Gaelic Players Association

1. What is a Concussion? A concussion is the most common form of head injury suffered by players. Concussion can be caused by a direct or indirect hit to the head or body. This causes a change in brain function which results in a variety of symptoms and signs outlined below. With a concussion there are typically no structural brain changes, meaning imaging studies such as CT or MRI scan appear normal.

2. Mechanism of Injury

When a player suffers a concussion injury, the brain suddenly shifts, shakes or rotates inside the skull and can knock against the skull`s bony surface. In the minutes to days following a concussion, brain cells remain in a vulnerable state. Brain function is temporarily impaired and therefore the athlete is at risk of further injury if not removed from play. Further injuries sustained by players who are suffering from concussion can be very serious and can cause long term damage, this has been called the "Second Impact Syndrome".

3. Symptoms and signs of concussion

Following concussion players may experience many different kinds of symptoms.

Contrary to popular belief most concussion injuries occur without loss of consciousness.

Some symptoms develop immediately others may appear gradually and other symptoms may be subtle and go unnoticed by the athlete, coach or medical personnel.

**Loss of consciousness (LOC) is not necessary for the diagnosis of concussion but if it occurs it requires immediate medical help.

Some symptoms and signs include:

Concussion should be suspected in the presence of ANY ONE or more or either symptoms, signs or memory difficulties.

4. Management.

If a concussion injury is suspected the following steps should be taken.

· The player should not to return to play in current game or training without medical assessment.

· The player should be medically assessed as soon as possible.

· The player should not be left alone, and regular observation for deterioration is essential over the next 24-48 hours after a concussion injury.

· Players should not drive after a concussion injury.

· Inform the player`s parents / guardians about the concussion injury.

· Deterioration in the player`s condition (such as increasing headache, drowsiness, confusion, repeated vomiting, unsteadiness, limb weakness or seizures) warrants immediate medical attention.

· Return to play must follow a medically supervised stepwise approach.

A player should never return to play while symptomatic “When in doubt ,sit them out!”

5. Diagnosis.

Diagnosis of concussion may take several steps including physical examination and specific tests of memory, coordination, concentration / attention and neurologic screening. Further evaluation may be required for more serious, prolonged or recurrent concussion injuries.

6 . Classification.

For management purposes concussion can be divided into simple and complex concussion.

Simple concussion

In simple concussion, a player suffers an injury that progressively resolves without complication over 7-10 days. The management of simple concussion is complete rest until symptoms & signs resolve fully. This is followed by a stepwise medically supervised return to play.

Complex concussion

Complex concussion includes cases where players suffer

· persistent symptoms including recurrence of symptoms with return to exercise

· prolonged loss of consciousness

· concussion associated with specific neurologic signs or symptoms

· persistent cognitive impairment ( e.g. memory difficulties)

· recurrent concussion injuries (e.g. second concussion in same season)

This group of athletes require additional assessment and evaluation by doctors with specific expertise in the management of concussive injury, such as sports medicine doctors, neurologists or neurosurgeons.

7. Return to play.

• A concussed player should be removed form play and should not return to play in current game or training session.
• A concussed player may attempt to minimize their injury or refuse to come off putting themselves at risk of further injury – players judgment may be impaired!
• Post-concussion symptoms may increase with exercise therefore return to play should be gradual and only begin when the athlete symptoms have fully resolved after a period of complete rest.

Return to Play Steps

Return to play process is gradual, and begins after medical personnel have given the player clearance to return to activity. If any symptom / sign return during this process, the player must be re-evaluated by a doctor. It is important to remember that symptoms may return later that day or the next, not necessarily while exercising.

An example of this stepwise approach is

1. rest until all symptoms and signs have cleared (physical and mental rest)

2. light aerobic exercise (e.g. exercise bike)

3. sport-specific training ( soloing with ball)

4. non-contact training drills

5. full contact training after medical clearance

6. return to competition ( game play) following medical clearance.

There should be at least a period of 24 hrs for each stage & the player should return to stage 1 if symptoms recur. Weight training should only be added in the later stages.

Medical clearance is required before return to play.

8. Coping with symptom and recovery.

The best medical management for concussion is rest (mental and physical). Players who suffer concussion injuries often feel tired, and may experience difficulties at work or school concentrating carrying out tasks. Players may encounter mood difficulties and feel depressed, anxious or irritable with family or team-mates. Other subtle symptoms can include balance difficulties sensitivity to noise and light. Avoidance of loud noises and wearing sunglasses are often helpful. It is important to report these symptoms to your doctor who will advise on treatment options.

When dealing with persistent symptoms it is essential to only take medications prescribed by your doctor. Alcohol should be avoided - it will hinder recovery and put you at risk for further injury. Recovery from concussion should not be rushed nor pressure applied to players to resume playing until recovery is complete, risk of re-injury is high and may lead to recurrent concussion which can cause long term damage.

Remember “ better to miss one game than the whole season”

9. Sports Concussion Assessment Tool.

The most recent review and expert opinion group on Concussion in Sports worldwide have developed a “Sports Concussion Assessment Tool (SCAT card)”

The purpose of this card is both for player education and for use by trained medical personnel in the assessment of players with suspected concussion injuries.

Side A

Provides players essential information on concussion such as definition, symptoms, advice on treatment, signs to watch for and information on recovery.

Side B

This side of the SCAT card could be used by Doctors and Physiotherapists as a tool for sideline evaluation of suspected concussion injuries. This side of the card outlines physical signs observed, tests of memory, concentration / attention and neurologic screening tests that have been shown to be practical and effective in assessing suspected concussion injuries. Guidelines on stepwise return to play are also included.

Concussion should be suspected in the presence of ANY ONE or more of the following

· symptoms ( such as headache) or

· signs (loss of consciousness, poor balance, speech) or

· memory problems

Any neurologic screening abnormality necessitates formal neurologic or hospital assessment.

It is recognised, however, that abbreviated testing cards are designed for rapid concussion evaluation on the sideline. The appearance of symptoms may be delayed several hours after a concussive episode. Further evaluation may be required for ongoing management of sports concussion.

Copies of side A and B of the SCAT cards are downloadable below.

Side A

Side B

10. References .

1. Summary and agreement statement of the 2^nd International Conference on Concussion in Sport, Prague 2004. Br. J. Sports Med. 2005;39;196-204
2. Concussion Information for Athletes- www.thinkfirst.ca
3. CDC “Concussion in Sports”- www.cdc.gov/injury

Dr. Sean Moffatt MB, MICGP, MScSEM, FFSEM.

GAA Medical, Scientific and Player Welfare Committee