HOW DO YOU TREAT A
The best treatment for a concussion is the reduction
of intellectual stimulation of the neurons. This can only be done through
physical and cognitive rest that is sufficient enough to give the brain
time to repair the damage through a natural healing process. The amount of
time that is sufficient can never be determined. It is different for each
If we fail to identify the signs, symptoms or
behaviours consistent with concussion, a student-athlete may be greatly at
risk of suffering serious long-term and/or life-altering consequences if
he/she is injured again before the original symptoms have resolved.
There is general agreement among experts that the
symptoms of “most” concussions, if treated with appropriate physical
and cognitive rest, will resolve within two weeks, but the recovery time
may be longer in children and adolescents. It should also be noted once
again with emphasis that there is no way to predict how long it will take
a student-athlete to recover from a concussion. Each person is different.
No one can look at a person with a concussion and make a prediction that
“you will be better in seven days”. That is a statement that no
parent/guardian should accept. It is better to wait until you hear “it
appears to be seven days since you were last observed to have any
Our goal as parents/guardians, school leaders,
coaches, and classroom teachers is to reduce the number of concussions
that are not identified by being more diligent in our efforts to recognize
the signs, symptoms and behaviours consistent with concussion and then
implement an effective rehabilitation protocol in order to give the brain
time to recover from the injury. If we can prevent concussions from going
undetected, there is less chance of a student-athlete returning to play
while his/her brain is in a vulnerable state from symptoms of the first
The best way to make sure that we properly identify
the signs, symptoms and behaviours that are consistent with concussion is
to make sure that we have done a good job of preparing student-athletes,
parents/guardians, classroom teachers, coaches, and school and minor sport
administrators. This means that we must create a training and awareness
program that is more than just a sheet of paper with a lot of symptoms
listed in a column. We must make sure that everyone understands how the
brain works; how a concussion affects the functioning of the brain; how to
spot the signs, symptoms and behaviours consistent with concussion; and
how to provide a high standard of care and rehabilitation for a
student-athlete who suffers a concussion.
THE CHALLENGE OF HIDDEN
greatest challenge when it comes to identifying a concussion is that so
few symptoms are visible to the casual observer. Many times the symptoms
of a concussion may not be identified until there is increased exertion
which causes symptoms to worsen. It may be something as simple as the
ringing of a bell to change classes or the ringing of a phone that
triggers a symptom. Or it may be the student-athlete returning to play in
a game within the next several days that causes the symptoms to present
have shown that as many as 4 out of 5 professional athletes do not even
know that they have been concussed so imagine how difficult it is for an
adolescent or young adult to be able to understand what is going on in
his/her brain? Imagine, they do not even realize they have a concussion,
but they often show signs of the injury. In other words, the people around
them may be more aware of the concussion than the person him/herself.
is why one of our goals is to make sure that all adults who are involved
in any way with student-athletes are as prepared as possible to look for
the signs, symptoms and behaviours consistent with concussion and then
take appropriate action to remove the player from further play to avoid
the possibility of further damage. We must all become “concussion
symptom detectives” when dealing with student-athletes. We cannot leave
this responsibility in the hands of any one person. We must belong to a
“concussion management team” where each individual has equal
responsibilities for the identification of concussions when they occur.
recommend that even if there are no apparent signs and the student-athlete
reports no symptoms, if a coach, teacher, the parent/guardian and/or the
School Leader has a strong suspicion that a particularly hard blow to the
body or head area may be cause for concern, then it should be at the
discretion of any one or more of them to initiate the protocols and
request that the Coach remove the player from further action. This may not
always sit well with the student-athlete who feels fine after the hit and
argues that he/she is all right. It may even be seen as over reacting, but
this is something that all partners must agree with and understand right
from the beginning.
should always err on the side of caution. Even if it means going through
the steps of the rehabilitation protocols to find out that there is no
evidence of concussion, it is worth the inconvenience for a week to be
sure that there is little risk of long-term damage to the student-athlete.
should never be upset with a person who initiates the protocol. It will be
clearly understood that you are acting out of care and concern for the
student-athlete and if it turns out to be a false alarm, we won't be
upset. We will be happy that there is no damage.
is, however, absolutely, positively no excuse for ignoring obvious signs
and symptoms. We feel that with so many “partners” looking out for the
safety of the student-athlete, someone will see a sign or recognize a
symptom if it comes up. The last thing we want anyone to say is that they
“should have noticed” or “should have paid attention” to signs and
symptoms. Concussions are brain injuries. Your brain controls everything
that goes on in your body and your mind. Permanent damage may change your
life forever, so we won’t take any chances.
SYMPTOMS & BEHAVIOURS
We are going to provide you with a comprehensive
review of the most universally accepted signs, symptoms and behaviours
consistent with concussions. Some of them require more explanation than
others. Most are pretty straight forward. At this time we are not so
concerned about the proper classification of the signs, symptoms and
behaviours consistent with concussions. Whether it is a sign or a symptom
or a behaviour is not important. Whether it is a physical symptom or an
emotional symptom is not important.
What is important is that no matter whether you are
a parent/guardian, a school leader, a coach, a classroom teacher, a health
care provider or a student-athlete, you should be aware of the signs,
symptoms and behaviours that are consistent with concussions so that you
can take appropriate action in order to reduce the chance of receiving a
second concussion before the symptoms from the first one have resolved.
SIGNS TO LOOK FOR
If you notice any of the following signs immediately
or shortly after an incident in a game or practice, then you should
suspect a possible concussion. We should remind you that a concussion is a
brain injury that can occur anywhere, not just in sports. Therefore, while
we will be focusing on signs, symptoms and behaviours consistent with
concussions that are sport-related, these are the same signs, symptoms and
behaviours that can be found in all other areas of life as well.
With respect to sport-related activities, we
recommend that you remove the student-athlete immediately from play if
appears to be dazed or
stunned immediately after the incident, even if only for a few seconds. This might be
evidenced by the student-athlete trying to get to his/her feet and falling
down or stumbling around for a few seconds. Usually the person will catch
his/her breath, take a few moments and then regain his/her senses.
However, it will be clear that there was something wrong immediately after
seems to be confused
about his position or assignment during the game or on the bench. This will often be
noticed by the coach or a line mate when the student-athlete discusses the
incident or the coach talks to the player about his/her assignment. If a
player is hit pretty hard during the shift, a coach should come up and
start up a conversation to check on the response of the player;
is not sure of the
score, the period, the opponent, the time, etc. when questioned by
coaches. This is a quick test
that can be done during the game. It may sound silly, and I know that
there are many players who cannot tell you the score of the game at any
given time, but when you ask all of the questions the player should know
the period and who he/she is playing. If the player cannot answer those
simple questions, then you must take that as a sign. And if the person
gives you the correct answer later, don’t just assume that everything is
seems to move clumsily
on the field/ice or around the bench/dressing room, displaying balance
issues. It is easy to pass
this type of motion off as being normal, but if it is being displayed
shortly after a blow to the body or head, then we must assume it is a
possible concussion. A person who is carefully observing the movement will
be able to determine whether or not it is a natural movement;
responds to questions
with a bit of hesitation or not at all, demonstrating a delay in
processing information. If it takes the person
an uncharacteristically long time to answer questions, especially if
he/she stars blankly as if thinking about the answer. You must know the
player when you are observing this particular sign or symptom. Some
players characteristically take a long time to respond, but if it is
unusual, then you must accept this as a sign that something may be wrong
and then do some other tests before allowing him/her to continue playing;
seems irritable or
displays uncharacteristic mood/personality changes which are out of the
ordinary. This may happen right
after the incident or it may be something that is noticed in the hours and
days following. Parents will often notice that their child is easier to
get upset, more argumentative, less tolerant of siblings, etc.; It is too
easy to pass this off as being emotional after losing a game, or from
being hit during the game. Do not ignore these behaviours. The part of the
brain that controls these functions is connected to just about every other
part of the brain. So if the behaviour is uncharacteristic it is an
excellent sign that something is not working properly;
can’t recall the play
where he got injured, even if he says he is fine. Memory loss at the
time of injury is common due to the chemical cascade that is produced.
Don’t just ask a simple question like “do you remember what
happened?” and accept the answer “he hit me from behind”. Take a
couple of minutes and become a detective. Have the player give you details
and even ask him/her to repeat the details to see if there is consistency;
can’t recall what
happened after he got injured. Once again this will require some prompting to ask what the player did
after he got hurt. And you must be careful not to give him clues or put
words into his mouth. Of course you must also know what he did after he
got injured or you won’t know if he is correct. This can simply be about
being helped off by a couple of players, the referee, or the trainer. It
might be that his helmet fell off. See what he can remember and if he
can’t recall then this is another sign;
seems easily distracted
with poor concentration. Unfortunately, it may take a while for you to notice this. One of the
ways of testing concentration is to take the player aside and start
explaining something to him in the dressing room. See if he/she is
distracted by what is going on around the room. You must know what the
player was like in these areas before the injury. Some student-athletes
are always easily distracted, so this has to be something that is
has a vacant stare or
seems to have glassy eyes. This is a sign that should be hard to miss. If the player simply stares
off into space or is fixated on the play in an uncharacteristic manner,
then don’t pass it off. Once again, it is important for coaches to be
looking for this sign immediately after an incident. It is also something
that a parent/guardian may notice at home following the game.;
is slurring his speech. Keep listening for this
sign while talking with the player to test his memory of the incident. It
is important to do this before the player goes back into the game
following the incident in question. This may be difficult to do during the
heat of the game, but nevertheless, it is important to take the time;
seems to be having minor
convulsions or seizures. This is serious and should be easy to spot, but
they may be minor in nature. However, this kind of reaction is cause for
going to the hospital right away;
seems fatigued or says
he/she feels like sleeping. This is a very common sign that something is
wrong. A coach or parent/guardian should be able to recognize unusual
fatigue during or following a game, especially among adolescents who usual
have plenty of energy;
than normal reflexes. A person with a concussion takes longer to react
to normal activities, so if you toss a ball at a person with a concussion
he/she may have trouble reacting fast enough to catch it. This is a good
test that can be administered on the sidelines or even at home.
reminded that some of the above signs may not be evident during the game,
or you may notice only one of the signs. However, if you notice that the
student-athlete is complaining about feeling fatigued while driving home,
ask some questions that may provide you with further evidence of a
concussion. Don’t just allow your child to pass it off as being tired
from playing a hard game. For example, once you are home you can ask your
child what the score of the game was; who he/she was playing; what
happened when the injury occurred; etc. If your child is unable to recall
or hesitates with the answering of obvious questions, then you know that
you must make sure he/she completely shuts down for the rest of the night
and you should be prepared to initiate the appropriate protocols. You
should also let the coach know immediately if you feel that protocols
should be initiated.
SYMPTOMS TO LOOK FOR
Besides the “signs” that may be evident, if the
student-athlete reports any
of the following symptoms, the School Coach or the Community Coach must
remove the player from further play. Symptoms will usually be identified
by the student-athlete but he/she may not articulate the symptom clearly.
We must be able to "read' the student-athlete.
The following self-admitted symptoms are absolutely
serious enough to assume a concussion has occurred and the Concussion
Identification Protocol should immediately be put into action. We remind
coaches, parent/guardians and teachers that you may have to prompt these
responses with questions to the student-athlete.
If the student-athlete:
complains of headache or
pressure inside the head, even if it is only a slight pain. Keep in mind that
headaches are one of the most common symptoms of a traumatic brain injury.
Migraines may be experienced following a concussion and if the
student-athlete had migraines before the injury they may be much worse
following the injury. Headaches are often a sign during rehabilitation
that excessive stimulation is being experienced by the brain as a result
of cognitive and/or physical exertion and therefore is a signal to reduce
complains of dizziness
or trouble keeping his balance. This is another very common symptom after a
concussion is experienced. The student-athlete may feel off balance,
especially during activity or immediately following and it will usually be
temporary. However, during rehabilitation, if dizziness returns it is a
signal that more rest is needed before continuing the recovery
is feeling nauseous or
feels like vomiting.
This nausea or what some describe as a kind of motion sickness is another
common symptom after a traumatic brain injury.
complains of vision problems; Damage to the neurons that control vision is
common in concussions. The vision affects balance, response time, etc. So
any complaint about vision is serious and could indicate a concussion.
complains about feeling sluggish, foggy or groggy; This could be caused by the increased demands
being made by the brain for energy to repair damaged areas, but it will
also be due to the fact that the energy demand is not being met.
that he is unusually sensitive to light or noise;
sleep difficulties. Most student-athletes who suffer from a concussion
will experience some sleep disruption for at least several days following
the injury. Some sleep more; some sleep less; some sleep during the day;
some need frequent short naps during the day; some wake up frequently
during the night; some feel fatigued, both mentally and physically
regardless of the amount of sleep they receive. It will take some time
following an injury for a person to return to pre-injury levels of energy
and student-athletes will often have trouble maintaining energy levels
once they return to school.
he/she is feeling confused;
he/she is just not feeling right;
he/she is seeing stars;
complains about a ringing in his/her ears;
unable to recognize people or places;
of a weakness or numbing in the arms or legs;
more emotional than usual;
Once again, we remind everyone that these symptoms
may not present themselves right away. It may be minutes, hours or days
before the symptoms occur. It is also possible that a parent/guardian may
not even be aware that their child was injured in the game if he/she was
not in the stands. However, because your child participates in a sport
where the risk of concussion is high, if he/she suddenly begins to
complain about feeling confused, or there is a sudden change in the child,
you really should not pass it off as nothing. You should communicate your
findings to the appropriate authorities so that the rehabilitation process
can be initiated. Remember that it is always better to be safe than sorry.
WARNING SIGNS & SYMPTOMS
We recognize that it may be very difficult to get in
to see a doctor right after a game or practice. Therefore, it is going to
be up to the parent/guardian and/or coach to make a judgement call with
respect to the urgency of seeking medical attention. There is no hard and
fast rule to guide you in this matter. You are going to have to consider
the nature of the symptoms and decide if they seem serious enough to go to
the hospital immediately or wait until the next day.
The following should be helpful:
the student-athlete was knocked unconscious,
even for a short period of time, then it is important to go to the
hospital and get checked out. This is especially critical if the
student-athlete was hit in the head and perhaps has a large bump as a
result. You want to make sure that there is no fracture to the skull or
internal damage. For a blow to be forceful enough to cause a person to
lose consciousness, it must have been significant.
the student-athlete begins to go into convulsions
or has some seizures during the night, then by all means, get to the
hospital for a check up. These symptoms are not all that common and could
indicate serious complications.
headache that keeps getting worse as the time passes is a signal that
perhaps something serious is going on inside the skull and you should have
a doctor take a look immediately.
the student-athlete continues to get more and more confused
then immediate attention is warranted. Once you stop the physical and
cognitive activity, symptoms should begin to get better. If even after
resting the symptoms continue to get worse, then that is a sign that there
may be complications. It is not always the case, but it is something you
should not pass off and ignore.
When you get home there is
nothing wrong with allowing your child to go to sleep, however you should
check him/her through the night to listen for breathing problems or
to see how he/she is sleeping. If you have any concerns wake your child up
and examine for more signs and symptoms. If you have trouble waking your
child up do not hesitate to bring him/her to the hospital immediately to
be checked out.
Vomiting is not unusual
following a traumatic brain injury, however, if your child continues to vomit during the night, then this is another indication
that there may be something more serious going on. I would recommend that
you bring your child to the hospital for a quick examination.
We want to acknowledge that symptoms of a brain
injury may get worse during the hours and days following the incident.
However, it is fairly easy to tell if the worsening of the symptoms should
be cause for concern. A parent/guardian usually can tell when something is
not right with their child. Go with your intuition and don’t second
guess yourself. It is well worth the time in the waiting room to get an
examination if you are concerned.
frontal cortex of the brain, which is located in the forehead area, has
been accepted as the region of the brain that is most involved in
behaviour, personality, and decision making. This is what we call
executive function, or a set of mental processes that helps one connect
past experiences to perform activities such as organizing, planning,
remembering details, and managing your time and space. It allows one to
differentiate between good and bad, better and best, same and different,
consequences of actions, goal-setting, predictions of outcomes and
expectations and perhaps most importantly for classroom teachers, the
ability to suppress socially unacceptable urges that could lead to
neurons in the frontal cortex extend throughout all areas of the brain, so
if one suffers a brain trauma it is quite likely that there will be areas
of the frontal cortex that will be affected. Even if the actual damage is
found in some other part of the brain, the communication between those
directly affected functions and the frontal cortex will be disturbed.
a student-athlete is going through the rehabilitation process following a
concussion, teachers and parents/guardians may find that the problems with
executive function aggravate the symptoms and result in all sorts of
behavioural and personality disorders. For example, common everyday things
might just be more difficult to do. Working memory may be seriously
affected and it might be difficult for the student-athlete to do what once
SIGNS OF EXECUTIVE FUNCTION PROBLEMS
A student-athlete who is recovering from a
concussion may have difficulty with one or more executive functions. It is
important for parents/guardians to watch for some of the following changes
in children who are participating in high risk sports. We want to
emphasize that you should continuously monitor for any of the following
issues at all times during the season, not just when you suspect a
concussion. It is very important to remember that some of the signs,
symptoms and behaviours consistent with concussion do not present
themselves immediately and may take days to evolve:
If a classroom teacher or a parent/guardian notices
any of the following signs, symptoms or behaviours, especially if they
come about suddenly and are quite different from what has been previously
observed as normal, then it is important that further investigation be
done to determine if this may be a sign of a brain injury.
A student-athlete may have difficulty with one or
more of the following if they are suffering from the effects of a
and long-term planning of projects and assignment;
track of time-lines and completing projects and homework on time;
orally or in writing in an organized, sequential manner;
and retrieving information from memory;
activities or tasks, or generating ideas independently;
information that is used in a conversation, even while speaking;
the phone number or email address while dialing or texting;
in group discussions, even around the kitchen table or with family
to shout out answers in class;
reluctant to ask for help in class;
track of several things at once – multi-tasking
trouble paying attention or remaining on task, even with simple
slow to respond to questions or to retrieve information during a
his/her attention from one task to another or from one subject to
another in school;
his grades up in certain subject areas;
from impulsive behaviours that are inappropriate;
mood changes that occur spontaneously without warning or reason;
feeling depressed or unhappy;
his/her attitude towards authority and may become defiant;
a clear mind and may seem confused.
are generally behaviours that one must observe over a period of time in
order to look for patterns. They may be more helpful during the
rehabilitation process to determine when the symptoms of concussion are
resolving. In other words, a student-athlete who is suffering from a
concussion may all of a sudden begin to have trouble with one or more of
the above executive functions. However, if the classroom teachers make
appropriate accommodations these problems should gradually clear up and
the student-athlete will return to normal, pre-injury levels of
performance. It is critical that accommodations be made during the
rehabilitation stage in order to help the brain recover from the injury.
section below on the possibility of concussion being a “spectrum
disorder” has significant implications when executive function
deficiencies present themselves.
IS CONCUSSION A SPECTRUM
studies on concussions are beginning to show evidence that we may be
dealing with a spectrum disorder when we examine the cognitive
deficiencies of traumatic brain injury. For example, let’s consider that
at the lower end of the spectrum a person has minimal brain damage from
brain trauma, while at the higher end a person has a maximum amount of
damage and has serious life-threatening symptoms.
has been customary to describe a concussion as being mild, moderate or
serious, so in a way concussions have always been considered to be part of
spectrum disorder theory explains the degree of concussion by imagining a
“continuum” where the “degree needle” is constantly moving between
points in mild and serious stages as the brain experiences new trauma and
recovers from previous injuries.
are times, for example, when the brain may be subject to a very small
force which causes minor damage. No symptoms of concussion are produced,
but the “degree needle” moves a little further from the absolute lower
end of the spectrum. Over time the “needle” will move up or down the
spectrum, depending on the number of what we may call sub-concussive blows
received. A sub-concussive blow would be one that produces no observable
signs, symptoms or behaviours consistent with concussion.
there is sufficient cognitive and physical rest following a sub-concussive
blow, the needle may begin moving back towards the lower end of the
spectrum. However, if there hasn’t been enough time for recovery before
the next sub-concussive injury is experienced, the needle may end up being
moved further up the continuum towards the upper level of the spectrum.
the accumulation of a number of sub-concussions, the needle will move into
the “tipping point” area, causing signs, symptoms or behaviours
consistent with concussion to emerge. When that happens, we say that the
student-athlete has suffered a “concussion” and must rest until he/she
recovers to the point where the symptoms have disappeared. In a short
period of time the symptoms will subside and the student-athlete will be
said to have recovered from the concussion.
questions are now being raised about whether the concussion has really
healed. In fact, it could be that the “needle” has moved far enough
towards the lower end of the spectrum so that the symptoms no longer
present themselves. Any further trauma to the brain will cause the needle
to begin moving along the continuum towards the upper level until once
again it reaches the point where signs, symptoms and behaviours consistent
with concussion occur once again.
spectrum disorder theory explains why once a student-athlete suffers their
first concussion, he/she is much more vulnerable to suffering second and
subsequent concussions from even less force than was needed in order to
cause the first. This may be explained by understanding that it takes a
while for the “degree needle” to move from the lower end of the
continuum to the point where symptoms emerge. However, after a
rehabilitation period which includes cognitive and physical rest, the
“degree needle” only moves to the point where symptoms subside and
everyone concludes that the absence of symptoms mean that the concussion
has healed. In fact, the healing is still going on and may not have
reached the original starting point. Therefore, it will take fewer
sub-concussions to produce symptoms of a second concussion and so on. A
significant enough force may end up moving the needle to new levels never
before experienced, thus making the recovery period even longer and
slower. Eventually, the “needle” will move so far along the spectrum
that the symptoms may never disappear and the student-athlete will suffer
from life-long post-concussive symptoms.
the spectrum disorder theory is valid, then the signs, symptoms and
behaviours consistent with executive function disorders may be a warning
sign that the student-athlete is approaching a danger zone. They may
become “warning signs” and in much the same way as scientists can
predict earthquakes, we may be able to predict potential concussions and
then take appropriate action to reduce the risk of a full scale injury
will require a whole new approach to dealing with traumatic brain
injuries. It means that we may have to initiate concussion management
protocols even prior to the occurrence of an incident during a game or
practice. It is hard to imagine how hard it will be to keep a
student-athlete out of a game because of the increased possibility of
concussion. Right now we are having problems keeping them out of action
even after there is clear indication of a concussion.
if we accept the spectrum disorder theory, we must also accept the
principle that all student-athletes have some degree of traumatic brain
injury, with most having a degree of injury that hasn’t quite reached
the “tipping point”.
is not uncommon for a person who has suffered a traumatic brain injury to
display symptoms that are emotional or psychological in nature.
When this happens, the care givers, including parents/guardians,
classroom teachers and coaches must do whatever they can to overcome or
alleviate these psychological issues since they can cause or exacerbate
Anxiety is an issue that
is common following a traumatic brain injury. The student-athlete
may admit to having flash-backs about the injury if it was particularly
traumatic. He/she may also worry about losing his/her school year or
position on the team. In this case it may not be so much the injury that
is causing the anxiety, but more from the stress of experiencing the
injury in the first place. It is important to remember that everyone is
going to experience some level of anxiety, but it becomes a concern when
it interferes with other normal, day to day functioning. This is why it is
critical that appropriate accommodations be in place with respect to
returning to normal activities at school and at home. You must avoid
increasing stress levels which will lead to further anxiety.
Depression is common
with injured student-athletes. There is, however, a difference between depression and unhappiness or
sadness. For adolescents, playing on the school team means everything. It
is what defines them in the eyes of their friends. When suffering from an
injury that others cannot understand or see, it is often extremely
depressing for the student-athlete and can interfere with the
accompanies a traumatic brain injury. Student-athletes become short-tempered and have
difficulty with their relationships which then makes it even more
difficult to recover. People must give concussion victims “more rope”
and not react negatively to some of the comments and arguments that ensue.
It is not the same person, but in time that old friend will return.
often accompany traumatic brain injury. A person may find that things that usually were of
interest and enjoyable are no longer so. This might not seem like the same
person because it isn’t. These are signs and symptoms that you must
recognize if you are a parent/guardian or classroom teacher because they
could be signals that the student-athlete has suffered a concussion.
are a number of simple tests that can be done at school, on the sidelines
or at home that will determine if the student-athlete has any problems
with balance. One of the common symptoms of concussion relates to balance,
so these tests can certainly uncover evidence of a traumatic brain injury.
The best source of these tests is the SCAT2 (Sports Concussion Assessment
Have the student-athlete
stand up straight with both feet together and hands on his/her hip. Then
ask the student-athlete to close his/her eyes for 20 or 30 seconds. See
how steady the student-athlete stands. It is always a good idea for the
parent to do this test before the season begins in order to get a baseline
performance to compare with once an injury occurs and a concussion is
Have the student-athlete
do the same drill but raise and bend the left leg first for 30 seconds and
then do the same with the right leg for another 30 seconds. Once again
close the eyes and you can see how well the person does with this test.
The final balance test
is to have the student-athlete stand toe to heel one foot behind the
other, with hands on hips and eyes closed for 30 seconds. Repeat the
procedure by switching feet. Observe how well the student-athlete does
with this test.
will have their own sense of balance to begin with and it is unlikely that
anyone will be able to pass these tests without moving. That is why it is
important to do a baseline set of tests as part of the Preparation Stage.
Make observations about how well the student-athlete performs the balance
test while not injured. Then compare the results after the injury. If
there is a significant deficiency, then you should seriously suspect a
concussion and follow established protocol.
goes without saying that the best cognitive assessment is through a
neuropsychological test such as ImPACT. However, if a parent/guardian
suspects that his/her child may have a concussion, there are some simple
little tests that can be performed at home at the kitchen table.
First, simply ask a
number of questions that your child should be able to answer easily.
What is the date today?
What is the day of the week today?
What year are we in?
What is your birthday?
You can ask your child
to perform a couple of tests that will demonstrate concentration skills.
List the days of the week backwards starting with Saturday.
List the months of the year forward and backward.
You can then test memory
by reading your child a list of words and asking him/her to repeat them
back to you in any order. Do this with a few different lists.
You can do the memory
test with digits from 0 to 9.
List a string of three digits and ask your child to repeat them backwards.
Do this for a string of four and five digits.
again, if possible, you should do this kind of test before the season in
order to establish a baseline. Your child may already find it difficult to
say the months of the year in reverse order. Therefore, unless you have a
baseline to compare with, it may be hard to determine if there is any
If you are concerned with the answers, then your child may have a
concussion and you should take appropriate action to initiate the
concussion management protocol.
are many signs, symbols and behaviours consistent with concussion.
it takes is one of these for a person to be suspected of having a
you spot one, the chances are that there are others that are going to
present themselves over the next several days.
means that the concussion management protocols should be implemented
immediately and everyone begin the rehabilitation procedures so that the
damage from the first concussion is contained and allowed to recover
before any further damage is caused.
know what to look for. Now we need to take action when we see the signs,
symptoms or behaviours! And we must put in place procedures and protocols
that make sense for this type of injury, keeping in mind the following:
Diagnosing a concussion
on the sidelines during a game is extremely tricky since it relies on the
student-athlete being honest about revealing symptoms such as headache,
nausea, dizziness, and blurred vision. It relies on the person evaluating
the player recognizing signs of concussion. All of this is used to help a
person determine if a student-athlete has a concussion.
Determining whether a
person has a concussion right after he/she takes a hit is further
complicated because symptoms do not always show up immediately. Some of
them present themselves over time, even days. That is why
neuropsychological testing is done several days after the incident to give
the symptoms time to develop. Because conditions can change, it is too
risky for a person on the sidelines to make an informed decision. There is
just too much risk that the student-athlete may appear normal while on the
bench and then be put back into the game only to find out that he/she
sustains a much more serious second concussion.
It is impossible to
determine the severity of a concussion at the time of the injury. Whether
a concussion is mild or severe will be determined by the extent of the
symptoms that evolve and by how long they take to resolve. And you can
never tell at the time of the injury just how long it is going to take to
heal. Therefore, you have to wait until the person completely recovers
before you can make any statement about the severity of the injury.
This is why we must do
more than just have the student-athlete examined by a medical doctor. We
must do more than have a health care provider or concussion expert on the
sideline to examine a player suspected of having a concussion. We must
have the parents/guardians observe for signs, symptoms and behaviours
consistent with concussion at home. We must have the classroom teachers
observe for signs, symptoms and behaviours consistent with concussion at
school. We must use neuropsychological computer testing to compare
baseline with post-injury cognitive functionability. We must involve the
student-athlete in rehabilitation programs to prepare him/her for
return-to-play, return-to-learn, and return-to-normal.
is why we will always recommend that as soon as a single sign, symptom or
behaviour consistent with concussion is spotted, the student-athlete must
immediately be removed from play and the full extent of the concussion
management program be initiated and followed through to the end. Only then
will we be sure that we have done everything possible to reduce the risk
of repeat concussions which could have life-altering consequences on the