MY EXPERIENCE OF CONCUSSION
Concussion is an ever growing issue in the media and often poorly understood by doctors as well as the general public. Myths like you need to lose conciousness to have a concussion still persist.
With a concussive event, lots of things start to happen in your brain. Energy demand increases but blood flow and glucose availability goes down. A further blow can exacerbate this which is why it is vital to "Recognise and Remove" in amateur sport to protect your brain in this state.
Once you have diagnosed a concussion the real skill is safely guiding a player back to every day life and then return to sport. There is lots of excellent protocols online for a single or 1st concussion but nothing for repeat concussions, prolonged concussions or a complicated concussion from a variety of factors. My aim is to ensure my patient has a realistic plan to control symptoms and then return to everyday life and then their sport over a number of stages to ensure their brain is coping with the additional challenges.
These factors are especially important with schools athletes and a large proportion of my Ulster Academy job is managing school age athletes concussions throughout the year.
SPORT RELATED CONCUSSION
Berlin Concussion Consensus
Sport related concussion is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilised in clinically defining the nature of a concussive head injury include:
SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.
Professional vs Amateur
In professional sport, players have baseline SCAT5s and baseline computer neurocognition scores to compare against as well as multiple camera angles of incidents. This is clearly not the norm for the general population and usually not needed either. In amateur sport the onus is on "recognise and remove" with no chance of returning to play that day. A detailed history and examination is then usually sufficient to diagnose a concussion after the event.
RETURN TO PLAY CONSIDERATIONS
Return to learn/work/play
There are lots of factors that can impact a return to learn/work/play schedule. Age, past medical history, past concussion history, symptom load, concussion subtype, type of sport and school/work commitments to name a few. It is important that someone experienced in concussion management helps formulate a return to learn/work/play schedule that will work for you.