What is a Concussion?

A concussion, also called a traumatic brain injury (TBI), is a bump, blow, or jolt of force to the head or body (causing rapid movement of the head) that causes a change in the way a brain normally works.

A single symptom or multiple symptoms can potentially be present from a concussion. Symptoms can range from very mild to severe and last a short or long amount of time. It is important to be evaluated by a physician experienced in concussion diagnosis and management.

Signs and Symptoms

The signs and symptoms of a concussion may be subtle and may not be immediately apparent to the injured party or those evaluating them. Symptoms may last for minutes, hours, days, weeks, or longer. In some cases, symptoms may also begin hours or days later. This is called delayed onset.

It is important to note that although amnesia and loss of consciousness are obvious signs of a concussion, they occur in less than 10% of cases. This means 90% of concussions contain one or more symptoms without having amnesia or losing consciousness.

Typical concussion symptoms fall into four categories:

Thinking/Remembering

  • Difficulty thinking clearly
  • Feeling slowed down
  • Difficulty Concentrating
  • Difficulty remembering new information

Physical

  • Headache
  • Fuzzy or blurry vision
  • Nausea/vomiting
  • Dizziness
  • Balance Problems
  • Sensitivity to light or noise

Emotional/Mood

  • Irritability
  • Sadness
  • More emotional than normal
  • Feeling Nervous or Anxious
  • Crying More

Sleep

  •     Sleeping more than usual
  •     Sleeping less than usual
  •     Trouble falling asleep

Symptoms in Small Children:

Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can’t readily communicate how they feel. Nonverbal clues of a concussion in a small child may include:

  • Listlessness, tiring easily
  • Irritability, crankiness
  • Change in eating or sleeping patterns
  • Lack of interest in favorite toys
  • Loss of balance, unsteady walking

When to Seek Care

If you suspect a student-athlete or injured adolescent is experiencing signs and symptoms of a concussion, they should immediately be removed from all activity, including sports, and evaluated by our experienced concussion team.

The American Academy of Pediatrics recommends that you call your child’s doctor for advice if your child receives anything more than a light bump on the head. If your child remains alert, moves normally and responds to you, the injury is probably mild and usually doesn’t need further testing. In this case, if your child wants to nap, it’s OK to let them sleep. If worrisome signs develop later, seek emergency care.

Seek emergency care for a child who experiences a head injury and has:

  • Continued vomiting
  • A headache that gets significantly worse over time
  • Changes in his or her behavior that are worsening, including irritability or fussiness
  • Changes in physical coordination, including stumbling or clumsiness
  • Confusion or disorientation
  • Slurred speech or other changes in speech
  • Vision or eye disturbances, including pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
  • Changes in breathing pattern
  • Blood or fluid discharge from the nose or ears
  • Large head bumps or bruises on areas other than the forehead, especially in infants under 12 months of age

Seek emergency care for anyone who experiences a head injury and has:

  • A loss of consciousness lasting more than a minute
  • Repeated vomiting
  • Seizures
  • Obvious difficulty with mental function or physical coordination that does not resolve within minutes
  • Symptoms that worsen over time

Athletes

No one should return to play or physical activity while signs or symptoms of a concussion are present. Experts recommend that an athlete with a suspected concussion not return to play until he or she has been medically evaluated. This is also THE LAW in North Carolina (please read the Gfeller-Waller Act).

Treatment

After a diagnosis of a concussion, our physicians and medical team here at Raleigh Orthopaedic Clinic will work with the patient, parents, coaches, teachers, and athletic trainers on getting them healthy once again. The initial treatment of concussions will involve both physical and cognitive (mental) rest, and may ultimately require medication intervention.

In order to heal, the brain needs as little stimulation as possible. This means limiting anything that stimulates or taxes the brain. Things that should be avoided or limited include exercise, sports participation, tests, studying, as well as things as simple as watching TV, listening to music, reading books, or playing video games. Our team will work with schools to develop the appropriate limitations and return to activity plan on a case by case basis.

Raleigh Orthopaedic Clinic’s state of the art concussion clinic will evaluate, diagnose, and treat the concussed athlete and then follow their progression from symptomatic to asymptomatic. We work closely with neurologists and other specialists when needed and will recommend and order additional testing including imaging and Neuropsychological testing when appropriate. Our medical team is experienced in working closely with athletes, athletic trainers, parents, teachers, guidance counselors, and coaches to modify workloads, avoid exacerbation of symptoms, and start a progression back to participation. We then clear the athlete to return to play when it is medically safe and appropriate.

Statistics

Concussions are common in both helmeted and non-helmeted sports. Recent data indicates a trend for increased concussion rates over the past decade.

The Centers for Disease Control and Prevention (CDC) estimates that between 1.6 to 3.8 million sports or recreation related concussion injuries occur annually in the US. These concussions account for 5-9% of all sports related injuries. Approximately 30% of all concussions in individuals 5 to 19 years of age are sports related. However, it is estimated that 50% of concussions go unreported.

High risk sports include: Football, Basketball, Soccer, Hockey, Lacrosse, Wrestling, Rugby, and Cheerleading/Gymnastics, among others. There is an increased incidence of concussions in female athletes when compared to male athletes who play the same sport. It has also been noted that younger athletes, and those with a history of concussion are at higher risk for a new or recurrent concussion.

Gfeller-Waller Concussion Awareness Act

The Gfeller-Waller Concussion Awareness Act was drafted and implemented to protect the safety of student-athletes in North Carolina and was signed into law on June 16, 2011 by Governor Beverly Purdue.

The Act applies to public high schools and middle schools and requires them to provide education on concussion awareness to student athletes, parents, coaches, volunteers and first responders.

It also requires players who exhibit signs of a concussion, during competition or practice, to be removed from play or practice immediately, and not return until being cleared by a medical professional. The medical professional should have experience in managing concussions. The process of clearing an athlete requires what is termed a Return-to-play protocol.

The act also requires schools to develop an emergency action plan to deal with serious injuries.

The bill is named after two high school athletes who died as a result of concussions. To read the full article regarding passing the Gfeller-Waller Concussion Awareness Act, please visit: http://www.highschoolot.com/content/story/9734410/

A copy of the Gfeller-Waller Concussion Awareness Act Return-to-Play form is available here http://gfellerwallerlaw.unc.edu/GfellerWallerLaw/gwlaw_files/Gfeller-Waller%20NCHSAA%20RTP%20Form.pdf.

Prevention

Although research continues to be done on limiting or preventing concussions, there is currently insufficient evidence to support that wearing a particular helmet or mouthpiece, or strengthening the neck, decreases the risk for concussion.

Despite the limited evidence, we encourage athletes to protect themselves as much as possible with by applying sport appropriate techniques, following the rules of play, appropriately adapting physically (by doing things like neck muscle strengthening), continuing to be educated, and seeking immediate evaluation if an injury is suspected.

Educational Sources for Parents, Athletes, and Professionals

CDC Website on Concussions (Traumatic Brain Injury)

Organization Position Statements:

American Medical Society for Sports Medicine (AMSSM)

American Academy of Neurology

Summary of Evidenced Based Guidelines for Physicians

ONLINE CLINICIAN EDUCATION COURSE:

References:

Head injury. American Academy of Pediatrics. http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Head-Injury.aspx. Accessed Dec. 2, 2010.

Halstead ME, et al. Clinical report — Sport-related concussion in children and adolescents. Pediatrics. 2010;126:597.

Heads up: Concussion in youth sports. A fact sheet for parents. Centers for Disease Control and Prevention. http://www.cdc.gov/concussion/pdf/parents_Eng.pdf. Accessed Dec. 2, 2010.

Traumatic brain injury. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/sec21/ch310/ch310a.html. Accessed Dec. 2, 2010.

Evans RW. Concussion and mild traumatic brain injury. http://www.uptodate.com/home/index.html. Accessed Dec. 2, 2010.

Lovell M. The neurophysiology and assessment of sports-related head injuries. Neurologic Clinics. 2008;26:45.

Heegaard W, et al. Traumatic brain injury. Emergency Medicine Clinics of North America. 2007;25:655.

Schutzman S. Minor head trauma in infants and children. http://www.uptodate.com/home/index.html. Accessed Dec. 2, 2010.

Wetjen NM, et al. Second impact syndrome: Concussion and second injury brain complications. Journal of the American College of Surgeons. 2010;211:553.

Lovell M. The management of sports-related concussion: Current status and future trends. Clinics in Sports Medicine. 2009;28:95.

Position statement on sports concussion. American Academy of Neurology. http://www.aan.com/globals/axon/assets/7913.pdf. Accessed Jan. 10, 2010.

McCrory P, et al. Consensus statement on concussion in sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clinical Journal of Sport Medicine. 2009;19:185

Appointments

Our expert concussion management team is ready to assist you in your head injury evaluation or by obtaining baseline Neuropsychological (ImPACT) testing.

Our concussion clinic will be available at four convenient locations in Raleigh, North Raleigh, Cary, and Garner. Raleigh Orthopaedic Clinic will also accommodate walk-in concussions to our urgent care clinic, located at 3001 Edwards Mill Road in Raleigh on weekdays from 8:00 am to 8:00 pm and Saturdays from 9:00 am to 2:00 pm.

Appointments can be scheduled directly by patients/parents, physicians, athletic trainers, or coaches. Please contact our concussion hotline which directs you to our Concussion Athletic Trainer at (919) 781-5600 Ext:5623 or call our appointment line at (919) 863-6808.