I first became interested in pediatric athletic concussion when my youngest son played high school football in the late '90s. The day after a game he told me about one of his team mates who received a hard hit during the game and couldn't remember driving home. At that time getting your "bell rung" was an accepted consequence of the sport and you were expected to "buck up" and get back in the game. After all, that's what you saw the pro athletes do.
Now we know there are more serious consequences of athletic concussion, particularly for children and adolescents because of their growing brains. The media is full of stories of the long term effects of concussion and the devastating effects of second impact syndrome. According to the consensus statement from the 4th International Conference on Concussion in Sport held in Zurich in 2012, a concussion is "a brain injury defined as a complex physiological process affecting the brain, induced by biomechanical forces" (McCrory et al., 2013). A concussion may be caused by a blow to the head, or elsewhere on the body and the force transmitted to the head. It may involve loss of consciousness although less than 10% of concussions involve loss of consciousness. Confusion, foggy or fuzzy thinking and being slow to react or speak can all be signs of a concussion.
Young athletes may not recognize they have a concussion or they may be reluctant to report their symptoms for fear of being held out of the game. If a concussion is suspected the athlete should not return to play the same day. When in doubt, sit them out. Conventional neuro-imaging such as CT and MRI detect hemorrhage and cerebral contusions, but may be normal in a concussed athlete because a concussion is a functional rather than a structural brain injury.
Both physical and cognitive rest are recommended for the symptomatic athlete. This may include limiting or restricting TV, video games, cell phones, texting, school work and school attendance, as well as driving and athletic activities. Return to play guidelines are tailored for each individual. No athlete should return to play if symptomatic at rest or on exertion. Although most (80%-90%) of concussions resolve in 7-10 days, some may have symptoms that persist, particularly in children and adolescents. Once the athlete is asymptomatic at rest, he or she progresses in a step-wise fashion with each step every 24 hours so that it takes approximately one week to progress through the protocol and return to play, according to the recommendations from the 4th International Conference on Concussion.
Neuroscience nurses need to be aware of the signs and symptoms of concussion as well as the long-term effects. Seek opportunities to educate parents, coaches and youth athletes about concussion. Encourage parents to speak to their child's coach about concussion and return to play guidelines. Resources are available for parents and coaches at the Centers for Disease Control and Prevention Heads Up Toolkit for High School Sports: http://www.cdc.gov/concussion/HeadsUp/high_school.html. We can play an important role in limiting the long term consequences of pediatric athletic concussion.
Additional Resources
http://www.cdc.gov/concussion/sports/
http://www.iom.edu/Reports/2013/Sports-Related-Concussions-in-Youth-Improving-th
http://www.nationwidechildrens.org/concussions-in-sports
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