I want to give parents a practical guide to concussion management. I would say for medical providers there are solid guidelines to follow for return to play for sports, but for other areas of their life there is not. I will review some of the main recommendations. No athlete should return to play on the same day to sports after a suspected concussion. All suspected concussions should be cleared by an MD or DO who is trained to manage concussions and is familiar with the international guidelines. No individual should drive if a concussion is suspected due to symptoms and delayed reaction times. Individuals should have mental and physical rest after sustaining a concussion. For any severe symptoms immediate medical attention should be sought out. I would recommend evaluation in an emergency room where providers are trained to manage head trauma and rule out more serious conditions.
Let’s talk about the plethora of advice out there for concussion prevention. Many folks advocated the use of mouth guards to avoid concussion. They are useful for avoiding dental trauma, but their utility for prevention of concussions has not been demonstrated. That is also true for the use of soccer headgear. There are many studies out there regarding headgear both pro and con, but looking at critical review of the literature there is no definitive evidence they help. Leading experts in the field such as Dr Robert Cantu strongly feel evidence is lacking for their use. Many feel they give players a false sense of security and they may alter their play feeling they are more protected than their peers. I would recommend strength training for athletes for core and neck stabilization, especially in girls and young women. This opportunity is often overlooked as a potential area of prevention. Football Helmets have been rated on their theoretical ability to decrease concussion in the lab but not in living subjects. Proper tackling techniques, rule changes and coaching style modification may have a much larger impact in reducing concussions than a specific helmet. Ensuring a properly fitted helmet is important. I would limit an athlete’s activity based on the skill and strength such as in stunting in cheerleaders or gymnastics.
I also recommend a gradual return to activities of daily living after a concussion. An individual with a concussion may not be able to attend school and have meaningful time there. Because both visual and word memory can be affected I recommend an individualized education plan that progresses as an athlete’s symptoms dictate. Often the symptoms can be severe and mental stamina and concentration can be severely impacted. A period of homebound status may be indicated. I often use the old expression from my youth of the “dumb jock” in order to explain the difficulties an athlete may be facing in the classroom. I believe many of those kids were in fact concussed athletes. They were fatigued in class, couldn’t concentrate and often put their head down on the desk. Teachers and peers would label them and when the preformed poorly in school no one was surprised. A portion of these kids in fact may have been suffering from a concussion. As recently as 10 years ago kids would go back in the same game and be expected to practice after having a concussion or having “their bell rung”. I recently read a newspaper article in the Citizen Times that quoted a current NFL player that he has had “bell ringers” but no concussions. The Associated Press’s writer did not clarify that “getting your bell rung” was in fact a concussion. We have a ways to go with education at all levels.
Another area that must be addressed is limited activity in other extracurricular activities such as music, chorus, and church youth activities to name a few. Often people forget that these too can make the symptoms worse and over stimulate an injured athlete. I hope this has been useful and further information is available at www.cdc.gov/concussion.