Concussions

Head and Face
NASPE/NCAT Sport Injury Resource

Concussions occur after an athlete has suffered a blow to the head resulting in a wide-range of signs and symptoms. How do you know what to do when an athlete sustains a head injury? It is a difficult decision and one that should be made by trained medical personnel. For the coach or parent, your main duty is to check for initial deficits, verify that there is no loss of feeling/movement in limbs (that would mean central nervous system damage) prior to moving an athlete, and remove the athlete from the playing field. Then monitor the athlete for changes in those deficits. It is your job to inform the physician of deficits you observed. All head injuries should be cleared by a physician prior to returning to practice.

What should you check for?

1. Cognition or thinking tasks:
Ask athlete simple to more complex questions that the coach or parent would know the answer to (i.e., What team are you playing?; Who did we play last week?, or count backwards by 2s, etc.). Repeat the same questions every five to 10 minutes to detect changes in response.
2. Eye Signs:
Look at the pupils- both should be the same size; both should dilate/constrict equally
Vision - check for blurred vision
Eye Tracking - make sure both eyes can follow an object (pen/pencil) up; down; to the right; to the left equally. Make sure the eye is not fluttering or jerking.
3. Postural or balance tasks:
Check the athlete’s balance by having him/her stand erect with feet together, arms at the side, and eyes closed. Or have the athlete stand on one foot.
4. Physical Signs:
Changes in pulse, breathing, and skin color; skull/face deformity; dazed/confused look; level of consciousness

Grading System for Head Injuries - Kevin Guskiewicz, UNC-Chapel Hill (1999)

Mild / Grade 0:

Signs & Symptoms: The athlete is mildly confused at first, but usually does not show any signs or symptoms within ten minutes of the initial injury. The athlete usually passes all tests, but may have a headache later.
Return to Play: The athlete may return to play that day if asymptomatic (shows no signs or symptoms) after 20 minutes of rest. (Determined by a physician)

Mild / Grade I:

Signs & Symptoms: Although there is no loss of consciousness, the athlete may exhibit cognition and/or cranial nerve deficits up to one hour past the initial injury, and/or coordination difficulties up to three days.
Return to Play: The athlete may return to RESTRICTED play when asymptomatic for two days and unrestricted play/practice if the athlete is asymptomatic for three days past the initial injury. (Determined by a physician)

Moderate / Grade II:

Signs & Symptoms: There is loss of consciousness for up to one minute or altered levels of consciousness for up to two minutes. The athlete may exhibit cognition and/or cranial nerve deficits lasting longer than one hour past the initial injury, and/or coordination difficulties lasting longer than three days.
Return to Play: The athlete may return to RESTRICTED play when asymptomatic for four days and unrestricted play/practice when asymptomatic for six days past the initial head injury. (Determined by a physician)

Severe / Grade III:

Signs & Symptoms: There is loss of consciousness greater than one minute or altered levels of consciousness greater than two minutes. The athlete will exhibit two or more of the following deficits lasting longer than 24 hours: cognition and/or coordination difficulties; cranial nerve deficits.
Return to Play: If signs and symptoms clear up within the first week, the athlete may return to RESTRICTED practice when asymptomatic for ten days and unrestricted play/practice if asymptomatic for 13 days from initial head injury (Determined by a physician). If signs and symptoms do not clear up within the first week, the athlete may return to RESTRICTED practice when asymptomatic for 17 days and unrestricted play/practice if asymptomatic for 20 days from initial head injury.

Monitor the athlete at night by waking him/her up periodically to check his/her condition. If the athlete suffers from one or more of the following symptoms after sustaining a head injury, or you cannot wake them up from a sleep, immediately contact a local emergency room:

Vomiting
Sever Headache
Fluid/blood from the nose or ears
Different sized pupils
Garbled Speech
Elevated temperature (above 100?F)
Convulsions or Seizures
Restlessness or irritability


Back to Sport Injury Resource Main Page
AAHPERD | AAHE | AAPAR | NAGWS | NASPE | NDA | RC | DISTRICTS
American Alliance for Health, Physical Education, Recreation and Dance