Concussion

"A Tangled Web"

Concussion science has made great strides in the past two decades; we have moved from 16 assessment/return to play systems in the 1990s to just a few now. Along the way, sport has served as a unique laboratory. NHL teams use more than one of these systems to assess a player, but first the diagnosis must be made. Therein lies the rub.

The 4th international Congress on Concussion in Sport (published March 2013) defines concussion as a:

Complex pathophysiological process affecting the brain

Induced by traumatic biochemical forces secondary to direct or indirect forces to the head

Just the Facts:

· there is no single physical, electrical, laboratory, imaging or cognitive test that is completely accurate in diagnosing concussion

· a concussion results in a constellation of symptoms: physical, cognitive, emotional, and sleep-related

· in addition, inner ear balance and neck injury may worsen the symptoms

· consequently, every concussion is different and diagnosis not always easy

· the athlete does not have to be unconscious to suffer a concussion (in fact, less than 10% do experience a period of unconsciousness)

· concussion onset may be delayed for hours, even days after the incident

· an athlete does not have to receive a blow to the head to suffer a concussion. See second part of the definition above - think "shaken baby syndrome"

· many factors can increase the frequency and/or severity of a concussion, including previous concussions, headache history, attention deficit and mood disorders, female gender, and certain genetic predispositions

· less than 10% of concussed patients show any abnormality on commonly used scans such as x-ray, CT, or MRI