Evaluation and management of sport-related concussions in adolescent athletes

Abstract

Sport-related concussions in young athletes are common, generally under reported and often go unrecognized. Concussion in sport may result either from a direct impact to the head or from indirect forces transmitted to the brain from impact elsewhere on the body. Concussions may also result from sudden acceleration, deceleration or rotational forces to the brain. The key features of concussion include confusion, impaired memory and reduced speed of information processing. Recovery may occur from a few days to several weeks or months. Both physical and cognitive rests are recommended for recovery.Long-term cognitive and behavioral complications are a concern. Preventive strategies include education, modification of sport rules, use of equipment such as headgears, face masks and mouth guards, and neck muscle training. Evidence is limited to support effectiveness of these preventive measures with the exception of rule modification in some sports. Laws have been enacted that require medical evaluation and clearance prior to return to play; however, evidence thus far does not show that laws have been effective in reducing the incidence of concussions in sport. More research is needed in all areas of preventive measures. Sports participation is a complex personal decision on the part of adolescent and his or her family. They should be provided with all information on inherent risks so that they can make an informed decision.

Patient, parent and educator perspectives on paediatric concussion

“…These findings are largely in line with those described in another study exploring caregivers of youth athletes in the United States. 30 That study, as well as our own, suggests that more uniform and detailed patient education material (e.g., hand-outs) provided at the time of health care visits is the preferred channel for patients and their families to receive information to recognize and manage concussion and post-concussive symptoms. According to our parentparticipants, handouts should include more detailed examples of cognitive and physical activities that are safe as well as those that should be avoided during recovery.…”

What is the knowledge of Newfoundland and Labrador Coaches’ regarding recognition of and response towards sports related concussive injury in the adolescent?

“…[24] Standardized knowledge of SRC has been underreported despite formal education on concussion associated risks. [16,[25][26][27] Evaluation of a coach delivered Heads UP (HU) program for 2514 U.S. high school football players reported a reduced SRC injury by 33% with 27% faster to full RTP. [28] Significant lower ratio rates (4.1 SRC/100 players) were noted for those players with HU education than the non-HU (6.0 SRC/100 players) group, concluding that structured concussion prevention and management programs have positive health outcomes.…”

“…While this study is dated it is still representative of current research findings. [24,26,31] Likewise, 80.8% to 83% of youth hockey coaches would return concussed athletes' to play especially for final or championship games. [31] The strongest statistical variable for this study was coaches' age and return-to-play activities.…”

“…However, parental knowledge in the adolescent athlete concussion symptoms, seeking care for recovery and returnto-play activity is still deficient. [13,21,26,39,40] Management of concussion in sports must begin prior to the start of the season to assist in recognizing and effectively managing a SRC. These pre-season assessments include baseline neurocognitive, balance and standardized assessments, which can be used to compare to current assessments when a concussion is suspected and are also useful to monitor repeated assessments during the recovery period.…”