|  What is a concussion?
A concussion is a short-term impairment of neurologic or brain function caused by a direct blow to the head, face or neck, or an indirect blow to another part of the body that transmits an acceleration or deceleration force to the brain.
How common are concussions?
It has been estimated that 1.6 – 3.8 million concussions occur each year, many of which go unreported or unnoticed. The sport with the highest risk of
concussion is football, followed by girl’s soccer, boy’s soccer, and girl’s basketball. As lacrosse grows in popularity, this sport may account for a significant number of
concussions, especially in the boy’s game.
What are the signs and symptoms of a concussion?
Signs (reported by observer) |
Symptoms ( reported by patient) |
Appears dazed or confused |
Headache |
Vacant stare |
Nausea/Vomiting |
Disoriented |
Dizzy, feeling foggy, “out of it” |
Clumsy |
Double or blurry vision |
Slow answering questions |
Sensitive to light and noise |
Emotional liability |
Changes in sleep patterns |
Behavior changes |
Impaired concentration |
Poor balance |
Irritable, emotional, sad |
What should I do if an athlete suffers a concussion?
Any athlete that shows signs or symptoms of a concussion should be held out from further participation until evaluated and cleared by a medical professional trained in the management of concussions. They should not return to play in the same contest. They need to receive immediate attention and monitored closely for deterioration in their condition. A sideline assessment card can be a helpful guide for the initial evaluation of an athlete suspected of suffering from a concussion.
When should an athlete go to the Emergency Department?
Any of the following conditions warrants referral to the Emergency Dept.
Loss of consciousness |
Progressive memory loss |
Severe or worsening headache, nausea or vomiting |
Seizures |
Will a CAT scan or MRI show that an athlete has a concussion?
Since a concussion is a functional injury to the brain vs. structural, standard imaging such as CAT scanning and MRI are normal. They may be helpful in ruling out other causes of symptoms like skull fracture, bleeding in the brain, and tumors.
When can athletes with a concussion return to play?
An athlete can return to sports when the following conditions are met:
- Resolution of all symptoms after complete rest (physical and cognitive)
- Remain symptom-free a gradual return to physical activity.
- Normalization of neurocognitive testing.
- Written clearance by a medical professional trained in the management of concussions.
What is neurocognitive testing?
ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is the first, most widely used and the most scientifically validated computerized concussion evaluation system. It was developed in the early 1990’s by a group a neurospsychologists at the University of Pittsburgh and consists of a 20-30 minute computer-based test that measures multiple aspects of cognitive functioning such as attention span, working memory, sustained and selective attention time, non-verbal problem solving, reaction time and response variability.
How is the ImPACT test used?
The ImPACT test should be administered within 72 hours of a concussion to all athletes age 12 and above. The test can be re-administered every 7-10 days to document normalization of neurocognitive functioning until the athlete fully recovers and is cleared by his/her doctor. It must be noted that the ImPACT test is only one tool to help determine when the athlete recovers and is not intended to be used as the sole determinant for return to play. Since each symptom, response, and recovery pattern, due to concussion, varies form individual to individual it is important that all athletes participating in high-risk sports, (i.e. football, soccer, lacrosse, wrestling, gymnastics, ice hockey, and basketball), take a baseline test at the beginning of the 7th, 9th and 11th grade. This will aid in determining when a concussed athlete’s cognitive function has returned to “normal.”
Can the ImPACT test be used if the athlete does not have a baseline test?
Yes, the ImPACT test can still provide useful information in concussion management even if a baseline test is not available. During the development of the test, a large amount of normative data was collected for various age groups. These “normal” scores can be used in comparison to the concussed athlete’s scores.
Can an athlete with a concussion go to school or come to practice
and just observe?
The concussed brain is in the midst of a metabolic crisis, and the injured brain cells are trying to recover despite having a decreased blood supply. Therefore, any type of activity, mental or physical, may stress the brain and worsen symptoms
and delay recovery. This concept is similar to continuing to run on a sprained ankle.
As long as the athlete has signs and/or symptoms of a concussion, he or she should be held out from school, avoid video games, texting, action-packed TV, computer work or prolonged reading. They should also not attend practice even just to “watch.”
When the symptoms subside, they can return to school in a partial-day format and eventually return to observe practice. Mental and physical work can be slowly increased until all symptoms subside. When asymptomatic, the physical stress will be ramped up, adding light, moderate, then full contact. When all symptoms remain absent with a full return to the school day, resumption of unrestricted activities, and ImPACT scores return to baseline or are normal, his or her doctor will determine clearance to return to competition.
What can happen if an athlete returns too quickly, or is not completely recovered before returning to play?
If an athlete suffers a 2nd blow to the head before he/she has fully recovered, The consequence can be permanent brain damage or death. This Second Impact Syndrome (SIS) results in a massive rush of blood into the brain causing irreversible brain swelling, seizures, coma and death in one-half of the people. Over 90% of survivors of SIS have permanent brain damage.
Another consequence of a second injury before full recovery is post-concussive syndrome. Post-concussive syndrome is when an athlete suffers long-term (over 6 weeks) of symptoms. It is difficult to predict who will get post-concussive syndrome, but kids with previous concussion, ADHD, migraines, or any other neurological condition may be at a higher risk.
It has also been shown that kids who suffer one concussion have a 3-4 times higher risk of suffering a second concussion. The second concussion may occur with a lesser impact, and the symptoms will generally last longer than the first concussion.
Does a boy’s response to concussion differ from girls?
It has been shown the there are gender differences between boys and girls response to concussions. On average, girls take a few days longer to recover than boys. It should also be noted that younger athletes usually take longer to recover than older athletes.
Children’s Orthopaedics of Atlanta
At Children’s Healthcare of Atlanta
Concussion Hotline
404-785-5998
David Marshall, MD
Medical Director, Sports Medicine Program
Children’s Healthcare of Atlanta
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