Course

Concussion

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10 Lessons

The primary focus of the initial on-pitch assessment of a player who has sustained a head trauma during training or match play is to screen the player for concussion or a more severe head or cervical spine injury. Once this has been done, and the assessment suggests that the player has sustained a concussion, he/she should be managed according to the (Concussion in Sports Group) consensus guidelines. From this point, the diagnosis should be confirmed ideally within the next 24 to 72 hours in a clinical setting by a concussion specialist. Making an accurate diagnosis (which includes the understanding of signs and symptoms) is the key to making an individualised therapeutic approach, preventing further harm and facilitating a safe return to school, work or football.

This 5th Consensus statement on concussion in sport and the SCAT5 are key resources to refer to when considering how to manage a sport-related concussion. 

Most players who have sustained a concussion need a short period of cognitive and physical rest (about 24 to 48 hours). The player is then progressed through a graduated return-to-play programme, developed by the Concussion in Sports Group. In many situations, players may require additional treatments. These may include physiotherapy focusing on vestibular and ocular motor or cervical spine treatments, analgesics or other treatment modalities. Physical activity can also be an important part of the treatment protocol.

The player should not be allowed to return to routine training or match play before his/her symptoms have resolved and not before medical clearance. 1

In this module, you will learn about how to assess and manage a player in a clinical setting, guide a return-to-play programme and learn about some of the potential sequelae and challenges that can be associated with a concussion.

The current module is designed to be used alongside the “Head and neck” module. This outlines how to approach an injury to the head or neck on the field of play.

Dr Mark Fulcher

Sport and Exercise Physician

Presented by

Learning outcomes

By the end of this module, you should:

  • have developed an approach to the assessment of concussion in a “clinical” setting;
  • understand how to use the SCAT3 assessment tool;
  • be able to develop and implement a graduated return-to-play programme;
  • understand the potential challenges associated with concussion and how they are managed;
  • understand the different treatment options available for players who have more refractory symptoms and be able to prescribe these appropriately;
  • be able to appropriately refer a player for a specialist assessment.

Tasks

  • Watch/listen to the media content and review the provided text
  • Read the suggested articles
  • Complete the case-based assessment task

References

  1. McCrory P, Meeuwisse WH, Dvorak J, et al. Consensus statement on concussion in sport: The 5th international conference on concussion in sport, Berlin, October 2016. Bri J Sport Med. 2017;51:838-847.
  2. Makdissi M, Davis G, Jordan B, Patricios J, Purcell L, Putukian M. Revisiting the modifiers: How should the evaluation and management of acute concussions differ in specific groups? Br J Sports Med. 2013;47(5):314-320.
  3. Kutcher JS, McCrory P, Davis G, Ptito A, Meeuwisse WH, Broglio SP. What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery? Br J Sports Med. 2013;47(5):299-303.
  4. Echemendia RJ, Iverson GL, McCrea M, et al. Advances in neuropsychological assessment of sport-related concussion. Br J Sports Med. 2013;47(5):294-298.
  5. Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?”: Recommendations for activity resumption following concussion in athletes, civilians, and military service members. J Head Trauma Rehabil. 2013;28(4):250-259.
  6. Zasler ND. Sports concussion headache. Brain Inj. 2015;29(2):207-220.
  7. Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21-27.
  8. Nordstrom A, Nordstrom P, Ekstrand J. Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players. Br J Sports Med. 2014;48(19):1447-1450.
  9. McCrory P, Davis G, Makdissi M. Second impact syndrome or cerebral swelling after sporting head injury. Curr Sports Med Rep. 2012;11(1):21-23.
  10. Andersen TE, Arnason A, Engebretsen L, Bahr R. Mechanisms of head injuries in elite football. Br J Sports Med. 2004;38(6):690-696.
  11. Benson BW, McIntosh AS, Maddocks D, Herring SA, Raftery M, Dvorak J. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med. 2013;47(5):321-326.