A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.
- All concussions are serious.
- Most concussions occur without loss of consciousness.
Recognition and proper response to concussions when they first occur can help prevent further injury or even death.
Children and teens are more likely to experience a traumatic brain injury, including concussion, and take longer to recover than adults. TBI symptoms may appear mild, but the injury can lead to significant life-long impairment affecting an individual’s memory, behavior, learning, and/or emotions. Appropriate diagnosis, management, and education are critical for helping young athletes with a TBI recover quickly and fully.
During the last decade, emergency room visits for sports- and recreation-related brain injuries, including concussions, among children and adolescents increased by 60%. Overall, the activities associated with the greatest number of ER visits due to brain injury included bicycling, football, playground activities, basketball, and soccer.
Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.
How Can I Recognize a Possible Concussion?
To help recognize a concussion, you should watch for the following two things among your athletes:
- A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head......AND
- Any change in the athlete’s behavior, thinking, or physical functioning.
Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.
Signs Observed by Coaching Staff
- Appears dazed or stunned
- Is confused about assignment or position
- Forgets an instruction
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows mood, behavior, or personality changes
- Can’t recall events prior to hit or fall
- Can’t recall events after hit or fall
Symptoms Reported by Athlete
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Does not “feel right” or is “feeling down”
Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. But for some people, signs and symptoms of concussion can last for days, weeks, or longer.
What Should I do If a Concussion Occurs?
If you suspect that an athlete has a concussion, implement your 4-step action plan:
1) Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.
2) Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:
- Cause of the injury and force of the hit or blow to the head or body
- Any loss of consciousness (passed out/knocked out) and if so, for how long
- Any memory loss immediately following the injury
- Any seizures immediately following the injury
- Number of previous concussions (if any)
3) Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion. Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.
4) Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.
What Can I Do to Prevent Concussions?
As a coach or parent, you play a key role in preventing concussions and responding properly when they occur. Here are some steps you can take to help prevent concussions and ensure the best outcome for your athletes, the team, league or school.
Check with your league, school, or district about concussion policies. Concussion policy statements can be developed to include a commitment to safety, a brief description about concussion, and information on when athletes can safely return to play (i.e. an athlete should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play). Parents and athletes should sign the concussion policy statement at the beginning of each sports season.
Involve and get support from other parents and/or league or school officials to help ensure that the concussion policy is in place before the first practice.
Create a concussion action plan. To ensure that concussions are identified early and managed correctly, have an action plan in place before the season starts. This plan can be included in your school or district’s concussion policy.
Educate athletes and other parents or coaches about concussion. Before the first practice, talk to athletes and parents, and other coaches and school officials about the dangers of concussion and potential long-term consequences of concussion. Explain your concerns about concussion and your expectations of safe play. Show the videos and pass out the concussion fact sheets for athletes and for parents at the beginning of the season and again if a concussion occurs. Remind athletes to tell coaching staff right away if they suspect they have a concussion or that a teammate has a concussion.
Monitor the health of your athletes. Make sure to ask if an athlete has ever had a concussion and insist that your athletes are medically evaluated and are in good condition to participate. Some schools and leagues conduct preseason baseline testing (also known as neurocognitive tests) to assess brain function—learning and memory skills, ability to pay attention or concentrate, and how quickly someone can think and solve problems. These tests can be used again during the season if an athlete has a concussion to help identify the effects of the injury. Prior to the first practice, determine whether your school or league would consider conducting baseline testing.
During the Season: Practices and Games
Insist that safety comes first.
- Teach and practice safe playing techniques.
- Encourage athletes to follow the rules of play and to practice good sportsmanship at all times.
Teach athletes it’s not smart to play with a concussion. Rest is key after a concussion. Sometimes athletes, parents, and other school or league officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let your athlete convince you that they’re “just fine.”
Prevent long-term problems. If an athlete has a concussion, their brain needs time to heal. Don’t let them return to play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short time period (hours, days, weeks)—can slow recovery or increase the chances for long-term problems.
Work closely with league or school officials. Be sure that appropriate individuals are available for injury assessment and referrals for further medical care. Enlist health care professionals (including school nurses) to monitor any changes in the athlete’s behavior that could indicate that they have a concussion. Ask athletes or parents to report concussions that occurred during any sport or recreation activity. This will help in monitoring injured athletes who participate in multiple sports throughout the year.
Keep track of concussion. Coaches should work with other school or league officials to review injuries that occurred during the season. Discuss with others any needs for better concussion prevention or response preparations.
Review your concussion policy and action plan. Discuss any need for improvements in your concussion policy or action plan with appropriate health care professionals and school and league officials.
Reference: Center for Disease Control and Prevention (CDC)