Dr. Karahalios, neurosurgeon at NorthShore University HealthSystem, urges all coaches of youth sports to become familiar with the necessary precautions they can take to reduce the number and severity of concussions in their athletes. Educational opportunities are available both before during and after a season. Coaches should take a leadership role in concussion prevention tactics – as is the case with all injury prevention programs. During pre-season, prevention tactics can include:
- Ensure players are in good condition to participate
- Establish an action plan for concussions that occur
- Explain your concerns and expectations about concussions and safe play to athletes, parents and officials
- Ask if players have had one or more concussions during previous season
- Remind athletes to tell coaching staff if they suspect that a teammate has a concussion
Return to play should be determined by a qualified concussion expert. When in doubt, sit it out!
Determine if pre-season baseline testing of brain function is feasible. This baseline testing may be performed using software called ImPACT Concussion Management Software. ImPACT is used by many professional, collegiate and high school sport programs throughout the country. In addition, it is also used physician offices and clinics specializing in the diagnosis and management of concussion. It is a sophisticated research-based software tool developed to help sports-medicine clinicians evaluate recovery following concussion. ImPACT evaluates and documents multiple aspects of neurocognitive functioning including memory, brain processing speed, reaction time, and post-concussive symptoms. If baseline testing is performed using the ImPACT software, post-injury tests are also performed to determine the severity of the concussion and the back to play or work timetable.
It is a parent’s responsibility to seek out excellent youth sports programs for their children. High quality youth sports programs are hallmarked by good coaches. Good coaches teach good technique which prevents the whole gamut of potential injuries.
Re-enforcement of the injury prevention messages conveyed preseason should take place throughout the season – both at practices and during contests. Key messaging for coaches and team staff on prevention during the season includes:
- Insist that safety comes first
- Teach safe playing techniques; players should follow rules of play
- 0% tolerance for unsportsmanlike conduct; strict officiating of game
- Ensure proper equipment; appropriate fit for equipment (helmet should move with head – and not wiggle around in the case of football/baseball)
- Teach athletes that it’s not smart to play injured
- It is NOT a badge of honor to play injured
- Discourage pressuring injured athletes to play
- Don’t let athletes persuade you that they’re “just fine” after they have sustained ANY bump, blow or jolt to the head.
The following symptoms are RED FLAGS – if any of these are present after a bump, hit or jolt to the head it is an emergency and the athlete should be sent to the nearest emergency room.
- Headaches that worsen
- Seizures
- Focal neurologic signs
- Looks very drowsy/can’t be awakened
- Repeated vomiting
- Slurred speech
- Can’t recognize people/places
- Increasing confusion/irritability
- Weakness/numbness in arms/legs
- Neck pain
- Unusual behavior change
- Significant irritability
- Any loss of consciousness > 30 seconds
The signs of concussion can be obvious or very subtle. As previously indicated, concussion can not be seen on an x-ray, MRI or any other imaging study of the brain. Signs and symptoms indicating a concussion that might be observed by the coaching staff or on-field medical staff can include:
- Appears dazed/confused
- Is confused about assignment
- Forgets plays
- Is unsure of game, score, opponent
- Clumsy
- Answers questions slowly
- Loses consciousness
- Shows behavior/personality changes
- Can’t recall events prior or subsequent to hit or fall
On the other hand, the injured athlete may report the following symptoms which are also suggestive of a concussion:
- Headache or “pressure” in head
- Nausea
- Balance problems or dizziness
- Double of fuzzy vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish or slowed down
- Feeling foggy or groggy
- Does not “feel right”
Appropriate on-field assessment is critical.
In order to assess the presence (or absence) of the aforementioned symptoms, the following on-field mental status evaluation may be helpful. The coach or trainer should ask the following types of questions to assess orientation, memory, concentration, etc.
- Orientation
- What quarter/half are we in?
- What field is this?
- What city is this?
- Who is the opposing team?
- Who scored last?
- What team did we play last?
- Amnesia
- Ask the athlete to repeat the following words: Girl, Dog, Green
- Do you remember the hit?
- What happened in the play prior to the hit?
- What happened in the quarter prior to the hit?
- What was the score prior to the hit?
- Concentration
- Ask the athlete to:
- repeat the days of the week backward starting with today
- repeat the months of the year backward starting with December
- repeat these numbers backward 63 (36), 419 (914), 6294 (4926)
- repeat the three words from earlier (Girl, Dog, Green
If any deficits are detected during the mental status exam or if any of the aforementioned symptoms are identified, you should assume the athlete has been concussed and the following action plan should be followed:
- Remove the athlete from play
- Ensure the athlete is evaluated by the appropriate medical professional; do not try to judge the severity of injury yourself
- Inform the athlete’s parents/guardians about the known or possible concussion
- Allow athlete to return to play only with permission from an appropriate medical professional
If you have any questions whether or not a player should return to play, please email Dr. Karahalios at info@DKNeuro.com for more information.