When it comes to concussion, knowledge is key. And knowing the truth that lies in the current research on concussion can be very helpful in guiding our decisions. Due to the recent attention concussion has gained, many parents struggle with the decision to let their children play contact sports. Here are some important truths to consider.
- Coaches have been encouraged, and sometimes required, to teach proper techniques specific to their sport — tackling, heading, etc.— to prevent contact in positions that make young athletes more susceptible to concussion.
- Organizations like the NFL, NHL, and the CDC have created heightened awareness of the signs and symptoms of concussion, and what to do if an athlete is pulled from play.
Here are some of the lesser-known truths found in research:
- The majority of singular concussions typically resolve within three weeks with early intervention. Therefore, the first concussion need not be alarming.
- However, sustaining a second concussion before the first one has resolved is significantly more likely to cause complications and prolonged symptoms like depression, headaches, and difficulty concentrating, making returning to learning and playing more challenging.
- The most important risk factor for concussion is having had a single concussion. The first concussion doubles the chance of having a second concussion.
- Young athletes (adolescents and teens) are more likely to experience complications.
- Young athletes need more time to recover.
- Tackle experience, size, age, and equipment have no bearing on the risk for concussion.
- Female athletes at the high school and collegiate level are at higher risk for concussion, and have longer duration of symptoms.
Based on these facts, it is clear that the key is identifying the first concussion. If we don’t know or can’t identify the first concussion, and the athlete is sent back to play, we are doubling their chance of sustaining another concussion. We hear of many athletes having prolonged complications from concussion because the reported complications are likely not due to the first concussion, but the second… or third… or fourth.
What do we need to understand to identify the first concussion?
- Loss of consciousness occurs in only 10 percent of concussions.
- Some athletes with a concussion don’t even display any of the visible or reported signs and symptoms — these are the “sleeper concussions.”
- It has been proposed that, due to lack of education about concussion and pressures to be successful, some athletes may not want to know they have a concussion on the sideline because they are so passionate and dedicated to their team.
- The truth is in the sideline evaluation — it is crucial for “pull from play” decision-making. With the right tools, it can be very effective at preventing multiple concussions.
What are the right tools? While a lot of money has been spent and research is being conducted on developing very innovative tests and tools, the most rudimentary tools can be the most effective.
- Research has proven that a simple vision test of rapid eye movement has exceptional reliability (.97). The tool has been used for many years with traumatic brain injury and reading disorders.
- This vision test is a brief clinical measure that detects impaired eye movements that are indicative of suboptimal brain function.
- It has also been shown to detect concussions — even those without signs and symptoms of a concussion.
- The best thing about this test is that ANYONE can learn to administer it effectively — parents and coaches included.
- The next best thing about this test is that it is very INEXPENSIVE.
It can be hard to believe that something so simple and easy could be the answer. We are led to believe that a trained medical person has to be the one to determine pull from play, and that we have to buy expensive testing tools to provide the best protection for our young athletes.
It’s not complicated. If the athlete’s score on the vision test declines, they are pulled from play so they aren’t subjected to further risk of concussion. The sideline evaluation allows the coach/parent team to make the right decision, and get the athlete the early intervention they need for optimal recovery.
Although computerized neurocognitive testing, such as ImPACT and ANAM, are popular, extensive reviews of the literature reveal that they have variable reliability and validity at best. In addition, the tests are often intentionally “sandbagged” by athletes to provide sub-optimal results at the baseline evaluation in an effort to reduce the likelihood of a concussion being identified.
Another powerful truth to assure the best possible outcome is that early intervention is imperative, within 48 hours by a clinician with vestibular and neurological training, and experience in treating concussion. Ignoring a concussion and getting a “pass” back to play is not in the athlete’s best interest, and sets them up for further injury and prolonged complications.
When coaches and parents have the truth, they are empowered. They have the ability to act quickly, and make an informed decision to protect their athletes. Identifying concussion and treating it appropriately is the only truth we need to know.
For more information on the Concussion Clinic at IPMR, visit IPMR.org or call 309-692-8670.
Sources available upon request.
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