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What is a Concussion?

A concussion, or mild traumatic brain injury (MTBI), is defined as an injury to the brain that results in pathophysiological processes affecting the brain.  It is important to note that concussions can be induced by direct or indirect forces. A concussion caused by a direct force is when an athlete receives a direct hit to the head or when their head collides with an object. However, concussions can also occur if an athlete receives a hit or contact to their body and there is a sudden movement at the head/neck without any direct force or contact to the head. During an indirect mechanism, the brain is shifted within the skull with high forces and is injured as it comes into contact with the skull. It is also important to note that concussions can occur with or without loss of consciousness. If an athlete presents with any of the signs and symptoms listed below after receiving a direct or indirect force to the head, they should be removed from activity and follow-up with a healthcare provider.

Signs & Symptoms:

A concussion may present with any of the signs/symptoms listed below.

  • Headache
  • Confusion
  • Nausea
  • Vomiting
  • Dizziness/balance problems
  • Disorientation/stumbling
  • Fatigue
  • Sensitivity to light or sounds
  • Blurred vision
  • Difficulty remembering
  • Difficulty concentrating
  • Difficulty sleeping
  • Drowsiness
  • Emotional Changes
  • Irritability
  • Sadness
  • Nervousness/anxiety

When an athlete sustains a concussion:

Below are the Senate Bill 1521 (2011) requirements regarding concussions for those participating in interscholastic athletic activities:

  • Immediate removal from activity if concussion is suspected
    • A healthcare professional, coach, official, or parent will remove an athlete from play if a concussion is suspected.
  • Referral to Health Care Provider
    • The athlete should see a health care provider to determine if he or she sustained a concussion and determine the course of treatment.
    • “Health Care Provider” refers to a Doctor of Medicine, Doctor of Osteopathic Medicine, Licensed Nurse Practitioner, Licensed Physician Assistant, or Licensed Athletic Trainer.
    • The athlete should be transported to the hospital if there is prolonged loss of consciousness, significant deterioration in mental status, or other significant injuries requiring medical attention.
  • Athletes must have clearance by health care provider before they can return-to-play
    • The athlete cannot return to play or participate in any supervised team activities that involve physical exertion including games or practices until they have received written clearance from a health care provider.

Risks of a Concussion

  • A single mild concussion may not seem like a big deal to a coach, parent or youth athlete. Often, symptoms of a concussion will rapidly improve without any residual symptoms or problems.  However, concussions may be complicated by the following conditions:  
    • Post-concussion syndrome
      • This is a complex disorder that can last for weeks or months after the concussion.  Symptoms can include headaches, dizziness, fatigue, anxiety, loss of concentration or memory, noise and light sensitivity, and insomnia. 
    • Second Impact syndrome (SIS)
      • Second impact syndrome (SIS) occurs when an athlete sustains a second concussion before signs and symptoms of a first concussion have fully resolved.  This can result in rapid brain swelling and possibly in death
    • Epilepsy
      • Athletes who sustain a concussion have a significant increased risk of developing epileptic seizures within the first five years after sustaining a concussion.
    • Chronic traumatic encephalopathy (CTE)            
      • Athletes who sustain multiple concussions are at risk for developing the degenerative disease of the brain termed Chronic Traumatic Encephalopathy (CTE).  Once the disease process has begun, it can continue even after exposure to brain trauma has ended.  Symptoms include memory loss, confusion, impaired judgement, paranoia, aggression, depression, and progressive dementia.  Symptoms can begin years or decades after brain trauma has ended. 

Concussion Testing:

Healthcare providers use a variety of tools to evaluate and manage a concussion and determine when it is safe for an athlete to return to play. The ImPACT test is a 25 minute, online test for individuals 12-59 years old that involves a series of neurocognitive tests that a healthcare provider will use as an essential tool in their concussion evaluation. Visit https://www.impacttest.com/ for more information.

When should an athlete take the ImPACT test?

  • Baseline: It is recommended that athletes take the ImPACT test prior to the start of the sport season to obtain a baseline measurement of their neurocognitive performance.
  • Post-Injury: This test is administered by a healthcare provider when an athlete has sustained a suspected concussion. The healthcare provider then compares the results of this test to the athlete’s baseline ImPACT test.  Even when an athlete “feels normal” following a concussion, they may still have residual brain impairment that can be measured via the ImPACT test.  This allows the healthcare provider to allow the athlete to return to sport only when they are back to their Baseline level of neurocognitive function. 

Where can I take the ImPACT test?

The Flagstaff Sports Institute provides baseline concussion testing for individual youth athletes and youth sports teams.  Cost of the test is $10, which covers the online registration fee.  Post concussive follow-up is provided at Flagstaff Bone and Joint by Dr. Kevin O’Donnell.  Dr. O’Donnell is certified in the ImPACT concussion tool, and is fellowship trained in sports medicine and concussion care.

For inquires, or to schedule a baseline ImPACT test contact Tiffany Kobordo, MS, ATC, OTC, CSCS. tkobordo@flagstaffboneandjoint.com