Now that you have an idea of some of the basic terms associated with concussions, we will talk a bit about what the signs and symptoms are and the evaluation process.

Signs and symptoms of a concussion are much more complex than just a headache. We now know that concussions effect various parts of the brain which in turn leads to various signs and symptoms depending on the part of the brain that is damaged. Signs and symptoms vary and include physical symptoms, cognitive symptoms, emotional and sleep symptoms. I think one of the most recent symptoms we hear of lately in the news certainly is the emotional symptoms both short term and long term- long after an athlete is on the field or court where they are sustaining concussions.

Physical Signs and Symptoms
Headache
Fatigue
Dizziness
Photophobia (sensitive to light)
Sensitivity to noise
Nausea
Balance problems
Loss of consciousness
Vision difficulty

Cognitive Signs and Symptoms
Difficulty remembering
Difficulty concentrating
Feeling slow
Feeling foggy
Slowed reaction time
Altered attention
Amnesia- both short and long term

Emotional Signs and Symptoms
Behavioral changes
Irritability
Sadness
Depressed
Feeling emotional
Anxiety
Nervous

Sleep Signs and Symptoms
Drowsiness
Sleep more than usual
Sleep less than usual
Difficulty falling asleep

These symptoms although we often think of how it effects someone on the field, certainly impact their everyday life both in the short term and long term aspects of their life which is part of the reason concussion management has changed over the years.

Concussion testing now begins even before an acute concussion or a season begins for some athletes. Using ImPact testing which is a neurocognitive test, we can get a personal baseline for athletes identified as being a higher risk for concussion and will be tested prior to first contest (blog to come explaining ImPact testing). Currently those sports tested include field hockey, football, men and women soccer, men and women basketball, diving, wrestling, baseball, lacrosse, and softball. Those who are not tested using a baseline test can still use ImPact testing if a concussion is sustained, their scores will be compared to "norms" which have been established.

If an concussion is suspected, an onfield assessment will be performed. An important note is that if a concussion is suspected, the athlete WILL NOT BE ALLOWED to return to sport that day. Further neurological, neurocognitive and neuromotor/neurocognitive testing will be performed as well as a signs and symptoms inventory will be noted. ImPact Testing will be completed on all athletes (including those who did not have baseline completed) within 48 hours of initial concussion or reporting of concussion signs and symptoms. Referral will be made if deemed necessary. Instructions while symptomatic includes no athletic involvement inluding recreationally, rest, limited scholastic work, limited computer/games. Frequent neurologic exam, neurocognitive exams, and neuromotor/neurocognitive evaluations will be completed to determine the athletes progress or lack of progress. Ideally, daily check ups will be completed. Once an athlete is deemed cleared via evaluation, testing and/or a doctor, a progressive return to play guideline will be used to introduce physical activity safely to ensure no symptoms return which can often happen. The term "cleared" does not mean the athlete is able to jump right into a practice or game- it means they begin a progressive return to full activity. More on the return to play guidelines in the next blog.

Hopefully this gives you a bit more of an understanding of signs and symptoms and evaluations. Please note also that any loss of consciousness, spinal injury, progressive symptoms,  drastic deterioration of mental status, focal neurologic defect, complex signs/symptoms and assessements will be referred to a doctor.