Concussion Guidelines - What's New?

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious. ( www.cdc.gov/concussion/sports )

An estimated 1.6 - 3.8 million individuals are affected each year by concussions. That's a staggering number and indicates the need for diligence and appropriate follow up care.

Last week the American Academy of Neurology issued their updated guidelines on sports concussion. This is a big deal - neurologists are involved in the evaluation & management of traumatic brain injuries and the AAN is their representative professional organization - so having them (AAN) issue updated guidelines speaks to the amount of attention this topic has received. And deservedly so. AAN's most recent update on sports concussions came in 1997. The AAN guidelines are based on a review of all available research through June 2012.

More interesting is that a majority of healthcare providers and state-level organizations have already made changes and have been following these "new" guidelines for a few years now.

So What's "New"?

• Move away from grading classifications - concussion severity and return-to-play decisions used to be determined based on a grading scale. No more. AAN states, "concussion and return to play be assessed in each athlete individually."

• Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play and;

• Not returned until assessed by a licensed health care professional trained in concussion, and;

• Return to play slowly and only after all acute symptoms are gone.

• Athletes of high school age and younger should be managed more conservatively in regard to return-to-play, as they take longer to recover than college athletes.

• The first 10 days following a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

• Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

• An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.

• The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

• There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.

• Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.

• Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.

• Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.

For more information on concussions, the following resources are available:

www.oakwoodsportsmedicine.com

www.cdc.gov