A concussion is a traumatic brain injury that is caused by a blow to the head or to the body that causes the head and brain to move rapidly back and forth. This movement can be likened to what happens to a ping pong ball inside of a coffee can with movement of the coffee can. The ping pong ball strikes the interior of the coffee can multiple times back and forth with force. In the same way, with a blow or sudden movement, the brain can move back and forth inside of the skull, injuring it. This sudden movement can cause the brain to bounce around or even twist within the skull, stretching and damaging the nerve cells of the brain. This type of movement has the medical term coup, contra-coup injury. When a concussion happens, brain function diminishes because of the injury. This results in the development of concussion symptoms detailed below. Permanent brain injury and brain swelling can result from a concussion. Of course, these developments can be quite serious.
Signs that may be observed in a child with a concussion:
- Can’t recall events prior to or after a hit or fall. This is called post traumatic amnesia.
- Appears dazed or stunned.
- Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
- Moves clumsily.
- Answers questions slowly.
- Loses consciousness for any length of time (even briefly).
- Shows mood, behavior, or personality changes.
- Symptoms that may be reported by a child with a concussion:
- Headache or feeling “pressure” in head.
- Nausea or vomiting.
- Balance problems, dizziness, double vision or blurry vision.
- Bothered by light (photo-phobia) or noise.
- Feeling sluggish, hazy, foggy, or groggy.
- Confusion, concentration or memory problems.
- Not feeling right, or feeling down.
- Exercise intolerance
Any of these symptoms after a blow to the head or body should raise your concern for a concussion. Because a second blow to the head resulting in a second concussion can be extremely serious resulting in extreme brain swelling and injury, immediate removal from athletic participation is mandatory following any concussion. Zackery Lystedt’s story is instructive as to why.
In 2009, the Zackery Lystedt Law was passed in Washington State with subsequent concussion legislation being passed in all 50 states, including Arkansas. Sometimes referred to as the “shake it off” law, Zack Lystedt’s story emphasizes why “shaking it off” puts players at risk for serious brain injury. Zack who played both offense and defense on his junior high school football team, was injured at 13 when his head struck the ground after tackling an opponent. Despite the blow, Zack shook it off and by the start of the 3rd quarter was back in the game. After a second blow to the head near the end of the game, Zack collapsed on the field and had to undergo emergency life-saving surgery to remove the left and right side of his skull to relieve the pressure from his injured and swelling brain. He experienced numerous strokes, ventilator management and three months in a coma before he awoke to a new severe reality. Prematurely returning to the game after an initial concussion resulted in severe brain swelling and injury for him.
Washington with many states to follow, would pass the Lystedt Law. In most states the key provisions of the Zackery Lystedt Law include:
- education for parents, athletes, and coaches on the dangers of concussion.
- immediate removal from play during a game or practice, after a suspected concussion with no return to play until item 3. below is complete.
- written clearance by a concussion expert for return to play.
- uniformity of rules for all schools who use public land.
In 2013, “The Arkansas Concussion Protocol Act” became law. It required the Arkansas Department of Health to provide and disseminate protocols appropriate for all youth athletic activities. The purpose of this act is to increase concussion awareness and establish a unified set of guidelines. These recommended guidelines are designed to serve all youth up to the age of 19 years of age who are engaged in competitive athletic activity. Our Arkansas law is therefore aimed at the educational purpose alone with no penalties for failure to remove athletes from participation. We at All For Kids do recommend that all provisions of the Lystedt law found in other states be followed. Thus, if your child suffers a concussion, do the following:
- remove him or her from play immediately. Your child’s life depends on it.
- if your child recovers from the concussion in just a few minutes, then make an appointment for an office visit during regular office hours to get medical clearance from your doctor before returning to play.
- if you child has more severe symptoms such as a severe headache, vomiting, prolonged loss of consciousness, double vision or disorientation, then you should seek immediate medical attention.
We want you to be aware that some schools offer psychometric testing for their student athletes prior to participation in sports to provide a baseline in case of concussion. The concussed athlete can then be re-tested to determine if their concussion has resolved.
Once released to again play by their doctor, concussed athletes should return to play gradually according to the following schedule.
- Day 1: Light exercise, including walking or riding an exercise bike. No weight-lifting.
- Day 2: Running in the gym or on the field. No helmet or other equipment.
- Day 3: Non-contact training drills in full equipment. Weight-training can begin.
- Day 4: Full contact practice or training.
- Day 5: Game play.
Thankfully, most concussions resolve in a few days with rest, although symptoms can last much longer. Post-concussion syndrome is a disorder in which concussion symptoms such as headaches and dizziness may last for weeks and sometimes months after the injury. In addition, please be aware that recurrent concussions can result in a dementia-like state many years after concussion injury. This condition has been labeled chronic traumatic encephalopathy (CTE). The movie “Concussion” details the discovery of this condition in NFL athletes.