What is a Concussion?
Any head, face or jaw injury can result in a concussion and has the potential to be dangerous. A concussion is a brain injury which results in a temporary disruption of normal brain function. A concussion often results from a blow or jolt to the head, or from the head striking an object such as the ground or another athlete. The brain is suspended in fluid within the skull and can get “shaken” with a sudden force to the head (similar to shaking yolk in a raw eggshell), causing injury. Although less common, bleeding in the brain can occur with some head injuries. Loss of consciousness, mental status deterioration and worsening symptoms raise the concern for a bleeding injury. An athlete does not need to lose consciousness (black out) to suffer a concussion. In fact less than 10% of concussed athletes lose consciousness.
Common Signs & Symptoms
- Signs observed
- Appears to be dazed or stunned
- Is confused about assignment
- Forgets plays
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even temporarily)
- Shows behavior or personality change
- Forgets events prior to hit (retrograde amnesia)
- Forgets events after hit (anterograde amnesia)
- Symptoms reported by athlete
- Balance problems or dizziness
- Double or fuzzy vision
- Sensitivity to light or noise
- Feeling sluggish
- Feeling "foggy"
- Change in sleep pattern
- Concentration or memory problems
Observe the athlete: Check your son or daughter frequently for any signs or symptoms after any direct or indirect head trauma. Consult a physician immediately if there is any question of a concussion.
Rutgers Preparatory School’s Concussion Policy and Guidelines for Return to Competition
Rutgers Preparatory School follows the concussion guidelines set forth by the Zurich Concussion Consensus Statement¹ and the NJSIAA² as follows:
Return to Play Guidelines
At any time during a practice or game that a student athlete experiences any sign(s)/symptom(s) of a concussion he/she will not be allowed to return to play/practice that day.²
First time concussed athletes with no loss of consciousness and signs/symptoms lasting less than 7 days may return to play when he/she meets the following criteria:
1. Asymptomatic (with no use of medications to mask headache or other symptoms).
2. Completion of the Zurich Activity Progression (see below). This may begin once the athlete is asymptomatic for 24 hours and medically cleared by a physician to do so.
3. ImPACT scores return to within normal limits of baseline (if applicable).
Any loss of consciousness, signs/symptoms lasting 7 days or longer, or repeat concussions will require a minimum 7 day asymptomatic period and medical clearance before beginning the Zurich Activity Progression and will be managed on an individualized basis as approved by the physician. The asymptomatic period for any concussion may be extended at the discretion of the athletic trainer and the supervising physician.
Athletes who hand in physician clearance notes inconsistent with this policy may be asked to seek a second opinion.
Zurich Return to Activity Progression
We follow a stepwise activity progression based on recommendations in the Zurich Consensus Statement from the 3rd International Congress on Concussion in Sport¹ as follows:
Step 1: Light aerobic exercise (ie: stationary bike, elliptical machine)
Step 2: Moderate aerobic exercises (begin running program)
Step 3: Functional exercises (increase running intensity, begin agilities, non-contact sport-specific drills)
Step 4: Non-contact practice activities
Each step is separated by 24 hours. If any symptoms occur, the athlete will drop back to the previous
level and try to progress again after 24 hours of rest has passed.
Step 5: Full contact practice activities
Step 6: Full game play
Concussion Frequently Asked Questions
What is Second Impact Syndrome?
Second Impact Syndrome is a dangerous condition that can occur if an athlete returns to sports before full recovery. If you receive a second blow to the head (even a relatively minor one) before the symptoms of the initial concussion have cleared, the consequences can be deadly. A second blow to the head after a concussion can cause the brain to lose its ability to regulate blood flow properly. Engorgement of the blood vessels occurs, which places excessive pressure on the brain. This pressure can result in rapid respiratory failure, coma and even death.
How can it be prevented?
Don’t return to sports after a concussion until your symptoms have completely resolved and you have been cleared by your physician or athletic trainer.
What are the most common signs and symptoms of a concussion?
According to one study, the top 3 signs/symptoms among 396 concussed athletes were headache (40%), dizziness (15%) and confusion (9%). Loss of consciousness and amnesia occurred in only 4% and 6% of the cases, respectively. This is supported by another study which found that headaches were the most commonly reported symptom following concussion, occurring in 70% to 86% of athletes.
Can my son or daughter take something for the headache?
Concussed athletes should avoid medications containing aspirin or nonsteroidal anti-inflammatories (ie: Advil, Motrin), since these medicines thin the blood and may potentially increase the risk of intracranial bleeding. It is generally OK to take acetaminophen (Tylenol), but check with your physician before giving any medication.
Do I need to wake my son or daughter every few hours during the night?
There is still some considerable debate about the necessity of nighttime wake-ups. Wake-ups disrupt the athlete’s normal sleep pattern, which can lead to increased symptoms the next day due the combination of sleep deprivation and the concussion itself. However, you should at least be able to easily “rouse” your son or daughter to check for a decreased level of consciousness and persistent or worsening symptoms if: the athlete experienced any loss of consciousness, had a period of amnesia (memory loss or difficulty), he or she still has symptoms at bedtime, or advised to do by your physician or athletic trainer. If you gently jostle a sleeping child and they grunt, moan or try to swat you away like a fly, they can be left alone again for a few hours to get some sleep, and then rechecked again as needed. Any child who appears non-rousable should be brought to the ER immediately.
When can my son or daughter return to play?
Return to play decisions are based on concussion severity and the athlete’s history of prior head injuries. For most minor concussions, return to play may occur once the athlete meets the following criteria: he/she has completed a symptom-free period (and not taking any medications to mask headache and other symptoms), has completed the stepwise activity progression, passed their ImPACT test (if applicable) and has been cleared by an appropriate medical professional. Adolescents are generally managed more conservatively than college-aged and professional athletes since they appear to be at a higher risk for Second Impact Syndrome. More severe head injuries and those who have had more than one concussion may need a longer recovery period. Concussed athletes should not return to activity until they have been cleared to do so by the physician or athletic trainer.
Does age affect how fast an athlete recovers from a concussion?
Yes. One study that compared recovery rates between NFL football players and high school football players found that high school players took longer to recover from a concussion than the NFL players. A brain that is still developing may be more sensitive to trauma, which likely affects recovery time.
What is imPACT?
Starting in the 2009-2010 school year Rutgers Preparatory School began utilizing an innovative program for our student-athletes in grades 7-12. The program is called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) and it is a computerized exam that the athlete takes prior to the season and again if the athlete is believed to have suffered a head injury. The results of the exam help determine; a.) The extent of the injury b.) The location of the injury and c.) When the injury has healed. The system is utilized throughout professional sports, has been mandated in the NHL, and is fast becoming the “Gold Standard” in recognizing and better managing concussion type injuries. The University of Pittsburgh Medical Center’s Sports Concussion Program is the founding group of this software.
The exam takes about 15-20 minutes and is non-invasive. The program is basically set-up as a “video-game” type format. What it is doing is giving the brain a preseason physical of its cognitive abilities. It tracks information such as memory, reaction time, processing speed, and concentration. It is simple and actually most that take it enjoy the challenge of the test. The exam has gained recognition around the world.
If a concussion is suspected, the test is re-taken and the information can be used to better determine recovery from concussion. The information can be shared with your regular doctor and a sound decision can be made as to when return-to-play is appropriate and safe. If an injury of this nature occurs I will be in contact with you on all the details, large and small.
Upper School athletes particiapting in soccer, basketball, wrestling, lacrosse, baseball and softball are required to take the test. Athletes who do not participate in these sports may take the baseline test on a voluntary basis. All Middle School athletes will take the test annually to gain the most accurate baseline results. Once the athlete reaches Upper School, baseline results can be used for two years, so the test will be taken every other year. I wish to stress that there is no invasive work being done with this program. This gives us the best available information in preventing brain damage that can occur with multiple concussions. The Rutgers Preparatory School administration, coaching, and athletic training staffs are trying to keep your child’s health and safety at the forefront of the athletic experience. If you have any questions regarding this program please feel free to contact me. You can also find more information about ImPACT at www.impacttest.com.
Treatment of Concussions
The goal of concussion treatment is to allow the brain injury to heal. Concussions are treated differently depending on their level of severity. Treatment may include:
- Rest - provide adequate time for recovery. Do not rush back into daily activities for work or school.
- Preventing re-injury - avoid activities that might jolt or jar the head.
- Observation by a responsible adult - ask someone to awaken the athlete every few hours as advised by a doctor or other health care professional.
- Limiting exposure to painkillers - ask a doctor or other health care professional before taking medications. This is especially true for aspirin and ibuprofen as they can cause blood thinning. Painkillers can also mask symptoms of a concussion.
Gessel et al, Concussions Among United States High School and Collegiate Athletes, Journal of Athletic Training, Dec 2007
Guskiewicz et al. National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion. Journal of Athletic Training, 2004; 39(3) 280-297.
National Federation of State High School Associations: A Parent’s Guide to Concussion in Sports. http://www.nfhs.org/
Pellman et al. Concussion in Professional Football: Recovery on NFL and High School Athletes Assessed by Computerized Neuropsychological Testing. Neurology, Vol. 58, No. 2 Feb. 2006.
Sabini, R. and Reddy, C. Concussion Management and Treatment Considerations in the Adolescent Population, The Physician and Sports Medicine. April 2010, No. 1, Volume 38
Eastern Camden County Regional School District: Concussion Policy and Guidelines for Return to Competition & Concussion Injury Information. www.eastern.k12.nj.us/activities/athletics/forms/permission.pdf