Tuesday, September 6, 2011

Head Injury Fact Sheet

Fact Sheet for Head Injuries

Due to the metabolic imbalance that occurs following a concussion, it has been shown that increased blood flow to the brain during recovery may impede or slow down the recovery process and worsen the symptoms of concussion. Most patients do not need to be placed on bed rest unless they are having severe symptoms (severe headaches, marked sensitivity to light, disorientation, balance problems, extreme fatigue, etc). They may participate in any activity that doesn't cause increased symptoms. In some cases, activities such as reading, watching TV, working at the computer, taking hot tubs and having heated discussions with others may increase symptoms. If patients develop increased symptoms while doing a specific activity, that activity should be discontinued.
Many individuals with a head injury may be unable to concentrate.  They may not be able to read or absorb material and may develop an increased headache while doing so. When this occurs, they might be able to participate in an activity for only a few minutes before symptoms increase. If a rest break can be interspersed between those few minute intervals, these activities can be done. As the symptoms abate, longer intervals can be spent reading, watching TV and using the computer.  Continuing activities, or exercise that increases symptoms, can delay the recovery from the concussion.  School attendance and activities may need to be modified.  While some individuals may be able to attend school without increasing their symptoms, the majority will probably need some modifications depending on the nature of the symptoms. Trial and error may be needed to discover what they can and cannot do.
  • If students are unable to attend school for an entire day without symptoms, they should attend for a half day. Some students may only be able to attend for one period, some not at all, due to sever headaches or other symptoms. Frequent breaks with rest periods in the nurse's office may be necessary. Often, alternating a class with a rest period may be helpful. Math causes more symptoms in many patients than other subject classes. As recovery proceeds, gradually hours spent in school may be increased.
  • Depending on their symptoms, some students may need to be driven to school to avoid walking and should be given elevator passes to avoid stairs. They should not attend gym or exercise classes.
  • Workload and homework may need to be reduced. Frequent breaks while doing homework may be helpful. Term papers should be postponed. Pre-printed class notes and tutors may help to relieve the pressure of schoolwork.
  • Tests: If there are concentration and memory problems, quizzes, tests, PSAT tests, SAT tests and final exams should be delayed or postponed. If test results are poor, a note to the school should request that the scores be voided. Extra time (un-timed tests) may be necessary initially when test taking is resumed.
  • If noise causes increased symptoms, students with concussions should not listen to loud music (especially in cars or on their I-Pods). They should avoid attending dances, parties, music concerts and sports events until the sensitivity to noise is gone.
  • If light causes increased symptoms or students have photophobia they should avoid bright sunlight and exposure to flashing lights (computer games). Sunglasses may be necessary.

Post-Concussion Syndrome
Fortunately, post-concussion syndrome occurs only occasionally but it is devastating to those individuals encountering it. It is usually defined as having concussion symptoms that last for greater than a month after the initial blow. The problems that can develop are categorized as follows:
  • SLEEP ISSUES - Initially, most concussed individuals are very fatigued and sleep more than usual. As the concussion persists, they may have difficulty falling asleep and sleep less than usual. Lack of sleep causes major difficulties and should be resolved before treating the next two issues. 
  • CONCENTRATION AND MEMORY ISSUES - Inability to concentrate and poor memory, often associated with increased headaches during schoolwork, may cause poor school attendance and performance. It can take months, or even longer, to recover from this. 
  • DEPRESSION AND OTHER PSYCHIATRIC PROBLEMS - Although depression may be caused by the concussion itself, the persistence of symptoms and being unable to play may also cause depression. 
  • Individuals with concussions often suffer frustration and anger due to the curtailment of their normal activities. They may not be able to participate in their chosen sport or attend school. 
  • Some athletes may not be able to return to contact sports due to the long term symptoms they have suffered as a result of their concussion.
The following is the researched recommendation for return to participation criteria following a concussion.

1st concussion

2nd concussion
3rd concussion
Mild Grade 1
Return to play when asymptomatic with exertion
Return to play when asymptomatic for 1 week
Return to play when asymptomatic for 2 to 4 weeks
Grade 1
Return to play when asymptomatic with exertion for 1 week
Return to play in 2 weeks when asymptomatic for 1 week
Terminate season. May return next season if asymptomatic
Grade 2
Return to play when asymptomatic with exertion for 1 week
Minimum 1 month; may return to play then is asymptomatic for 1 week; consider terminating season
Terminate season. May return next season if asymptomatic
Grade 3
Minimum 1 month; may return to play then is asymptomatic for 1 week; consider terminating season
Terminate season.  May return next season if asymptomatic

What you need to do if your child has a concussion:
  • Call your son/daughter’s primary care physician and make an appointment for them to be evaluated.
  • Bring the completed assessment sheet filled out by the Athletic Trainer and return to participation criteria for the physician’s review.
  • Make sure to read through all given information and follow guidelines.
  • Tylenol may be given to help with headache symptoms.
  • Check on your son/daughter every hour to see if their symptoms increase/worsen.  If they significantly increase, immediately bring them to the emergency room for evaluation.
To access a free course titled: Concussion in Sports:  What You Need to Know, please visit www.nfhslearn.com the National Federation of State High School Associations.