Education on concussion
This section is designed to help build community awareness and influence behaviour by informing a variety of stakeholders about reducing the risks for concussion in team sports. Included are skill-building and public awareness resources that aim to inform individuals about how to prevent concussions, recognize the signs and symptoms of concussion, as well as take action with respect to safe management of the concussed person.
The "invisible injury" concussion is one that any person may experience at some point in his or her life. Concussion not only has an impact on the student-athlete, but also affects parents, coaches and educators. The education section of this tool kit will provide you with some insight on the aspects of concussion.
What is a concussion?
A concussion is a brain injury that cannot be seen on routine X-rays, CT scans or MRIs. It affects the way a person may think and remember things, and can cause a variety of symptoms. Any blow to the head, face or neck, or a blow to the body, which causes a sudden jarring of the brain inside the skull, may cause a concussion (e.g., a ball to the head in soccer or being checked into the boards in hockey).
A common question is "what is the difference between concussion and brain injury?" None. A concussion is a type of brain injury. There are other types of brain injuries such as haemorrhages and bruises of the brain.
Concussions cause various signs and symptoms, which may include:
PhysicalCognitive (Thinking)Emotional headache general confusion or fogginess more emotional nausea or vomiting, difficulty concentrating, irritability, dizziness, difficulty remembering, sadness, blurred vision nervousness or anxiety, fatigue or low energy sensitivity to light or noise, loss of consciousness.
Recovering from a concussion takes time. It involves following the right steps when it comes to returning to play, school, and life. Seeing a medical practitioner trained in concussion recognition and management, and following the six Return to Play steps can help with the recovery from concussion.
A concussed person should be removed from activity immediately and should be assessed by a medical practitioner. Given that symptoms may worsen later that night and the next day or two, you should not return to your current activity. When concussed, your ability to assess your situation may be impaired.
Post-concussive symptoms may worsen with an increase in mental or physical activity, so it is important that return to activity steps be followed.
These steps do not correspond to days, though each step should take a minimum 24 hours between, and double that for children and adolescents. If symptoms return during this process, the individual should stop the activity and return to rest until symptoms resolve before they try any activity again. A physician should be consulted if symptoms persist.
Familiarize yourself about the signs and symptoms when a concussion is suspected by completing this fun word search activity.
Check out this brief video by Dr. Mike Evans called Concussion 101, A Primer for Kids and Parents.
Some common concerns associated with concussion include:
Post Concussion Syndrome (PCS)
The Mayo Clinic's definition of Post Concussion Syndrome describes it as a complex disorder where a variable combination of post-concussion symptoms (e.g., headaches, dizziness) can last for weeks and sometimes months after the injury that caused the concussion.
Second Impact Syndrome (SIS)
The Mayo Clinic's definition of Second Impact Syndrome describes rapid swelling of the brain which sometimes can be catastrophic if the person afflicted suffers a second head injury before the symptoms from the first have gone away. Although this condition is rare, it can lead to death.
As a child's body grows, develops and changes, so does his/her brain. A brain injury during this stage of life may temporarily interfere with the way the brain works, and interrupt the development of critical cognitive and communication skills. Children can be impacted in so many ways by concussion and can experience various symptoms including:
- Decreased processing speed
- Short-term memory impairment
- Concentration deficit
- Irritability/ depression
- Fatigue/ sleep disturbance
- General feeling of “fogginess”
- Academic difficulties
The right steps need to be taken to ensure that a child's concussion is properly diagnosed, managed and treated. Management of concussion should not only focus on returning to play, but also help with returning to school, work (where appropriate) and life.
Concussion attitudes and behaviours
A concussion is a physical injury. Minimizing stress on the injury, taking time away from sport, school, etc., engaging in appropriate exercises at the doctor's discretion, and allowing the injury to heal are examples of activities that someone with a concussion would abide by, just like someone with a visible physical injury.
A concussion is often referred to as an "invisible injury." Without having the proper knowledge about concussion, it is challenging to form the right attitudes and behaviours regarding what a concussion is or how to seek treatment, how to "deal with" someone who has a concussion, and the steps that need to be taken to get better both on the field and off. Receiving the right education is one way to become properly informed and by being educated, our attitudes and behaviours towards or about concussion can change.
Here is an example –
The Centers for Disease Control and Prevention (CDC) in collaboration with partners and experts, developed a tool kit for high school coaches consisting of practical, easy-to-use concussion-related information in an effort to reduce this injury. An evaluation was conducted by Sarmiento et al. (2010) looking at the success of the tool kit in changing knowledge, attitudes, and practices, related to the prevention and management of concussions.
Through a self-reported survey, respondents reported favourable changes in knowledge, attitudes, and practices toward the prevention and management of concussions. Coaches reported that the tool kit changed their views on the seriousness of concussion and took steps to educate others about preventing and managing concussions.1
Knowing about concussion is important and having the right attitude towards the injury is key. By increasing your knowledge, you will have a better understanding of what a concussed person is experiencing and how to help him/her return to play and school.
Concussion and coping
Recovery from a concussion can be very stressful for everyone affected. It may be helpful for those affected to have access to supportive resources. Here are some examples of things you can do:
- Communicate your concerns to your family doctor and/or attending health care professional
- Reach out to others who have been affected by concussion.
- Be patient. Patience with recovery is key for safe return to daily life activities such as school.
A variety of coping tools are available to help deal with concussion. Writing in a journal is an opportunity to pause at some point in the day to write down what is on your mind. There are two main reasons to keep a journal during this challenging period in your life. The first is to recapture the moment and describe what happened and what you recall thinking or feeling. This knowledge can help you gauge the progress you are making with your recovery plan.
Second, journalling is a great self-teaching tool. It provides a safe environment for examining how changing your thoughts or behaviours might bring about a different outcome. Getting started may seem awkward at first. Just like developing any other positive new habit, it takes time, commitment and a quiet time and place to journal. Every person is different. Here are a few things people keep track of in their journal:
- interactions with others
For your convenience, we have included a Concussion Journal Template to help get you started.
It is important that the individual is seen by a doctor or a qualified health care professional to receive proper management/treatment of his/her concussion. If possible, seeing a doctor with experience in treating concussions is ideal. Sport medicine physicians are doctors who are trained in concussion recognition, treatment and management.
Contact the Canadian Academy of Sport and Exercise Medicine (CASEM) to find a sport medicine physician near you.
The bottom line on concussion
Concussion consensus statements, guidelines and legislation have been written to provide the most current, accurate, and up to date information about concussion.
The Consensus Statement on Concussion in Sport: 4th International Conference on Concussion in Sport (held in Zurich, November 2012) was developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. Topics discussed are: concussion, concussion evaluation, concussion investigations, concussion management, modifying factors in concussion management, special populations, injury prevention, knowledge transfer, future directions, and medical legal considerations
The 4th International Consensus Conference on Concussion in Sport (Zurich, Switzerland) occurred on Nov. 1-2, 2012. This conference facilitated many topical research discussions, including: the role of protective equipment in concussion; the importance of a child version of the Sport Concussion Assessment Tool; the SCAT3; and chronic traumatic encephalopathy (CTE). The conference also touched on return-to-play issues, the role of rest in returning to play, the value of balance testing, and managing concussion in remote communities. More information about the conference can be found from a FIFA media release posted on You Tube. The guidelines produced by the Consensus will be posted once available.
The Canadian Paediatric Society recommendations are guidelines only, based on current data as well as expert opinion. The present statement reviews: the definition and classification of concussion; the evaluation of concussion, including signs and symptoms; investigations; concussion management and return-to-play (RTP) guidelines; and prevention. Because the science of concussion is evolving, physicians are encouraged to be conservative when managing children and adolescents with sport-related concussions.
Bill 39: An Act to amend the Education Act with respect to concussions in Ontario. The Bill amends the Education Act and requires boards to establish policies and guidelines respecting head injuries and concussions and requires boards to address the specified matters.
1 Sarmiento, K. et al. (2010). Evaluation of the Centers for Disease Control and Prevention’s Concussion Initiative for High School Coaches: ‘‘Heads Up: Concussion in High School Sports.’’ Journal of School Health, 80 (3) 112-118.