A concussion is a brain injury that temporarily changes the way the brain works. The symptoms of a concussion can be subtle. A concussion can occur even if a person has not lost consciousness (passed out).
Watch Cynthia LaBella, MD, discuss concussion treatment in the video below.
During activity or sports, a concussion can result when a child’s head is hit by another player, a moving object (ball, baseball bat, hockey stick, golf club, etc.), a stationary object (goalpost, fence) or the ground. Concussions can also result from a blow or hit to the body that causes a significant jolt to the head. Sports and physical activities are not the only settings in which concussions occur. For example, they can also occur during car accidents and unexpected falls.
A physician will take a thorough history and perform a physical and neurocognitive exam. The neurocognitive exam includes questions and tasks that test memory, balance, reaction time and attention; your physician may also have your child perform a computerized exam that tests these abilities. If symptoms are prolonged or if there are particular findings on the physical exam, the physician may prescribe medication or vestibular therapy, or refer you to a neurologist or neuropsychologist for additional evaluation and/or treatment.
Physicians may use tomography (CT) or magnetic resonance imaging (MRI) to evaluate for the presence of other conditions that may be causing the symptoms. Not everyone with a concussion or head injury needs a scan of the brain. The physician will determine if a scan needs to be done based on your child’s injury, observable signs, and symptoms. Learn about our concussion treatment program.
There are many observable signs and symptoms that may help identify a concussion. Symptoms often appear immediately after the trauma to the head, but sometimes are not evident until hours or days after the injury.
If any of these observable signs and/or symptoms is noticed following a blow to the head, your child should have an evaluation by an athletic trainer or physician. These providers can examine your child and recommend appropriate treatment, such as sitting out the remainder of the competition or activity, and/or additional evaluation in an emergency department, or following-up with a physician with experience in concussion care.
Your child should not return to play until they have been evaluated a by a physician who has experience in concussion management.
Your child should not be left alone for the first few hours following a concussion; they should be accompanied by an adult who can monitor for signs of worsening symptoms. If a you or coach notices that your child has progressively worsening symptoms following a head injury, you should arrange to have your child evaluated in the emergency room right away.
The brain needs rest after a concussion. The physician may call for a period of rest from cognitive activities (i.e., those that require a lot of mental strain and concentration). They may recommend delaying school projects and tests, avoiding or even taking time off school. Decreasing or eliminating "screen time" (video games, television, computers, text messaging) can also help rest the brain.
Avoid all sports and physical activities — not just those with a higher risk of head injury. Your child should not perform any activities that raise the heart rate (for example organized sports, running, biking and dancing) until your physician gives you the go-ahead. Once the signs and symptoms have resolved, your doctor will develop a protocol for gradually returning your child to activities safely.
No two concussions are the same. Recovery from a concussion is different for each individual. There is no standard time period for recovery. The severity of a concussion is measured by how long the symptoms last. Thus, it is not possible to know how severe a concussion is until the athlete is fully recovered.
Every patient receives a detailed letter to inform their school about their specific needs during the recovery process. If needed, our team can help patients and families work with the school to develop a 504 plan or IEP (individualized education plan).
According to the new Berlin Guidelines, after a brief period of rest during the acute phase after injury (24-48 hours) patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptoms - exacerbation thresholds (i.e. activity level should not bring on or worsen their symptoms). It is reasonable for children and teenagers to avoid vigorous exertion while they are recovering.
Returning to sports too early puts your child at risk for prolonged symptoms and a more serious brain injury. Your medical provider will develop a schedule for how your child should progress back to activities safely. Below is an example of a typical schedule for return to activities.
|Stage||Aim||Activity||Goal of Each Step|
|1||Symptom-limited activity||Daily activities that do not provoke symptoms||Gradual reintroduction of work/school activities|
|2|| Light aerobic exercise||Walking or stationary cycling at slow to medium pace; No resistance training||Increase heart rate|
|3||Sport-specific exercise||Running or skating drills; No head impact activities||Add movement|
|4||Non-contact training drills||Harder training drills (i.e. passing drills); May start progressive resistance training||Exercise, coordination & increased thinking|
|5||Full contact practice||Following medical clearance, participate in normal training activities||Restore confidence and assess functional skills by coaching staff|
|6||Return to sport||Normal game play|