Sports-related concussion or mild traumatic brain injury (MTBI) occurs at all levels of sports participation and at epidemic proportions. The Centers for Disease Control estimates that at least 1.6 to 3.8 million sports-related and recreation-related concussions occur each year. Participation in competitive sports, especially full contact sports, increases an individual's risk for MTBI. High risk sports include football, ice hockey, wrestling, soccer, and lacrosse.
A concussion occurs as a result of a bump, blow, or jolt to the head or body which causes the brain to move rapidly and crash into the skull. This does not result in a structural injury of the brain, but causes an impairment of brain function. Since CT and MRI scans only show structural or bleeding injuries of the brain, they are always normal and not helpful in excluding the diagnosis of concussion.
The signs and symptoms of concussion are quite varied. An athlete may exhibit only one symptom, or may demonstrate several. Signs include varying levels of consciousness, disorientation, balance problems, memory and concentration problems, change in personality, and inappropriate emotions. Symptoms may include headaches, nausea, ringing of the ears, feeling off balance or dizzy, visual difficulties, sensitivity to light and noise, and feeling “out of it” or “hazy”.
Treatment is directed at resting the injured brain. This includes restriction from participation in sports and other physical activities. On occasion a concussed athlete may be advised to remain home from school. Medications for headaches are not recommended in the initial time period following a concussion.
Current management of MTBI utilizes computer-based neurocognitive testing to confirm resolution of a concussive injury. This major advancement eliminates the sole reliance on the self-reporting of symptoms by the athlete.
ImPACT (Immediate Post concussion Assessment and Cognitive Testing) is a computer-based neurocognitive test. This test assesses brain function by measuring performance in verbal memory, visual memory, reaction time, and processing speed. These “test scores” are compared to the athlete's baseline or pre-injury test results. One can demonstrate depression of these scores following a concussive injury. The test scores return to baseline as the athlete recovers from the injury, reflecting the normalization of brain function.
A concussed athlete has resolved his or her injury when there is complete symptom resolution and normalization of his or her neurocognitive test scores. Under no circumstances should an athlete be returned to play if he or she is symptomatic.
Preinjury ImPACT baseline testing is recommended for all athletes, especially for those who participate in contact sports or for athletes with prior history of concussion. Baseline testing should also be considered for athletes with learning disabilities.