A concussion is a type of traumatic brain injury that interferes with normal function of the brain. It occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body. As the brain is suspended in fluid inside the skull, even what appears to be a mild jolt or blow can create enough force to result in a concussion. In a young brain, a concussion has the potential to result in short or long-term changes in brain function, or in some cases, death. There is no such thing as a minor brain injury. A suspected concussion must be taken seriously by the athlete, the parents or guardian, the coaching staff, as well as the training and medical staff. An athlete does not have to lose consciousness to have a concussion, in fact, these only accounts for less than 10% of all Concussions. The injuries that occur to the brain with a concussion are not entirely understood but essentially involve microscopic stretching or tearing of brain cells. Because these are microscopic physical and chemical changes, they cannot be seen on CT or MRI scans and therefore must be managed on an organized way based on symptoms.

Initial signs and/or symptoms according to patient include:

__ Headache __ Dizziness __Double or fuzzy vision __Unsteady gait/ balance issues
__Nausea __Vomiting __Light sensitivity __Sound sensitivity
__Felt foggy __Confusion __Short term memory loss __Long term memory loss
__Poor concentration __Weakness __Inappropriate behavior
__Bloody nose __Neck pain __Numbness/ tingling in arms

Initial signs and/ or symptoms according to coaches, training staff, or family include:
__Appeared dazed or stunned __Was confused about what to do __Forgetting plays
__Unsure of game __Unsure of opponent __Unsure of time
__Unsure of location __Answered questions slowly __Moved clumsily
__Had loss of consciousness __Showed behavior or personality changes
__Couldn’t recall events prior to injury __Eyes not tracking smoothly

The National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee (SMAC), and the Texas University Interscholastic League (UIL), have certain guidelines suggested for management of a concussion in sports. Those Guidelines will be followed in this instance.
If a concussion is suspected by a Coach, Trainer, or Sideline Physician:
1. Remove the athlete from play.

2. Ensure that the athlete is evaluated by an appropriate health-care professional.

3. Inform the athlete’s parents or guardians about the possible concussion and give them information of concussions.

4. Keep the athlete out of play on the day of injury and until an appropriate health-care professional says he or she is symptom-free and gives the OK to return to activity.

5. The athlete should be observed following a concussion and never be left alone.

6. Athletes must know that they should never try to “tough out” a suspected concussion. Teammates, Parents, and Coaches should never encourage an athlete to “play through” the symptoms of a concussion.

7. If a concussion is suspected, NO ATHLETE SHOULD RETURN TO PLAY OR PRACTICE ON THAT SAME DAY. (Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury. Newer studies have shown that the brain does not recover quickly enough to return to play in such a short time.)

8. Rest is the first step in recovering from a concussion. Returning to sports and regular activities too quickly can prolong recovery. The athlete will need cognitive rest form physical and mental activities that require concentration and attention such as exposure to loud noises, bright lights, computers, video games, television and phones (including texting), which all may worsen the symptoms of a concussion. As the symptoms lessen, increased involvement in these activities may be allowed.

9. Once an athlete no longer has signs, symptoms or behaviors of a concussion, and is cleared to return to activity by an appropriate health-care professional, He or she will return to activity following the Progressive Physical Activity Program.

10. The Progressive Physical Activity Program is as follows:

Step 1: Light aerobic exercise 5-10 minutes on an exercise bike or light jog; no weight lifting, resistance training, or any other exercises.

Step 2: Moderate aerobic exercise 15-20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment.

Step 3: Non-Contact training drills in full uniform. May begin weight lifting, resistance training and other excursuses.

Step 4: Full contact practice or training.

Step 5: Full game play.

In most cases, the athlete can progress one step each day.

11. If symptoms of a concussion re-occur, or if concussion signs and/ or behaviors are observed at any time during the Progressive Physical Activity Program, the athlete must discontinue all activity and be re-evaluated by their health care provider.

12. Patient and parent voices understanding.