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Impact.
Sport NI Concussion Care Pathway.
NI Sports
Concussion
Care Pathway
Impact.
Sport NI Concussion Care Pathway.
• Please find here information and resources to help manage Sports
Concussion in Northern Ireland.
• Successfully treating Sports Concussion requires moving through the
following three pillars of management
Early
Recognition
Management
Return to Sport
Protocols
NI Sports Concussion
Guidelines.
NI Sports Concussion Guidelines.
Caution
Age Group
Minimum period of
rest
Period between
progression in
Graduated Return to
Play Protocol.
Minimum period
between
Concussion and
return to full impact
sport
Under 20’s
2 weeks
2 days
21 days
Adults
1 week
1 day
14 day
Athletes should only
commence return to
play protocol when
medically cleared to
do so.
NB. Some sports
recommend longer
return to play time
frames than are
recommended here.
1 )What is1)
What is
Concussion
it?
Medical
Discharge
Advice.
Early Recognition
3) Assessing
concussion.
2)Recognising
concussion.
1) What is Concussion
• Concussion is a traumatic injury that causes alterations in brain function
occurring either by receiving a direct hit to the head, or an indirect impulse
to the head via the body.
• Concussed athletes are at high risk of sustaining a more severe brain injury
if they receive a second impact.
• Most athletes are unaware they have sustained a concussion and don`t
lose consciousness. It is important therefore that we recognise concussion
and remove athletes from play. Athletes who have been concussed should
not return to play until they have been medically cleared to do so.
• Thankfully the majority of concussions resolve with several days of rest.
2) Recognising Concussion.
If an athlete sustains a concussion they may exhibit signs and symptoms immediately, or
they can develop over a number of hours through to the following 1-2 days.
Some signs of a serious head injury are obvious with the athlete requiring urgent medical
assessment – examples include an athlete who is knocked out, an athlete lying motionless,
having seizures or losing their balance and falling over.
However, on most occasions the signs of concussion are more subtle causing changes only
to an athletes behaviour or how they look. The following clues may alert you to
concussion:
• Visible signs: dazed/blank facial expression, vomiting, lack of co-ordination/balance.
• Behavioural changes: confusion or repeatedly asking the same questions, lack of
awareness in where they are at, or of recent events, agitation.
• Athlete may complain of: headache, a pressure in their head, dizziness, blurred vision.
3) Assessing concussion.
• If you suspect someone is concussed remove them from play and get them
medically assessed.
• Concussed athletes sometimes have difficulty remembering recent events. It is
useful to assess for this as it may help confirm a concussion. Appropriate
questions can be found on the “Pocket Scat” tool attached below.
• Please record anything you have observed on a “Pocket Scat Document” so that
this information can be transferred with the athlete for any subsequent medical
assessments. Concussed athletes will often forget events which occur around the
time of their concussion and are therefore unable to describe this to someone
managing their condition.
• Pocket scat
• http://bjsm.bmj.com/content/47/5/267.full.pdf
Medical Discharge Advice.
• Document to be created.
Acute
Episode
Management
Returning to
Sport
Fundamentals
of treatment
Physical
Rest
Unresolving
sysmptoms
Management
Concussion
assessment
tools
Cognitive
Rest
Fundamentals of Treatment:
“Rest the Body-Rest the Brain”.
• The mainstay of concussion treatment is simply Rest! Both Physical and
Mental Rest.
• 80-90% of Concussions resolve spontaneously within 7-10 days.
• Symptoms should be clear before you return to Sport.
• It is recommended you seek medical clearance to ensure your symptoms
are clear and that it is appropriate to begin return to play protocols.
• Returning to sport when the brain hasn’t completely recovered is
dangerous and an athlete can be exposed to “second impact syndrome” if
they receive another trauma. Young athletes are at greater risk of second
impact syndrome and this can be fatal.
Physical Rest
• Thankfully most concussions resolve with rest. It is important that the
athlete avoids exercise until symptoms settle. Why? Raising blood
pressure and heart rate can aggravate symptoms and slow down
recovery.
• When we recommend avoiding exercise we don’t expect athletes to
become completely bedbound…it is OK to stand, walk, and move
around.
• Once symptoms have settled and you have been medically cleared to
recommence exercise then you should follow a return to play
protocol specific for your sport. A generic return to sport protocol is
provided in this resource.
Assessment tools
• As there are currently no absolute diagnostic tests for Concussion the
current best practice guidelines suggest we use the following tools to
aid decision making:
• Adults SCAT3
• http://bjsm.bmj.com/content/47/5/263.full.pdf
• Children SCAT3 ages 5-12.
• http://bjsm.bmj.com/content/47/5/263.full.pdf
• Videos and demos available at World Rugby Concussion Resource:
• http://playerwelfare.worldrugby.org/?documentid=module&module=
22&page=681
Un-resolving Symptoms- advice for Medical
Providers.
• Unfortunately a small number of athletes have ongoing problems following
concussion. Athletes may present with any of a wide array of ongoing
symptoms that long term may be classed as Post Concussion Syndrome.
• Common problems are ongoing sleep disturbance, headaches, dizziness,
sensitivity to light or noise, mood disorders to include irritability.
• If an athlete is symptomatic beyond 2 weeks consider onward referral to
Secondary care. Providers of this specialism would be Sports Medicine
Departments /Neurology /Neurosurgery Departments.
• Sometimes Concussions have associated vestibular or cervicogenic
components that influence ongoing symptoms of dizziness, headache and
balance disturbance. Where this has been identified then appropriate
treatment should be delivered by other disciples such as Physiotherapy.
Cognitive Rest
• As concussion is a mild brain injury – it is recommended that athletes avoid working their brain
“too” hard until their symptoms settle.
• Concussion often affects our cognitive ability such that it is hard to concentrate and process
information. This can affect our ability to work or study.
• Cognitive activity is defined as anything that taxes the brain. This would include anything from
reading, to doing homework, to watching TV or going to a movie, and it also includes texting,
being on the phone, or being on the computer.
• Current research suggests that concussed individuals who engage in high levels of cognitive
activity take longer to recover than individuals who modify their cognitive activity. Naomi Brown :
Pediatrics.
• It is therefore advised upon sustaining a concussion that the athlete to take 1-2 days off
work/school to recover.
• Prolonged absence from school/work is generally not felt to be constructive. Upon return to
school or the workplace some temporary adjustments may need to be made to ensure that the
injured brain isn’t overexerted too early, provoking symptoms and delaying full recovery.
NI Sports Concussion Return To Learn Protocol
Stage
Immediate Post
Concussion
Initial Cognitive
activity.
Moderate Cognitive
Activity.
Full Cognitive
Activity.
Advice
48 hours complete
cognitive rest.
Engage in short
periods of activity
requiring attention.
Recommence
activities requiring
sustained
attention/concentra
tion.
Engage in all
activities that
involve full
concentration and
retention of
information.
Practical
implication.
Rest at home in a
quiet environmentavoiding reading,
homework, texting,
computers, gaming
etc.
Return to
environments which
involve
conversation. Try
short periods of
watching TV. Take a
walk outside.
Continue to avoid
activities that
require processing
or retention of
information.
Return to lessons,
recommence
reading, homework.
Short periods of
gaming.
Recommence study,
attend all
lectures/exams. Use
computers/gaming
Standardised letter
for educational
institutions/
employers.
Resources/Links
• Effect of Cognitive Activity Level on Duration of Post-Concussion
Symptoms:
• http://pediatrics.aappublications.org/content/pediatrics/early/2014/
01/01/peds.2013-2125.full.pdf
Return to Play Protocol