Dr. Lopez was trained in sports concussion evaluations under John Woodard (dissertation chair and doctoral mentor), neuropsychologist for the Atlanta Falcons and former associate psychology professor at the Rosalind Franklin University of Medicine and Science in North Chicago. Dr. Woodard is currently at Wayne State University.
A concussion is a Mild Traumatic Brain Injury (MTBI caused by mechanical forces that disrupt the normal functioning of the brain. The mechanical trauma that causes a concussion can be a direct blow to the head, face and neck, or an indirect blow elsewhere on the body. Loss of consciousness is common, but not necessary for the diagnosis of concussion. It can also be caused by shearing forces due to whiplash. It is the most common type of brain injury associated with sports. Once an athlete has sustained a concussion, they are at great risk of similar future injury. Multiple concussions can have cumulative and lasting consequences.
The signs and symptoms of a concussion may be slight and may not be noticeable at first. Once they appear, they can last for days, weeks or longer. The early warning signs include: headaches, light-headedness, poor concentration, trouble with memory, irritability, fatigue, increased sensitivity to bright lights and loud noises, and anxiety or depression.
Second Impact Syndrome (SIS) is a rare condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided.
A new cutting edge technology is now making it possible to more easily diagnose concussion symptoms. Pre-season baseline assessment consists of a short, computerized test administered prior to the beginning of the sports season that measures selected brain processes and scores the test for each individual athlete. If an athlete sustains a concussion during the season the result of a post concussion test is compared to pre-season baseline results to help determine the severity and extent of the injury.
Utilizing a baseline test on athletes can change the way concussions are identified and managed. A concussion is difficult to diagnose and even more difficult to treat. The data helps the physician and athletic trainer determine when the athlete’s brain functions have returned to baseline scores and when it is safe for the athlete to return to sports or activity.
Research confirms that multiple successive concussions have the potential for more severe and lasting problems for athletes. It is essential that the brain is given time to heal following a concussion. Physicians and trainers should be aware that it is common for athletes to minimize their symptoms in the midst of their drive to return to the field. The new computerized testing process is more objective and individualized than previous assessments, which will help to mitigate difficulty in diagnosing this disorder.
A negative MRI or CT scan does not rule out the existence of a brain injury. These tests measure structure and to some extent function of certain brain regions, and often cannot detect the temporary metabolic changes characteristic to Mild Traumatic Brain Injury. Imaging is valuable, however, in ruling out more severe problems such as hematomas and skull fractures.
Mild Traumatic Brain Injuries (or concussions) are extremely dangerous to athletes everywhere, not least because they are so difficult to diagnose. In addition, athletes often downplay their own symptoms for fear of being benched. It is crucial for all athletes to have a baseline of cognitive function established before the season starts so that inconsistencies caused by concussion can be teased out. It is also crucial to efforts of physicians and athletes to measure the healing process and determine when it is actually safe for them to resume their normal activities.
AAN Guidelines suggest observation for features of concussion in sports-related concussions:
- Vacant stare (befuddled facial expression)
- Delayed verbal and motor responses (slow to answer questions or follow instructions)
- Confusion and inability to focus attention (easily distracted and unable to follow through with normal activities)
- Disorientation (walking in the wrong direction, unaware of time, date. and place)
- Slurred or incoherent speech (making disjointed or incomprehensible statements)
- Gross observable poor coordination (stumbling, inability to walk tandem/straight line)
- Emotions out of proportion to circumstances (distraught, crying for no apparent reason)
- Memory deficits (exhibited by the athlete repeatedly asking the same question that has already been answered, or inability to memorize and recall 3 of 3 words or 3 of 3 objects in 5 minutes)
- Any period of loss of consciousness (paralytic coma, unresponsiveness to arousal.
- AAN Guidelines Suggest Monitoring for “Early” and “Late” Symptoms of Concussion
- Dizziness or vertigo
- Lack of awareness of surroundings
- Nausea or vomiting
Late Symptoms (days to weeks):
- Persistent low grade headache
- Poor attention and concentration
- Memory dysfunction
- Easy fatigability
- Irritability and low frustration tolerance
- Intolerance of bright lights or difficulty focusing vision
- Intolerance of loud noises, sometimes ringing in the ears
- Anxiety and/or depressed mood
- Sleep disturbance