What do Sidney Crosby, John Tavares, Ian Laperriere, Marc Savard and Eric Lindros have in common?  Aside from the fact that they have all played hockey in the NHL and earned great salaries doing so, they have jointedly suffered from one, if not multiple concussions.

The word concussion is derived from the Latin word “concussus” which is the action of striking together.  During a concussion, the brain’s cortex is struck against the skull of the head.  Concussions are considered to be the most common type of traumatic brain injury (TBI).  In fact, they account for up to 5% of all sports related injuries. This represents approximately 300 000 per year in the United States of America.  Unfortunately, a 2005 survey revealed that more than 88% of these injuries go unrecognized.

The most common causes of concussions include sports injuries, bicycle accidents, motor vehicle accidents (MVA) and falls. In adults, the latter two are by far the most prevalent.
 

Signs and Symptoms

Concussions are associated with a multitude of symptoms that usually begin shortly after the injury was incurred.  Symptoms usually disappear within hours, days or weeks.  Depending on the extent of the injury, the number of symptoms as well as their severity and duration will vary from person to person and from injury to injury.

Typical symptoms observed may include one or any combination of the following:

1. Headaches: the most commonly reported complaint following a mild TBI.

2. Dizziness.

3. Nausea.

4. Vomiting.

5. Ataxia: a lack of muscle coordination.

6. Impaired balance.

7. Visual problems such as: sensitivity to light, seeing bright lights, blurred vision, double vision.

8. Tinnitus: ringing in the ears.

9. Convulsions: occurs in 1 out of every 7 concussions.  They are thought to arise from a temporary loss of muscle function.

10. Confusion: may occur immediately or several minutes after the event.

11. Disorientation.

12. Attention deficit.

13. Loss of consciousness: may occur but does not correlate to the concussion’s severity.

14. Post traumatic amnesia: where the person cannot recall the events leading up to the injury, following the injury or both.

15. Slurred or incoherent speech.

 

When to Seek Medical Attention

It is always a good idea to have a certified health care professional properly evaluate the injured person.  One should be especially attentive if an individual has:

  1. Sustained a severe head trauma such as a fall.
  2. Lost consciousness.
  3. Exhibited a delayed loss of consciousness where the person is unconscious momentarily and then awakens only to lose consciousness again.
  4. Vomited more than once.
  5. Confusion that is not improving nor disappearing rapidly.
  6. Restlessness or agitation.
  7. Extreme drowsiness and/or weakness.
  8. An inability to walk.
  9. A severe headache.
  10. Amnesia.
  11. A seizure or convulsions.
  12. Slurred speech.

 

Treatment

In 2010, the American Academy of Neurology implemented that any athlete suspected of having sustained a concussion, is to be removed from play immediately.  In fact, four steps have been established should any minor TBI (MTBI) secondary to a sporting event occur:NHL-puts-concussion-protocol-into-effect

 

  1. Remove the athlete from play.
  2. Ensure that the individual is properly assessed by a medical professional experienced in MTBIs.
  3. When appropriate, inform the athlete’s parents about the possibility of a concussion and provide them with a “Facts Sheet” on the subject matter.
  4. Avoid allowing return to play until a health care provider deems that the athlete is healthy to do so.

 

One of Cappino’s own, Rony Varga is the founder of reACT Canada. reACT is a multi-disciplinary concussion management organization that implements a unique return to LEARN system before a traditional return to PLAY system which will protect Canadian student athletes of all ages and levels from the short and long term cognitive consequences of concussions.

 

reACT’s mission is two-fold:
1) To instill emphasis and importance on a return to LEARN system FIRST and a return to PLAY system SECOND. Concussion diagnosis is usually based on the presence of multiple cognitive and physical symptoms. However, traditional return to play decisions are mostly made regardless of return to learn cognitive status and usually using the “all symptoms have resolved”model. reACT has developed a concussion management program that will allow health care professionals, athletes, parents, schools, leagues and organizations to increase awareness and recognition and to supply post-concussion management for student athletes for a safe return to learn FIRST and a safe return to play SECOND.

2) To empower all student athletes that have suffered a concussion by monitoring and managing their symptoms, but above all, by educating them on how to set their own individual limits in order for them to play an integral part in their own rehabilitation.

reACT will achieve this through 3 steps: 1) Concussion attestation and education programs given to parents, coaches, teachers and administrators alike. 2) Baseline Testing. 3) Postconcussion management with implementation of personalized return to learn and play protocols.

For more info on reACT, please visit their website at www.reactcanada.org
Prognosis

Although concussions are quite serious injuries, the mortality rate is almost non-existent.  Most symptoms resolve within hours, days or weeks.  However, some problems may persist longer than this.  The rate of recovery is largely influenced by numerous factors and can be slowed in the presence of: a history of prior head traumas, co-existing medical conditions, substance abuse problems, clinical depression, poor pre-traumatic health and a stressful lifestyle.

For reasons that are unknown, having a single concussion predisposes an individual to others.  Although the cumulative effects of concussions are poorly understood, it is thought that the severity as well as the symptoms involved my increase with successive traumas. Cumulative concussive effects may include psychiatric disorders, long term memory loss and even Alzheimer’s disease.  In some cases, a condition known as Chronic Encephalopathy or “Punch Drunk” syndrome, associated commonly with boxers, can lead to both mental and physical deficits such as Parkinsonian symptoms, speech and memory problems, tremors and delays in thought processing.

 

Even though fatalities resulting from concussions do not appear to be overly common, it is nevertheless absolutely necessary to decrease as many “risk factors” as possible in order to prevent these MTBIs from occurring. Wearing seat belts and ensuring the presence of airbags in motorized vehicles, using helmets for high impact activities such as hockey, football, cycling and downhill skiing as well as ensuring that your house is fall proof (decluttering your living space, making sure rugs are intact, making sure to clean up spills on floors) are all simple ways one can avoid concussions.

 

 

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