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Concussion and mild traumatic brain injury (TBI)

December 22, 2013

My high school rugby coach used to say, “A concussion happens when your noodle knocks against your noggin.” This rough definition–given by the rugged men of sport–is further refined and more eloquently expressed by genteel neuroscientists, who describe it as a disturbance in brain function, when an impulsive force is transmitted to the brain. Thus, the condition is also known as “minor traumatic brain injury.”

Concussion may or may not involve loss of consciousness. It can happen after a direct or indirect force to the head or body, when jarring forces are transmitted to the brain and “shake” it’s neurons into disarray.

Follow this link to read about pro hockey players speaking out about concussion.

Concussion should be suspected in the presence of any one or more of the following:

– Loss of consciousness – Headache

– Seizure or convulsion – Dizziness

– Balance problems – Confusion

– Nausea or vomiting – Feeling slowed down

– Drowsiness – “Pressure in head”

– More emotional – Blurred vision

– Irritability – Sensitivity to light

– Sadness – Amnesia

– Fatigue or low energy – Feeling like “in a fog“

– Nervous or anxious – Neck Pain

– “Don’t feel right” – Sensitivity to noise

– Difficulty remembering – Difficulty concentrating

It is important to involve an experienced professional early on.

All patients suffering a suspected concussion MUST not return-to-play the same day. Symptoms of concussion may be cumulative, and a second impact (while the brain is still healing) may result in massive brain swelling. Time away from sport is important to give the brain time to rest and recover but also to reduce the risk of re-injury while the brain is still very vulnerable.

Be aware! Recognition is critical.

“An estimated 30,000 Canadians a year experience a concussion. Put another way, each year roughly 1 in 5 athletes involved in some contact sports may suffer a concussion. In 2010 a study of Canadian hockey players, aged 16 – 21 years,  found that 25.3% of players sustained at least one concussion in a single season.”

“By the time children reach 10 years of age, 16% will have had at least 1 head injury requiring medical attention, and although head protection probably lowers risk, no specific type of headgear can be recommended.”

Remember, it is better to be safe. If concussion is suspected, see your doctor and do not return to play until medically cleared.

The following RED FLAGS require urgent attention

– Athlete complains of neck pain

– Deteriorating conscious state

– Increasing confusion or irritability

– Severe or increasing headache

– Repeated vomiting

– Unusual behaviour change

– Seizure or convulsion

– Double vision

– Weakness or tingling / burning in arms or legs

What will your doctor do?


Your doctor will decide whether you need a CT scan of the head. Even though concussions do not show up on imaging studies, such as MRIs and CATs, a doctor may identify clinical red flags that need to be investigated by brain scan. Depending on the circumstances, your doctor may perform an acute concussion evaluation or ACE, an Abbreviated Westmean Post Traumatic Amnesia Scale (A-WPTAS), complete a Sport Concussion Assessment Tool 3 (SCAT3), or track your symptom recovery with The Rivermead Post Concussion Symptoms Questionnaire.

Return to Learn and Return to Play


Graduated return-to-learn and return-to-play should be individualized, and follow a stepwise, multi-stage approach. It is usually a 5-step graduated increase in activity. This is to be done in consultation with a doctor. There should be at least 24 hours (or longer) for each stage and if symptoms recur, the athlete should rest until they resolve, and then resume the program at the previous asymptomatic stage. Resistance training should only be added in the later stages. Therefore, prior to normal game play, it will take a minimum of 5 days to go through each of the five steps in the graduated process. However, in many individuals it will take longer.

The Steps to Return to Play include:

  1. No Activity. Mental and Physical Rest until symptom free

  2. Light Aerobic Activity like walking or stationary cycling

  3. Sport Specific Activity like skating or running

  4. Training Drills without Body Contact

  5. Training Drills with Body Contact – only after clearance by a physician

  6. Game Play

Return to activity guidelines for children and youth.

Return to school guidelines for children and youth.

In children, a return-to-learn strategy needs to be discussed with the patient’s teacher after parents and school professionals have been educated on the condition. 

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