Concussion Information

Three Rivers School  – Return to Play Form


Definition of Concussion  The Zurich statement defined concussion as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include: Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head. Concussion typically results in the rapid onset of short?lived impairment of neurologic function that resolves spontaneously. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course however it is important to note that in a small percentage of cases however, post concussive symptoms may be prolonged. No abnormality on standard structural neuroimaging studies is seen in isolated concussion. (1)

“Catastrophic brain injuries rank second only to cardiac-related injuries and illnesses as the most common cause of fatalities in football players. However, the National Center for Catastrophic Sport Injury Research reported that fatal brain injuries have occurred in almost every sport, including baseball, lacrosse, soccer, track, and wrestling. For a catastrophic brain injury such as second-impact syndrome, which has a mortality rate approaching 50% and a morbidity rate nearing 100%, prevention is of the utmost importance.” (2) In the United States, the annual incidence of sport-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season. Although the majority of athletes who experience a concussion are likely to recover, an unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury.

Signs of Concussions (Observed by Coach, Athletic Trainer, Parent/Guardian)
Appears to be dazed or stunned
Is confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loss of consciousness (LOC) of any length of time
Shows behavior or personality changes
Forgets events prior to hit (retrograde amnesia)
Forgets events after hit (anterograde amnesia)

Symptoms of Concussion (Reported by Student-Athlete)
Balance problems or dizziness
Double vision or changes in vision
Sensitivity to light/sound
Feeling of sluggishness
Feeling of fogginess
Difficulty with concentration, short term memory, and/or confusion

Unequal Pupil size
Irregular eye movement
Headache that continues to increase in intensity
Irregular respiration
Increasing impairment of cognitive, behavioral or motor ability

Recovery Athletes that are not fully recovered from initial concussion are significantly vulnerable for recurrent and catastrophic consequences of a second concussive injury. Such difficulties are prevented if the athlete is allowed time to recover from concussion and return to play decisions are made carefully. No athlete should return to sport or other at-risk participation when symptoms of concussion are present. The best way to prevent difficulties with concussion is to manage the injury properly when it does occur.


What is Second Impact Syndrome?  Second impact syndrome occurs when an athlete returns to sport too early after suffering from an initial concussion. The athlete does not need to receive a strong second blow to the head to set the effects in motion. The athlete may receive only a minor blow to the head or a hit to the chest or back that snaps the head enough to have the brain rebound inside the skull. Because the brain is more vulnerable and susceptible to injury after an initial brain injury, it only takes a minimal force to cause irreversible damage. The brain’s ability to self-regulate the amount of blood volume to the brain is damaged resulting in increased cerebral blood volume which can result in brainstem herniation and death. The pressure to the brain increases rapidly causing brain death in as little as three to five minutes. Because brain death is so rapid, second impact syndrome has a high fatality rate in young athletes.

Any athlete that has any signs and symptoms of a concussion after significant impact is to be removed from play until a Licensed Athletic Trainer or Physician rules out concussion. If an athlete has a baseline Impact test the post-injury test will be given 24-72 hours after the injury to determine the severity of the post concussive symptoms. After it is determined that an athlete has a concussion, the parent is contacted, an adult must pick up the student, and a referral will be given to be evaluated by The Sports Medicine Program at Dartmouth-Hitchcock Concord offices; and/or the Primary Care Physician.

Return to Play Guidelines
*****Any Athlete that has sustained a concussion has to provide a Concussion or Head Injury Return To Play Form or a similar health care provider form documenting a physician’s written clearance for the student to return to practice and games.

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