Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Case study ( 5041 views as of July 22, 2019 )

Bradley is a 20-year-old hockey player who collided with the boards after a hard body check. He was not knocked unconscious, but felt dizzy and nauseated. He could not remember the score in the game or the name of his coaches. A trainer at the rink assessed him for concussion and did not let him return to play.

Later, he developed a headache and couldn’t sleep that night. The next day he noted that his balance was off, he couldn’t tolerate any noise or bright lights, and he felt nauseated when looking at the TV or computer. He couldn’t organize his thoughts and he felt as though he was in a fog. He became irritable and occasionally tearful. He could not return to school.

Bradley should first be assessed by his family physician or a sports medicine specialist within 24-48 hours. He should not return to play for a minimum of four weeks, and not before his symptoms have resolved. A determination about whether a neurologist should be consulted and whether an MRI is needed can be made. Medications may be helpful to treat some of the symptoms. A psychologist may be consulted for management of mood symptoms and assessment of psychological function.

As his symptoms settle, Bradley may benefit from a graduated conditioning program under the supervision of a physiotherapist or athletic trainer. A plan for returning to play can be made with the help of his physicians. Persistent symptoms (post-concussion syndrome) may develop and he should be monitored by his physician until his symptoms resolve.

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Conversation based on: Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

Concussions in Sports - Symptoms and Treatment " Bradley is a 20-year-old hockey player "

  • I wonder if there is a change happening in concussion management. Just recently two children of friend's of mine have suffered concussions. They both had clear return to school and recovery plans provided to them by the hospital
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    • I think this is a huge step forward @MichelleKaarto. I know when my daughter hit her head the doctor was worried about the wound and didn't even examine her for a concussion. It wasn't until a week later when we were at home that our family doctor brought it up.
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    • @K.Michael - I believe there is far more awareness today with the increasing focus on brain health and the impact of concussions. I think the schools and most family doctors are far more aware of the importance of monitoring symptoms of concussions, and of having a structured plan to return to school or work.
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  • Does anyone know if there is mandated training for coaches of children's recreational and competitive sports teams to help them assess concussions? I would hope that all coaching staff is trained to perform baseline assessments and then treat kids who sustain a head bump or injury, even at a recreational level since concussions can happen at any level.
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    • I know several people whose children play hockey and none of them have ever encountered staff trained in more than the most basic first aid
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    • Certainly was not done in my children's soccer leagues in Vancouver.
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  • I have come across literature that suggest high fat and/or high glucose diets might negatively affect cognition. Important to note that a rat model was used, but does anyone have additional information on whether or not this might be useful for Bradley's recovery?
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    • That's very interesting. I wonder if what is normally considered to be good fats - avocado is an example - would in turn help in healing a concussion or dealing with the side effects
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  • Concussions most definitely affect a student's ability to learn and retain information. Primarily because a prominent symptom of concussion is diminished ability to focus or sustain attention. This directly impacts and impedes the ability to encode or store that information, an integral part of the learning process. Return To Learn must be managed in a similar way to Return to Play, or recovery can be prolonged or complicated. Consulting with a concussion specialist, such as at Advance Concussion Clinic, can support a healthy and safe Return all around.
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  • This Case Study touches on a number of navigational challenges for the average concussion patient. While it can be clear that the athlete must not return to sport in the immediate aftermath of the injury, the return process can be difficult to manage. How long should an individual rest? What happens if symptoms don't resolve spontaneously? And, for students for whom return to learning should begin within 3-5 days post-injury, how can this be balanced with ongoing recovery? Concussion rehabilitation to address commonly affected systems--preferably by an interdisciplinary team--can be valuable in supporting healthy recovery, successful return to learning, and a guided return to normal exertion tolerance and
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    • @K.Michael, I believe it does! Especially if more than one concussion has been sustained, the effects accumulate since damaged brain cells don't regenerate.
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    • Would a concussion affect a student's ability to learn and retain information ?
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  • One of the most important advances in concussion management is the need for base-line testing. A baseline test is simply a tool that allows a comparison to be made following a suspected head injury. Without pre-injury scores, it is not possible to accurately determine how the brain has been affect. MRI's are not accurate enough to be able to determine the brain's function following injury. Base-line testing looks at a number of parameters such as balance and coordination, cognition, memory, reaction time and so on. Some of these tests are available on-line, but the best baseline tests are a combination of online and in-person tests with a trained professional. Having something to compare to following an impact to the head or neck allows the player and his/her medical team to be able to accurately determine if the player is at risk of the possible lethal "second impact syndrome", and safely decide how the player should be rehabilitated and returned to play. Completeconcussions.com has more information and 110 clinics across Canada.
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    • Baseline testing is becoming mandatory in children's minor hockey leagues. I think it is a great idea. I did not know it was a good idea to have it repeated at the beginning of every season.
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    • @KMichael- yes! Anyone who plays an impact recreational sport should definitely have a base line test performed at the beginning of each season. I would recommend you seek out a health care practitioner proficient in administering testing versus doing an online test.
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    • Would you suggest that anyone that plays recreational sports do an online base line test ?
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  • It is extremely important for sports teams, whether children or adult, to have coaches trained to assess concussion and head injuries. My husband obtained a head injury while playing rugby. He returned to the game after sitting out for 10 minutes. one week later, when he was still vomiting frequently and unable to work due to the headache he received an X-ray and 3 broken vertebrae were discovered. 14 years later he still has difficulty with his head and neck and is no longer able to play team sports. The outcome could have been significantly worse
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    • Is there a protocol in place for a team member to be assessed after an injury occurs ? Should the coach / trainers not suggest a person be checked out when an injury happens - especially a head injury ?
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  • I have started hearing about baseline testing for athletes - some of the children - in case of concussion. Is there any validity to this practice? What does having a baseline help with?
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  • Working as a former trainer for rugby and hockey players, I have seen some pretty significant concussions in my day. The gold standard for on-field assessment is the SCAT2 Evaluation system. There are also rigid return to play (RTP) guidelines that should be followed by athletes who have suffered concussions. It is extremely important in an attempt to prevent second impact syndrome and post concussive syndromes. I also highly recommend the athlete be seen by the same health care practitioner over the course of a few months so proper monitoring can ensue.
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    • I think this is great advice. These days it's common for people to NOT have a family doctor. Which means that follow up on an injury can involve multiple physicians. Continuity is vital to make sure nothing is overlooked.
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  • I'm curious as to the various field tests that are used to diagnose a suspected concussion in the field. I know we have done some research on the impact of balance testing and concussion, which can potentially be used to monitor recovery from a concussion (i.e., balance getting progressively stronger as injury resolves). @Dr. Johnston, what field tests are you aware of that are used in these situations? Are all trainers/coaches adequately knowledgeable on how to assess for concussion?
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  • Two summers ago my daughter fell on vacation and cut her temple open. The doctor glued it shut but didn't really do any further exam, just advised we take it easy for that day. She had headaches and dizziness for a month after. Our family doctor suspected that she had a minor concussion that was never diagnosed. It happens a lot easier than people assume and is really something that should be taken seriously
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    • It seems many concussions go untreated, as the patient does not express much concern and the doctor treats what they can see. We had a family friend fall off a swing and hit his head on the wooden deck. There was a small bump and a bit of redness, which he didn't think anything of. Another friend who is a nurse took a quick look at it and said to put some ice on it and he would be fine. Later that night he started to feel dizzy and vomit but didn't put two and two together and thought he might have a tummy bug. This continued through the night until his wife suggested he go to the ER and have it checked out. The ER doctor did an exam and told him he may have a mild concussion and to monitor it. Several months later he was playing hockey with a group of friends and hit his head pretty hard and was taken to the hospital. They did some tests and the doctor asked if he had a concussion before and he explained the previous situation. The doctor was not pleased as there appeared to be some damage and he was told not to play physical sports for the time being. He is now being monitored for head injury.
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  • This Case Study touches on a number of navigational challenges for the average concussion patient. While it can be clear that the athlete must not return to sport in the immediate aftermath of the injury, the return process can be difficult to manage. How long should an individual rest? What happens if symptoms don't resolve spontaneously? And, for students for whom return to learning should begin within 3-5 days post-injury, how can this be balanced with ongoing recovery? Concussion rehabilitation to address commonly affected systems--preferably by an interdisciplinary team--can be valuable in supporting healthy recovery, successful return to learning, and a guided return to normal exertion tolerance and sport.
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    • Many times patients receive conflicting advice which makes the situation more difficult to manage their recovery.
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  • Once a person experiences a concussion, are they more susceptible to having another one ? What are the consequences related to multiple concussions ?
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    • @Shirley, concussions can definitely recur more easily if one returns to sports prior to being completely rehabilitated. It is so important to have the post-concussion period monitored by the appropriate medical team and ensure that the coaching team is on-board with the return-to-activity plan, if applicable.
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  • Concussion are becoming more and more common not only in sport but in the playground as well. There is a concussion protocol at the school where a student must see a doctor if they have a severe bump to their head. They are not allowed back into the school without a signed form from the doctor stating they are ok and do not have a concussion. Is there signs that can appear after the 24hr mark or are the individuals in the clear once 24hrs has passed ?
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    • @T.Brown if a child bumps their head in additional to physical signs of bumps and bruises, you should look for any changes in their behaviour. This includes, but isn't limited to loss of appetite, lethargy, inability to focus on an object, and emotional changes. For the next few hours after, keep their activities limited to very low stimulants- NO technology. If the child still exhibits unusual behaviour after a few hours, I would always err on the side of caution and bring them to the ER. A quick tip for minor bumps and bruises is to place a cold spoon directly on the site for 2-4 seconds, remove, and repeat again a few times. It's as effective as ice without the mess. :)
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    • What should we look for when a child bumps their head? That happens a lot! and it would certainly crowd up medical waiting rooms if we went to the doctor/ER for every head bump. But you wouldn't want to miss a concussion either. So what should parents look for?
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    • That's great that the school has a protocol like this in place. I hope we will see more of this when a student falls at school. I know my daughter experienced a bad fall at school and hit her head, and I was contacted. She hadn't lost consciousness, but the school said they simply weren't comfortable making the call on whether she needed assessment so I had her seen by our physician immediately. It's one of those injuries where earlier intervention is ideal.
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  • Dr. Johnston, I am wondering what the treatment is in those initial 24 hours at home. Is it best for the person to just sleep, or stay active but calm? Would they take any medication, like Advil or Tylenol? thanks
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