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| 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
Level of Activity
No activity (symptom limited physical and cognitive rest)
Light aerobic exercise e.g., walking, swimming, stationary cycling; <70% maximum permitted heart rate)
Sport-specific exercise, (e.g., skating drills in hockey, running drills in soccer)
Noncontact training drills (progression to more complex training drills (e.g. passing drills in football and ice hockey) may start progressive resistance training
Full-contact training, following medical clearance
Return-to-play, normal game play
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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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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.
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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.