Concussions

Question 1

definition: concussion

Answer 1

trauma induced alteration in mental status that may or may not involve transient loss of consciousness

Question 2

how is the concussion injury described?

Answer 2

• functional disturbance rather than a structural injury

- diffuse axonal injury

Question 3

what are the MRI and CT scan findings in a concussion?

Answer 3

normal

Question 4

what is the most common reason for lack of concussion reporting?

Answer 4

did not think it was serious enough

Question 5

what is the proposed pathophysiology in concussion injury?

Answer 5

• increased potassium activates ATP dependent Na/K pumps, creating a need for more glucose and adding to the metabolic stress
• glutamate increases extracellularly and may contribute to increased potassium influx
• brain’s need for glucose increases acutely and cerebral blood flow and oxidative metabolism are reduced
• sometimes called disruption of metabolic autoregulation
• increase in intracellular calcium may be related to regional reduction of cerebral blood flow
• frontal and temporal hypometabolism during working memory tasks

Question 6

what are the current sideline evaluation recommendations?

Answer 6

• no return to play same day as a head injury

- if head injury is suspected, player is done for game/day regardless of whether or not symptoms resolve

Question 7

what is the late / delayed evaluation?

Answer 7

• head injuries should be reassessed within 24 hours
• repeat much of the sideline evaluation
• use family members to corroborate athlete’s story and symptoms

Question 8

what is the cornerstone of concussion management?**

Answer 8

physical AND cognitive REST until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play

Question 9

what is the step wise process for return to play?

Answer 9

1. REST
2. INCREASE HR
3. ADD MOVEMENT (sport specific)
4. EXERCISE, COORDINATION, INCREASE COGNITIVE LOAD (non contact training drills)
5. RESTORE CONFIDENCE AND ASSESS FUNCTIONAL SKILLS
6. GAME PLAY

Question 10

how long should each step take in the return to play protocol?

Answer 10

24 hours

Question 11

what do you do if symptoms occur during a return to play phase?

Answer 11

drop back a level and retry after 24 hours

Question 12

what is the typical treatment for concussions?

Answer 12

• time and waiting
• possible pharmacological intervention
• possibly sports psychology

Question 13

do helmets prevent concussions? what about mouthguards?

Answer 13

NO and NO

Question 14

what can be done to help prevent concussions?

Answer 14

• rule changes

- education

Question 15

what are the advantages of NPT?

Answer 15

• assessing if head injury if there is a question of concussion
• monitoring recovery phase of mTBI
• can help in return to play decisions

Question 16

what are the disadvantages of NPT?

Answer 16

• financial
• can be too sensitive
• need time and expertise to administer to athletes before every season
• athletes intentionally score low pre-season so that if they have a concussion, they can return to play sooner