemed like it
would never go away but has finally abated. I fought to stay caught up in school which
ultimately led to more symptoms of PCS. Sometimes when I close my eyes now I get
dizzy and cannot make it stop until I open my eyes. Whenever I run or ride my horse I get
a clicking noise in my ears and they feel as if they are full of fluid. This sometimes gives
me a migraine-like headache. I also found it difficult to go back to school because the
workload made my symptoms worse. At this time I feel that it is hard for me to stay
focused on simple tasks. Concussions will always be a huge interest to me and I hope to
help patients with similar issues. Now I am healing but I am sure I will have setbacks. I
find myself second guessing activities I am doing because of the risk factors but I will not

let my fear of another concussion keep me off of horses. I now think twice about my
actions and am definitely more aware of the potential for a concussion if I fall even if
my head doesn't hit the ground.

Bibliography[1] Clinic, Mayo. "Concussions." Mayo Clinic. 1 Jan. 2015. Web. 7 Jan. 2015.

[2] "Concussion, Head Injury, Traumatic Brain Injury and Coma Classification
Systems." Clinical Psychology Associates. 17 Mar. 2006. Web. 2 Jan. 2015.

[3] "Implementing Evidence-based Recommended Practices for the Management

of Patients with Mild Traumatic Brain Injuries in Australian Emergency Care
Departments: Study Protocol for a Cluster Randomised Controlled Trial." Pubmed. NET
Program, 11 July 2014. Web. 6 Jan. 2015.

[4] Mccrory, P., A. Collie, V. Anderson, and G. Davis. "Can We Manage Sport
Related Concussion in Children the Same as in Adults?" Pubmed. Concussion in
Children, 11 July 2014. Web. 6 Jan. 2015.

[5] and [7] "Premature Return to Play and Return to Learn after a Sport-related
Concussion." Pubmed. Ed. Pierre Frmont. Physicians Chart Review, 5 June 2014. Web.
2 Jan. 2015.

[6] "Treatment and Management of Prolonged Symptoms and Post-Concussion

Syndrome." Pubmed. Ed. Graham R. Sports-Related Concussions in Youth: Improving
the Science, Changing the Culture., 4 Feb. 2014. Web. 2 Jan. 2015.

[8] "ImPACT Testing." 4 Feb. 2014. Web. 2 Jan. 2015.

[9] "American Medical Society for Sports Medicine Position Statement:

Concussion in Sport." Pubmed. Pubmed, 1 Feb. 2013. Web. 2 Jan. 2015.

[10] Avila, Jim. "RIddell Unveils Overhauled New Football Helmet Spedflex."
ABC. 27 Apr. 2014. Web. 2 Jan. 2015.
[11] "Concussion Has Long Term Effect On Cognitive Function and Visual
Processing, Studies Find Read More: Http://www.momsteam.com/concussion-has-longterm-effect-cognitive-function-visual-processing-studies-find#ixzz3Ogwgobwf." Moms
Team. Ed. Lindsey Barton Straus. Journel of Concussions, 19 Sept. 2014. Web. 2 Jan.
2015.