Concussion

Concussion is defined as traumatic brain injuries arised by external forces (a blow or jolt to the head or body) where a neurological dysfunction occurs and most often it is solved without resorting to medical interventions.

The grades of concussion (Glasgow Coma Scale) range from minimal to mild, mod to severe (Schumacher case).

The pathophysiology takes in consideration the following process:

• external mechanical forces;
• transient axonal lesions;
• neuronal excitotoxicity (an energetic crisis is in place due to decrease of glutamate).

When this happen to young athletes it should be considered also the immature brain, partial myelinisation, bony fragility, neck muscle weakness.

As demonstrated in the scientific article: "Sport-Related Concussion in Female Athletes: A Systematic Review", the incidence of concussion is higher for girls compared to the males.

Below you can find the main symptoms:

Cognitive	Physical	Emotional	Sleeping condition
Mentally foggy	Headache	Irritability	Sleepiness
Difficulty concentrating	Nausea	Excitable	Disturbs in sleeping (over/under)
Delay in the reasoning	Vomiting	Melancholy	
Difficulty remembering	Balance issues		
Repeated questions and replying slowly to them	Giddiness		
Does not remember the latest information well	Visual challenges		
Getting confused	Fatigue		
	Sensitivity to noise		
	Tingling feeling		

What to do in case of a concussion

• Sit the involved player out of field of play;
• assess medically the player and monitor him/her for deterioration;
• if it has been diagnosed a concussion, he/she must not return to play on the day of injury.

How to assess a concussion

Use the Sport Concussion Assessment Tool – SCAT5.

1. Recognise and remove: red flag (be aware of the following signs):

• blurred vision
• pain close to the neck
• headache
• vomiting
• tingling sensations
• reduction of consciousness
• convulsion attacks
• upset, anxious

2. Re-evaluate monitoring and follow-up:

• has been hospitalised for a head injury;
• has received a diagnosis for headache disorder/ migraines / learning disability/ dyslexia / ADD-ADHD;
• has been diagnosed with depression, anxiety or other psychiatric disorder;
• uses some medications.

3. Cognitive evaluation:

Evaluate the cognitive assessment of the athlete through the Standardised Assessment of Concussion (SAC).
In particular asking athletes if he/she remembers easy things such as what month is, what is the date today, what is the day of the week, what year is it, etc.

4. Carry out an evaluation about the balance – BESS:

Put the athlete stationary on a pillow for 20 seconds in different positions (before standing on two legs, then on one) and evaluate if he/she has a good balance.
Please note that there is no threshold score that can guide decision-making. The score is only a tool for assessment and follow-up monitoring.

5. Rest and rehabilitation:

Rest from a physical and cognitive point of view, don’t use screens, avoid noisy environments, etc.
Rehab: use physio for neck pain, physio if vestibular symptoms, use adapted nutrition, etc.

Usually, you can see the first signs of progression in between 10 and 14 days in adults, less than one month in children.

6. Return to sport:

Make some exercise steps such as starting with light aerobic exercise, sport-specific exercise, non-contract training drills, full contact practice until return to play. You can do it starting with walking at slow pace (no resistance training) – increasing the heart rate; running or skating drills by adding movements; starting progressive resistance training, adding hard exercises testing coordination and increased thinking; following medical clearance, participating in normal training activities, by restoring confidence and assessing functional skills by coaching staff. At the end you should be able to return to play.

Suggestions: use prevention

1. Equipment:
   • mouthguard
   • helmets
   • grill/ facemask for face protection
2. Follow rules/regulations;
3. Do good training: improving strength and resistance of neck muscles; working on peripheral vision/eye tracking; enhancing strength and physical conditioning;
4. Inform yourself (follow education).