Ring Your Bell?

Recently there has been a much greater awareness of concussions in sports. More recent studies link concussions, particularly repetitive concussions with long term maladies. In the United States, there’s been a movie released that is quite critical of the NFL and their treatments of concussion. Yes, they were a bit slow to the uptake, but the NFL and other sports giants have been enacting standards for assessment and protocols to follow for the concussed athlete. While these protocols don’t do too much toward prevention, they do their best to mitigate the effects.

A Concussion happens when someone hits their head. The brain, which is not attached to the skull but rather encased by the skull and floating in synovial fluid, shifts rapidly and “jolts” or sometimes shifts temporarily within the skull. Make no excuse, this is a Traumatic Brain Injury. If there is a loss of consciousness, it is most certainly a concussion.

Helmets are a wonderful thing, but do not really prevent concussion. They are much better at preventing skull fracture. In fact, some have said that a helmet may worsen the potential for concussion as they give a false sense of security. Imagine how much less leading by the head would be in sports if it actually hurt.

We place too much emphasis in getting our children involved in contact sports when they’re young, but their bodies and brains are still developing. A minor concussion during development may have life long effects. I’ve seen many parents coaches in pee-wee sports that promote unsportsmanlike conduct by encouraging “leading with the head” (“spearing” when I was young). My personal opinion is that heading the ball in soccer should be prohibited until after high school. I’ve witnessed many concussion and occasional neck injuries by young players that just had to make the play.

Concussions can be recognized by a myriad of symptoms, including confusion or being dazed, clumsiness, slurred speech, nausea or vomiting, headache, blurred vision, sensitivity to light or noise, sluggishness, tinnitus, changes in behavior or personality, difficulty concentrating or amnesia. If any of these are recognized after a hit to the head, please do not just “blow it off.”

Please remember that concussion can occur from MANY sports activities. They can also occur as the result of a motor vehicle crash, a slip on the sidewalk or a hard hit to the head at work. Men out there, concussions can also occur in a physical fight.

Because everyone is taking their own path, and nobody coordinates efforts, skiing has sustained many concussions or worse traumatic brain injuries. Some high profile accidents (Sonny Bono, Natasha Richardson, & Michael Kennedy) have even resulted in death.

Prevention is by far the best plan, for some of the more extreme athletes out there, stop doing stupid things. A helmet will may prevent a concussion but should still be worn in any activities were a potential exists. A helmet is designed to pad, or slow the movement of the head in relation to the blow, but is still not a panacea; as mentioned earlier it may give only a false sense of security.

There is a very nice assessment tool that should be done to any athlete with a potential for injury before the season, immediately after the injury and as follow up. The SCAT-3 (Sports Concussion Assessment Tool) can provide a baseline, as well as monitor the progression through the healing from the injury.

Adult – SCAT 3 Assessment
Child –  SCAT 3 Assessment for Children 5-12

If you have a patient who has sustained a concussion the brain must be allowed to heal. Stop the activity immediately, sit out the rest of the game or day. Continued contact, stimulation or conversation must be avoided as it increases the neurological stimulus to the brain. A physician should be consulted, and may order tests to ensure that there’s not bleeding in the brain (a type of stroke). If they do not require hospitalization, rest will be recommended with non-aspirin or NSAID treatment of pain. A victim should avoid TV, Reading, Electronic Games and should spend 24 hours in a dark room to avoid stimulus. If symptoms worsen, IMMEDIATE medical consult is recommended.

The American Academy of Neurology has released guidelines that should be used to determine return to activity. Children should be treated with a much more conservative view for the return to activity as their development may affect their healing. In addition, there is no set time period, each athlete must be considered unique.

American Academy of Neurology – Concussion guidelines

When you do return to your activity, extra care should be used to avoid repetitive injuries as multiple concussions may have a greater than cumulative effect.

Sports that potentiate injuries to the head are fun, do doubt. But care must be taken to avoid injuries and treatment should be regarded as paramount, not disregarded to continue the activity.

Years ago, Saturday morning cartoons would show hits to the head concurring with a sound that resembled a broken cowbell. When someone sustains an injury to the head, many report a similar sound. Take care to avoid “Having Your Bell Rung.”

This entry was posted in Altered Mental Status, Neurological, Trauma. Bookmark the permalink.

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