Recovering From A Sports Concussion Not Just A Waiting Game

Matt Stresak, Physician's Assistant at the Sports Concussion Institute in Marina del Rey, California, talks about the Institute's pro-active approach to concussion evaluation and management.

Parents play an important role in their child's recovery from a suspected concussion.

Here's what experts say parents should do:

1. Regular and close monitoring for first 24 to 48 hours. Although most sport-related concussions are mild, the potential always exists for complications, some life-threatening (such as bleeding on the brain or second-impact syndrome). Such complications may occur immediately (minutes to hours) or over several days after the injury. If your child experiences any of the following signs of deteriorating mental status, take her to the hospital immediately:

   • Has a headache that gets worse

   • Is very drowsy or can't be awakened (woken up)

   • Can't recognize people or places

   • Is vomiting

   • Behaves unusually, seems confused or very irritable

   • Experiences seizures (arms and legs jerk uncontrollably)

   • Has weak or numb arms or legs

   • Is unsteady on his feet

   • Has slurred speech

2. Waking up: The traditional rule has been to wake up a concussed athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma. A good rule of thumb to use is to wake up your child during the night to check for signs of deteriorating mental status (see #1) only if he experienced a loss of consciousness or prolonged amnesia after the injury, or was still experiencing other significant post-concussion symptoms at bedtime. There is no need to check his eyes with a flashlight or test his reflexes.

3. Medication: Acetaminophen (e.g. Tylenol®) should be given sparingly after the injury. Avoid medications containing aspirin or non-steroidal anti-inflammatories (e.g. Ibuprofen/Advil®). An ice pack on the head and neck is okay as needed for comfort.

4. Drug use warning: Warn your child about the dangers of ingesting alcohol, illicit drugs, or other substances that might interfere with cognitive function and neurologic recovery.

5. Physical rest: Rest is important, but not complete bed rest. Allow your child to resume normal activities of daily living such as driving once symptoms begin to resolve or decrease in severity, but engage in exercise or training only after his symptoms have completely cleared, and return to physical and mental rest if symptoms recur.

6. Cognitive rest. Because activities that require concentration and attention may exacerbate post-concussion symptoms and delay recovery, youth athletes who have sustained concussions should limit their day-to-day and school-related activities until they are symptom free. This means no homework and staying home from school while symptomatic.

7. Graduated return-to-play. Recent concussion guidelines recommend that athletes follow a step-wise approach to return-to-play utilizing progressive aerobic and resistance exercise challenge tests.

8. Normal diet: Limited information is available regarding the recommended diet for the management of concussion. A normal well-balanced diet that is nutritious in both quality and quantity should be maintained to provide the needed nutrients to aid in the recovery process. Avoid spicy foods.

9. Further testing/management. Your child should be seen by a specialist if any of the following are true:

   • His post-concussion symptoms  last more than 10 days or recur with exertion;

   • He experienced concussive convulsions or loss of consciousness (LOC) of one minute or more at the time of injury;

   • He has suffered one or more concussions in the past, especially where they appear to be recurring with progressively less impact force (e.g. a minor blow); or

   • He has learning disabilities.

10. Trust your instincts. Be as involved in the management of your child's concussion as your instincts tell you to be. Don't be afraid to ask your child how he is feeling, or take him to his pediatrician or a specialist if you suspect something is wrong.