Recognizing the Signs and Symptoms of a Concussion

In today’s fast-paced, high-intensity sports culture, it’s important for parents and coaches to be aware of the signs and symptoms of a concussion so that their athlete can get the right treatment as soon as possible. While you should not attempt to diagnose a concussion, ensuring that a person who suffered some form of head trauma is being continually observed following the injury is important. Some of the symptoms can be very subtle and may not become apparent for hours or days after the incident. Here are some signs and symptoms to be aware of:

Physical Signs

  • Headaches
  • Nausea
  • Vomiting
  • Balance and/or visual problems
  • Dizzy spells
  • Sensitivity to light and/or noise
  • Fatigue and/or low energy

Emotional Changes

  • Depression
  • Nervousness
  • Irritability
  • Panic attacks

Cognitive Symptoms

  • Difficulty concentrating
  • Troubles with memory
  • Feeling mentally slow or as if in a fog that will not lift

Sleep Disturbance

  • Sleeping more or less than usual
  • Trouble falling asleep

Monitor your athlete, note changes in behavior, and be acutely aware of worsening symptoms such as headaches that increase with intensity, vomiting, slurred speech, seizure activity and increasing confusion. If you notice any of these signs, seek immediate medical attention.

Does losing consciousness increase the risk of concussion?

Only 9 percent of concussions result in the loss of consciousness. That means 91 percent of people diagnosed with concussions do not lose consciousness. A loss of consciousness should be viewed as a potentially serious traumatic brain injury and as a result can carry greater risks. However, do not minimize the potential for a serious injury due to the lack of loss of consciousness. Remember, 91 percent of those who are diagnosed with a concussion did not lose consciousness.

Should you wake someone frequently during the night if a concussion is suspected?

It is not necessary to wake them unless directed to do so by a physician or licensed health care professional.

Get back to exercise as soon as possible.

False! Although exercise is very important, especially for student athletes, returning to physical activity too soon may prolong the symptoms. Your physician or physical therapist can guide the patient back to symptom-free exercise and activity with specific protocols that include monitoring symptoms, heart rate and blood pressure.

Should TV and electronics be limited if symptoms persist?

Yes. Your physician or licensed health care professional will help with modifications and accommodations that may be needed to get through the day without increasing symptoms. Things such as TV, computers, texting and video games may need to be limited and then gradually reintroduced.

What will the classroom experience be like for a student with a concussion?

Things that were never a problem may suddenly become overwhelming. One or all of the following may affect the classroom experience: noise, light, vision, concentration, memory, and sleep difficulties. Your health care provider can work with the school nurse to modify the student's day. Extra time may be needed for assignments, a hall pass may be required to change classes prior to the commotion that occurs when the hallways are full of students and rest breaks may need to be built into the day.

 A Dynavision, seen here with staff occupational therapist Kristen Dixon-Keilty (right) at our Rehab Center in Concord, is used for baseline testing, as well as for concussion evaluation and rehabilitation.

A Dynavision, seen here with staff occupational therapist Kristen Dixon-Keilty (right) at our Rehab Center in Concord, is used for baseline testing, as well as for concussion evaluation and rehabilitation.

What is the benefit of pre-season baseline testing?

Baseline testing gives a snapshot of how a student-athlete’s brain performs in a normal everyday state. Three domains are assessed: cognitive, balance or vestibular, and visual. The ImPACT (cognitive) test is a computer-generated test that assesses memory, attention, processing, reaction time, and symptoms. The BESS (Balance Error Scoring System) test examines balance under several conditions such as eyes open, eyes closed, on a firm surface, and on a foam surface. The King-Devick test assesses visual skills such as the ability to track eye movements using accuracy and speed as the benchmark. One or all three of these domains may be affected with a concussion. Having a comprehensive baseline allows the physician or licensed health care provider to compare pre-injury to post-injury scores. Depending on where the deficits lie, recommendations for treatment can be determined. Consistent concussion management will result in improved return-to-play decision making.

How often should a student athlete be baseline tested?

A student athlete should undergo a baseline test prior to 13 years old. If the student athlete is involved in high-risk sports such as football or girls soccer, then testing should be yearly as the brain is developing and changing rapidly. After the age of 13 the tests should be performed every two years.

What would happen if a student athlete who suffered head trauma returned to play and did not report concussion symptoms?

It is very important to know that most concussions resolve within a time frame of a few days to two or three weeks. The benefits of reporting and getting good recommendations and/or treatment are critical to a speedy recovery and a return to baseline (normal). The ramifications of returning to play while still experiencing symptoms increase the risk of severe brain injury such as Chronic Traumatic Encephalopathy (CTE). Many severe brain injuries occur from a secondary blow to the head when the original injury is not yet healed.

Should I keep my student away from contact sports?

No! Sports are extremely important for all who want to play. Team building and positive lifelong experiences come out of playing sports. The message is to play smart, play at the appropriate level, and get good advice. Don't be afraid to ask questions and, if you suspect a concussion, seek medical advice.