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Sports Concussion: Now There Are Guidelines

Sports Concussion: Now There Are Guidelines

Concussion-TestingGuidelines on Concussion

Hello. I’m Dr. Sandra Fryhofer, and welcome to Medicine Matters. The topic is concussions and the new evidence-based guidelines on its evaluation and management, from the American Academy of Neurology and published in the journalNeurology.[1] Here is why it matters.

Each year, as many as 3.8 million people in the United States suffer a sports-related concussion. Many of these individuals don’t seek immediate medical attention. The new guidelines reviewed studies dating back to 1955. The first (and probably the most important) rule is that if concussion is suspected, take the player out immediately. And if in doubt, the best advice is to sit it out.

Concussion is defined as a biomechanically induced alteration of the brain function, typically affecting memory and orientation. It’s a clinical diagnosis. Blackout or loss of consciousness is not required and it occurs in less than 10% of cases. The first 10 days after concussion are especially critical, which is also the time in which athletes are at a greater risk of having another concussion.

The guidelines debunk the so-called second-impact syndrome concept due to lack of evidence; this is that a second impact could cause cerebral edema and death. They do, however, explain that athletes recovering from a concussion have both a slower reaction time and a slower cognition processing time, which may leave them more vulnerable to another unexpected hit.

These new guidelines also place emphasis on individual management. The concussion severity is no longer classified at the time of the event, and there is no general safe timeline for return to play. The timing of return to play depends on the individual, the symptoms, and how quickly those symptoms resolve. Athletes should not return to play until all symptoms have resolved and until cleared by a healthcare professional well versed and trained in concussion diagnosis and management. Younger people generally take longer to recover than those in college.

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Concussion: Effects on the Brain

Another new study, presented at the American Academy of Neurology’s 65th annual meeting, highlights the concussion effects on the developing pediatric brain.[2] It suggests that children with concussions may experience emotional and behavioral problems that can last for months. A symptom checklist can help diagnose concussion, but it can’t be used alone.

Concussion signs and symptoms include headache and sensitivity to light and sound; changes in reaction time and balance and coordination; and also changes in memory, judgment, speech, and sleep. If an athlete says he feels foggy, that’s not a good sign. It could mean that a longer recovery time is needed.

The sports with the greatest concussion risk for boys are football and rugby, followed by hockey and soccer. For girls it’s soccer and basketball. Helmets are important, so make sure they fit properly and are well maintained.

Risk factors for chronic concussion-related problems include prior and repeated concussion as well as genetics. Having the ApoE-4 gene increases the risk for chronic problems following concussion. To quote one of the study authors, “You only get one brain; treat it well.”

Other Support for the Guidelines

The new guidelines are endorsed by many other organizations, including the NFL Players Association, the American Football Coaches Association, and the Neurocritical Care Society. Others organizations are also getting on board.

The NFL, General Electric, and sports outfitter Under Armour have put together a $60 million initiative for brain injury research, including new technologies to protect the brain.

In January 2013, the Institute of Medicine launched its own study of sports-related concussions, but as the experts have pointed out, the key to success is educating athletes and also their families about the signs, symptoms, and dangers.

Helpful resources include Sport Concussion Assessment Tool — 3rd edition and Sport Concussion Assessment Tool for children ages 5 to12 years.

For Medicine Matters, I’m Dr. Sandra Fryhofer.

Source: Medscape

 

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