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Sport-Related Concussion & the Olympics

by User Not Found | Feb 07, 2014

Written By Michael J. O’Brien, MD and William P. Meehan III, M.D.

Sport-related concussion, sometimes referred to as mild traumatic brain injury, is a temporary, trauma-induced interruption of normal brain function. Concussions occur due to a rapid, rotational acceleration of the brain, often as a result of a blow to the head or face. It is a functional injury, as opposed to a structural injury. There is no detectable bleeding, swelling or bruising of the brain.    

Concussions occur in all sports. Although much of the medical literature on sport-related concussions focuses on American football players, higher incidence rates have been reported in one of the sports featured in the winter Olympics: ice hockey.1,2  Concussion has also been reported in skiing, snowboarding, luge, and speed skating.3-7 8,

Concussion is suspected if, after a rapid acceleration of the head, an athlete shows any of the signs of concussion or experiences any of the symptoms of concussion. Signs of concussion include vomiting, amnesia, imbalance, confusion, and less commonly loss of consciousness, among others. Symptoms of concussion include headaches, dizziness, nausea, sensitivity to light, and changes in sleep patterns, among others.

On-site management of brain injury during the Olympics will start with assessment of the airway, breathing, and circulation of the injured athlete and proceed along established protocols. Once all other injuries are addressed, focus will turn to managing the athletes’ concussions.

The mainstays of concussion management are physical and cognitive rest.10-12 The athlete will avoid strenuous activity and rigorous training during the recovery period. In order to achieve cognitive rest, intellectually challenging tasks, such as studying, reading, playing video games, and working online, will be minimized. Once the injured athlete’s symptoms subside, they will be started on a return-to-play regimen, beginning with some light aerobic activity, and advancing as tolerated by symptoms to more rigorous activities. Stages for the return-to-play progression have been outlined by the international conferences on concussion in sport. The stages from the 4th conference are shown below (table).11

Stage

Level of Activity

1

 No activity  (symptom limited physical and cognitive rest)

2

Light aerobic exercise e.g., walking, swimming, stationary cycling; <70% maximum permitted heart rate)

3

Sport-specific exercise, (e.g., skating drills in hockey, running drills in soccer)

4

Noncontact training drills (progression to more complex training drills (e.g. passing drills in football and ice hockey) may start progressive resistance training

5

Full-contact training, following medical clearance

6

Return-to-play, normal game play

Table.  Return-to-play stages as adapted from the 4th international conference on concussion in sport.11.  Athletes should proceed to a given level, only if asymptomatic at the previous level.  Each level should take, at a minimum, 24 hours to complete.11

According to recent consensus statements, same-day return-to-play should no longer be allowed.11

Readers are encouraged to post their comments on the following question: Does the opportunity to win an Olympic medal outweigh the potential risks associated with an earlier return to play after a sport-related concussion

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REFERENCES

1.         Koh JO, Cassidy JD, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj 2003;17:901-17.

2.         Tommasone BA, Valovich McLeod TC. Contact sport concussion incidence. Journal of athletic training 2006;41:470-2.

3.         Chaze B, McDonald P. Head injuries in winter sports: downhill skiing, snowboarding, sledding, snowmobiling, ice skating and ice hockey. Neurologic clinics 2008;26:325-32; xii-xiii.

4.         Cummings RS, Jr., Shurland AT, Prodoehl JA, Moody K, Sherk HH. Injuries in the sport of luge. Epidemiology and analysis. The American journal of sports medicine 1997;25:508-13.

5.         Florenes TW, Bere T, Nordsletten L, Heir S, Bahr R. Injuries among male and female World Cup alpine skiers. British journal of sports medicine 2009;43:973-8.

6.         Quinn A, Lun V, McCall J, Overend T. Injuries in short track speed skating. The American journal of sports medicine 2003;31:507-10.

7.         Wasden CC, McIntosh SE, Keith DS, McCowan C. An analysis of skiing and snowboarding injuries on Utah slopes. The Journal of trauma 2009;67:1022-6.

8.         Steenstrup SE, Bere T, Bahr R. Head injuries among FIS World Cup alpine and freestyle skiers and snowboarders: a 7-year cohort study. British journal of sports medicine 2014;48:41-5.

9.         Graves JM, Whitehill JM, Stream JO, Vavilala MS, Rivara FP. Emergency department reported head injuries from skiing and snowboarding among children and adolescents, 1996-2010. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 2013;19:399-404.

10.       Cantu RC. Consensus statement on concussion in sport--the 3rd International Conference on Concussion, Zurich, November 2008. Neurosurgery 2009;64:786-7.

11.       McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med 2013;23:89-117.

12.       Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP, 3rd. Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics 2014.

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