Several years ago, the MBRC committee adopted a comprehensive concussion policy. It details what to look for and what to do in the event of a suspected concussion. It includes an easy to follow flow chart. In addition, each MBRC coach carries a concussion card with them when working with our athletes, and they all know they must call me if any athlete suffers any injury (especially a potential concussion).
Within our concussion management plan, ALL members are required to undertake a simple test to establish a baseline "normal" cognition score. Our Club is using the Axon Test, which was developed in Melbourne. Go to www.sportsconcussionaustralasia.com for comprehensive information about concussion and access to the test.
The test requires the athlete to play an electronic game of cards on any laptop or pc which has an internet connection. It only takes a few minutes to complete - it is really simple to do, although it is probably better done when the young athlete is supervised by a parent. The result is that the athlete will have a baseline cognitive function score – I.e. a "normal" score – against which a post–injury test score can be compared. Then if the athlete has a suspected concussion, when they are able, they can retake the test and any change in score noted. A concussion will typically result in a lower score than baseline and this then offers the treating doctor a sophisticated tool in the monitoring of the athlete's recovery.
The baseline test is mandatory for ALL members (all athletes, as well as Masters and Coaches). Cognitive function testing in no way replaces the need for a doctor to assess and treat concussed athletes.
For further information please contact MBRC Medical Officer Dr Geoff Brooke.
Mt Buller Race Club Concussion Policy
■ Concussion refers to a disturbance in brain function caused by trauma.
■ Serious complications can occur if the athlete is returned to training or competition before having fully recovered from injury.
■ The key components of management include:
a) Suspecting the diagnosis in any athlete with symptoms such as confusion, blurred vision or headache after a knock to the head;
b) Referring that athlete for medical evaluation; and
c) Ensuring that the athlete has received medical clearance before allowing a return to competition or a graded training program.
c) Ensuring that the athlete has passed the After Injury Test before allowing a return to a graded training program or competition.
■ The cornerstones of medical management include rest until symptoms have resolved, cognitive testing to ensure recovery of brain function and then a graded return to a sport program with monitoring for recurrence of symptoms.
■ In general, a more conservative approach (i.e. longer time to return to sport) is used in cases where there is any uncertainty about the athlete’s recovery (“if in doubt sit them out”).
■ Difficult cases, such as those involving prolonged symptoms or deficits in brain function, require a more detailed, multi-disciplinary approach to management.
Any MBRC athlete with suspected concussion must be withdrawn from competing or training until medically evaluated and cleared.
Concussion is a relatively common injury in sport. It reflects a disturbance in brain function caused by trauma, rather than a structural injury. Resulting symptoms and changes in brain function are usually temporary and most recover spontaneously. The recovery process however, is variable from person to person, and injury to injury, and may take from just a few minutes through to several weeks.
Symptoms of concussion typically include headache, blurred vision, dizziness and nausea. Brain function is also affected. Changes include confusion, memory loss and reduced ability to think clearly, concentrate and process information. These deficits can impair the way an athlete reacts during competition, which may put athlete at risk of further head or musculoskeletal injury. Repeated head injury, particularly when the athlete has not yet fully recovered from a previous head injury, has been linked with a number of potential complications, such as prolonged symptoms and long-term deterioration of brain function. Therefore, it is important to make the diagnosis and manage the condition appropriately. This means keeping the athlete out of training and competition until fully recovered.
This document summarises management guidelines developed for care of MBRC athletes following a concussive injury.
Overall, these guidelines should serve only as a general guide for the management of concussive injuries. Treatment of individual athletes will be determined by the experience of the examining practitioner, the specific clinical circumstances presented and the resources available for assessment and testing.
On-site evaluation and treatment
The key components of initial management involve making an accurate diagnosis and careful monitoring of the injured athlete.
1. On-site assessment
- Loss of consciousness (LOC), confusion, and memory disturbance are classic features of concussive injuries, but these are not present in every case of concussion.
- Other symptoms that should raise suspicion of a concussive injury include: headache, blurred vision, balance problems, dizziness, feeling dazed, an athlete saying “I don’t feel right”, drowsiness, fatigue, difficulty concentrating or difficulty remembering.
- Any athlete with a suspected concussive injury must be removed from training or competition for further evaluation.
- The diagnosis can be confirmed using sideline mental status assessment tools.
- Basic first-aid principles apply when dealing with any unconscious athlete (i.e. “ABC” - Airway, Breathing, Circulation). Care must be taken with the athlete’s cervical spine, which may have also been injured.
2. Post Incident Action
- Children (i.e. athletes under 18) suffering a concussion injury must be seen by a medical practitioner as soon as possible after the incident.
- Indications for referral to hospital are listed in Table 1.
- Regular reassessment of symptoms and brain function in the hours following injury is essential to monitor for deterioration. This helps differentiate concussion (improvement) from structural head injuries (deterioration).
- If the athlete is discharged home after a medical examination, clear and practical instructions, particularly regarding abstinence from alcohol and driving, medication use, physical exertion and medical follow up, should be given to the athlete and relevant caregivers (e.g. parents, relatives, etc).
- Tools such as the Axon Test (www.sportsconcussionaustralasia.com) facilitate regular re-assessment of concussed athletes and provide simple and practical advice for patient education. It is preferential that athletes perform such a test prior to the season in order to obtain a baseline “normal” score, against which a post-injury score can be compared.
- It is important to note that abbreviated sideline evaluation tools are designed for rapid concussion evaluation. They are not meant to replace a more comprehensive cognitive assessment and should not be used as a stand-alone tool for the ongoing management of concussive injuries.
Indications for referral to hospital
- Deterioration of conscious state post-injury (e.g. increased drowsiness).
- Focal neurological signs (e.g. numbness or weakness in the arms or legs).
- Prolonged confusion (for more than 30 minutes) or loss of consciousness for more than one minute.
- Persistent vomiting or increasing headache post-injury.
- Where there is difficulty with assessment or uncertain follow-up
- High-risk patients (e.g. haemophilia, use of blood thinners).
- Children (under 18) suffering any concussion injury must be examined by a medical practitioner.
- Any athlete who has suffered from a concussive injury must obtain medical clearance before being allowed to return to training.
The basic principle of return-to-training decisions following concussive injury is to ensure that the athlete has fully recovered before being allowed to return to competition. In practical terms, this means resting the athlete until symptoms have resolved, then performing an objective test to assess recovery of brain function, followed by a graded return to play with monitoring for recurrence of symptoms (“concussion rehabilitation”).
- In every case, decisions regarding the timing of return to training should be made by a medical doctor with experience in concussive injuries. Do not be swayed by the opinion of athletes, coaching staff or others suggesting premature return to play.
- Cognitive tests can be used to assess recovery of brain function. These tests should be performed after symptoms have resolved. The important aspects of this testing involve comparing the post-concussion results to the athletes’ own pre-injury baseline and using a test that is sensitive to the effects of concussion. Ideally, computerised test platforms should be used. Overall, it is important to remember that cognitive testing is only one component of assessment, and therefore should not be the sole basis of management decisions.
- In general, a more conservative approach (i.e. longer time to return to sport) is used in cases where there is any uncertainty about the athlete’s recovery (“if in doubt sit them out”).
Returning on the day of injury
- MBRC athletes with concussion must not return to training or competition on the day of injury. The safest course of action is that the athlete not be allowed to return to the training session or competition.
Following a concussive injury athletes should be returned to play after medical clearance in a graded fashion (see below).
Early rest (do nothing!).
Graduated return to activity (to commence 24-48 hours after resolution of symptoms).
1. Light aerobic exercise e.g. stationary bike.
3. Mild training drills.
4. Full training.
- If symptoms recur at any stage of the “concussion rehab”, the athlete should be re-evaluated by their treating doctor.
- “Complex concussions” are cases in which symptoms or changes in brain function persist for more than 10 days, where the athlete has suffered multiple concussions over time or where the athlete has sustained a significant injury in response to a minor blow.
- These cases are best managed in a multi-disciplinary manner by doctors with specific expertise in concussive injuries.