A concussion is an injury to the brain due to a direct or indirect blow to the head. The force of impact causes a metabolic imbalance within your brain at the cellular level. This imbalance is the cause of the symptoms you are experiencing.What should I watch for?
Although most concussions do not cause long-term or permanent damage, any concussion can be potentially dangerous because it affects the brain. As an athlete, you should be monitored for 24-48 hours for any signs and symptoms (or increase in symptoms) of a concussion. If serious problems are going to occur, they will generally show up during this time.Concussion Symptoms you may ExperiencePhysical Symptoms
- headache, dizziness, nausea, fatigue, problems with vision or balance, sensitivity to light/sound, vomitingCognitive Symptoms
- feeling of fogginess or slowness, difficulty with concentrationEmotional Issues
- irritable, more emotional, sadnessSleep Changes
- drowsiness, insomnia, more or less sleep than usual When to Seek Emergency Medical Care
It is always prudent to contact your physician if injured. Seek immediate medical care if any of the following symptoms develop:
- A headache that worsens
- Confusion that worsens
- Difficulty recognizing people or places
- Slurred speech
- Loss of consciousness
- Inability to be awakened
- Numbness in the arms and/or legs or neck pain
Do not take medications without the permission of your healthcare provider. Generally, you will be allowed to take acetaminophen (Tylenol). Be sure to avoid aspirin and aspirin containing products such as Excedrin or Midol; ibuprofen (Advil, Motrin), naproxen (Aleve) and any form of alcohol (cough syrups and cold medications included). Avoid medications that cause drowsiness.Treatment of Concussions
The most effective initial treatment for a concussion is rest. The rest must be both physical and cognitive.
- There should be no physical activity of any sort while you are experiencing concussion symptoms. Any activity that increases concussion symptoms or elicits new concussion symptoms is indication that those activities are too much for your injured brain.
- Cognitive activities (such as school work, reading, watching TV/movies, playing video games or texting) that increase existing concussion symptoms or elicit new symptoms indicate that those activities are too much for your injured brain.
Failure to stop activities that increase your symptoms or elicit new symptoms will actually slow your recovery.Concussion and School
Because cognitive and physical activities may be too much for you while you are suffering from a concussion, you will probably find that your schoolwork is impacted. Your health is your first priority so you must rest as much as needed, despite your concern about “getting behind”. This will allow you to recover as quickly and as uneventfully as possible.
Recent knowledge based on years of research shows that thinking, “exercising the brain,” and most cognitive tasks can prolong concussion symptoms and slow recovery. Exercise, whether physical or mental, will usually increase the symptoms of headache, dizziness, nausea and lightheadedness. Most students will have difficulty with concentration, memory, and the speed in which they process information - which negatively affects their school learning and performance. Symptoms are usually pronounced in the early post-injury phase, rendering the student unable to take tests. Struggling to learn and perform “overuses” the brain at a time when it is working hard to recover, and can negatively affect recovery.You should initially rest at home and avoid the following activities until headaches or other significant symptoms resolve:
homework, tests, papers and projects, reading, watching TV, computer use, video games, text messaging, physical exercise, bright lights, noise, hot tubs, socializing with friends (going to the movies etc.). In other words, REST. Once headache-free, you can begin brief periods of studying or reading. If symptoms return, you should discontinue the activity.
Returning to school is advised for gradual increasing periods of time once you can tolerate a couple of hours of thinking. Sleeping longer in the morning and coming to school later might be an option. Another option is rest time during the day in the nurses’ offices. The school nurse and grade chair should serve as liaisons between the teachers, athletic trainers and coaches to facilitate the above.Academic Accommodations
are generally required when you return to school following a concussion. Your physician will give you a recommended list of accommodations upon your return. Please turn this form in to the MS/HS nurse. She will be in close contact with the guidance counselor to see that the Accommodation Plan is communicated to your teachers.
Each concussion is unique, so it is impossible to predict your symptoms or course of recovery. Some concussed individuals are back to functioning at 100% in a few days; others take weeks or even months to recover. It is truly a day-to-day, week-to-week process. Your teachers are willing to work with you in making-up your school work and helping you stay on task with your academic studies.
Below are actions that other students with concussions have found helpful in aiding their recovery:Required Actions
- Let your guidance counselor know about your concussion so he/she can notify your teachers.
- Once you return to school, communicate with each of your teachers to discuss your class work and assignments.
- Do not attend PE classes. Report to the Infirmary so that you may rest during this time.
- Avoid band and chorus if loud noises make you feel worse. Again, report to the Infirmary to rest during this time.
- Rest in the Infirmary any time you don’t feel well but are not ready to go home.
- Come in late and/or go home early if fatigued.
- Stop all after school activities.
- Do not attend sports practice or games. Even sitting on the bench is too much.
- Make an effort to get extra sleep and rest.
Please know that if concessions are made in regard to schoolwork, then you also need to make concessions in regard to your activities outside of school. You should not attend practices, games, dances, retreats, movies, etc. if you are receiving academic accommodations. If you choose to do so, then your academic accommodations may be in jeopardy. If you fail to do your part in the recovery process, then a meeting with school officials may be required.ImPACT Test
The ImPACT test is a 30-minute computerized test that measures cognitive processing, memory, problem solving, and reaction time. Hopefully you took the ImPACT test while in good health and have a baseline on file. You will be asked to retake the ImPACT test a number of times (approx. every 5-7 days) until you are symptom-free and feel like you’re back to normal. If the test results are at your baseline or better, it indicates that your concussion has resolved. Once cleared by your physician, you may slowly begin to return to physical activity. Return to Physical Activity
It is important to allow the brain to properly heal before participating in any activity that could lead to another blow to the head. With repeated concussions, the severity and duration of symptoms can be much more serious and last far longer.
Once all concussion symptoms have resolved, your ImPACT test has returned to baseline (if you had a baseline test), and your health care provider has approved for you to return to physical activity, you must do so gradually. This will be coordinated by one of the athletic trainers. Typically, there should be a minimum of five days of increasing activity before you are ready to return to full, competition level play. Any activity that elicits concussion symptoms indicates that you are not fully recovered.
Day of Injury
____ Remove your child from all physical activity.
____ Read the handout “Concussion Care” regarding concussions and look for the signs and symptoms of a concussion. Seek immediate medical care (911 or Emergency Room) for your child if his or her condition worsens.Day After Injury
____ Keep your child home from school if he or she has any symptoms associated with his or her injury.
____ Contact Health Services so that they can send you additional information regarding concussions.
____ If it is a school day, notify the school Administrative Assistant that your child is home due to a concussion or possible concussion.
____ Consult with your child’s healthcare provider or a concussion specialist if your child has moderate or severe symptoms, or if his or her symptoms have become progressively worse.
____ Enforce cognitive and physical rest.
____ Encourage liberal fluid and carbohydrate intake.Second Day After Injury
____ Continue with all of the measures from the previous day.
____ If your child does not look or feel 100%, it is advisable to contact a healthcare provider (preferable a concussion specialist) if you have not already done so. A healthcare provider will be able to provide a more thorough assessment of your child’s status and can prescribe academic accommodations. Academic accommodations will allow your child to defer his or her school work as needed and until he or she is well.
____ If academic accommodations are instituted, your child may not participate in any extracurricular activities. Doing so will cause him or her to lose his or her accommodations. If your child is not well enough to complete his or her school work, they are not well enough to have fun.
____ If your child looks to be 100%, contact Health Services or one of the athletic trainers to discuss the situation. It may be appropriate for your child to retake the ImPACT test at this time to get more information regarding his or her recovery.Subsequent Days After Injury
____ Continue to limit cognitive activities as needed based on your child’s symptoms. Avoid all physical activity.
____ Touch base with your child’s grade chair, Health Services or one of the athletic trainers at least twice a week.After Passing the ImPACT Test
____ Encourage your child to meet with his or her grade chair to plan for completion of outstanding school work.
____ Work with your child’s physician or one of the athletic trainers to begin graduated return to play.
____ When your child has completed all required school assignments, he or she may resume attending extracurricular activities.
Children’s Healthcare of AtlantaDavid Marshall, M.D.
Medical Director, Sports Medicine Program at Children’s Healthcare of Atlanta
3155 North Point Parkway, Building A, Suite 100, Alpharetta, GA 30005
404-255-6202 (Schedule appointments with Daphne)
678-357-0738 (Use this number after hours
to obtain assistance from Dave Kloehs, Dr. Marshall’s assistant, for any Wesleyan sports-related concussion)J. Stephen Kroll, M.D.
Children’s Orthopaedics of Atlanta at Children’s Healthcare of Atlanta
5445 Meridian Mark Road NE, Suite 290, Atlanta, GA
404-255-1933 The Sports Medicine & Orthopaedic Institute of GwinnettMathew Pombo, M.D.
3855 Pleasant Hill Road, Suite 470, Duluth, GA 30096
770-813-8888Emory Orthopaedics & Spine CenterJeffrey Webb, M.D.
59 Executive Park South, Atlanta, GA 30329
General Scheduling: 404-778-3350
Ken Mautner, M.D.
59 Executive Park South, Atlanta, GA 30329
General Scheduling: 404-778-3350Please know that physicians on this list are familiar with the concussion protocols that we use at Wesleyan. It is, however, your option as a parent to utilize any concussion specialist who is not listed above.
Health Services Department Chair/LS Nurse