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A blow to the head which can disrupt normal brain functioning is considered a concussion. There is a great deal of confusion about how to recognize and grade the severity of a concussion. I have seen three concussions on my son's house league hockey in the last year alone. Minor concussions often go unrecognized, but we all have seen the results of multiple recurrent concussions in the likes of one Mohammed Ali. There are a great number of symptoms that go with a concussion, and treatments and recommendations also vary. For this reason, an International Conference on Concussion in Sport was conveyed in Vienna in 2001. Participants agreed on defining a concussion as:
1) caused by a direct or transmitted force to the head
2) results in a rapid onset of short-lived impairment that resolves spontaneously
3) reflects more of a functional rather than a structural injury
4) may not involve loss of consciousness, but does have a graded severity
5) symptoms typically associated with normal CAT-Scans and other tests.
More practically, anytime there is a stoppage of play after a potentially blunt force interaction, concussion should be considered. Players should be removed from the playing surface and be observed for several minutes. They should not return to play immediately! There are many signs of a concussion. These include:
a) Amnesia, or inability to recall parts of the event.
b) Any loss of consciousness, however brief.
c) Headache, double vision, ringing in the ear or unequal pupils.
d) Confusion.
e) Nausea or vomiting.
f) Neck pain, weakness, numbness or poor co-ordination.
The signs may disappear quickly. That a minor concussion has occurred needs to always be considered and medical follow-up is necessary. Minor concussions without loss of consciousness, amnesia less than 30 minutes and without another injury, are not considered emergencies. These people should be observed for a full 30 minutes before considering a return to play or activity. If further symptoms continue to develop during this time, such as increasing headache, more confusion or vomiting, then an emergency evaluation is in order. Moderate concussions are associated with a loss of consciousness not greater than 5 minutes, but there is usually little recall of what happened, and other minor symptoms. The most recent consensus is that this group of patients abstain from physical sport for at least a week and seek medical clearance. Severe concussions, with prolonged loss of consciousness greater than 5 minutes, should be considered emergencies, and full evaluations take place to rule out other injuries. This group may be kept in hospital for observation, and will generally get side-lined for at least a month.
Why the caution if things appear normal? Well, it gets more serious if one suffers a second or third concussion, even if they are minor. In a small minority of people, even minor concussions can result in persistent symptoms. Problems with memory, foggy feeling, headaches, pain, speech problems, inability to concentrate, sleep problems, mood changes and more. The brain is a large and diverse organ. Jolts to different areas can produce different symptoms, which are very difficult to quantify.
Still, the best treatment is prevention. Wearing helmets for hockey, skiing, bicycling, skateboarding, ATVing (All Terrain Vehicle), motorcycling and in-line skating does make a difference. Most people don't realize that most concussions are accidental. Adults seem to be most resistant to protecting themselves. Visit your local arena, and see how many coaches will run a practice without helmets, yet insist that kids wear them. Similarly, concussions and body-checking do go together, and there is little medical justification in maintaining it at any level of house league sports. This is an invisible injury that can produce a life time of grief in a flash. So, let's do it for the kids and ourselves!
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