In the news there has been a handful of genuine cases of early degenerative brain function in retired professional rugby union, league and AFL players. Overseas in the NFL there have also been legal cases on similar lines. While these cases focus on adults, my concern was with the younger cohort. It would seem logical later in life that any young concussed player will have some (small) risk of premature neurodegenerative diseases. Where is the balance point between allowing them to play, have fun, experience team involvement, physical challenges and push their personal limits and long-term safety?
In the past few weeks while helping our son’s U16 football team, we have been involved in a fractured clavicle, possible ACL rupture, dislocated finger and two concussions (plus another that occurred at training). It has been the concussions that made me most uncomfortable – young children, long term neuro ramifications and their immediate want to continue playing. I realised I needed to know more than what I had learnt from my 1st Aid Course.
Apologies if I am arriving a bit late at the train station for some of you, but as I was researching and learning in this area I thought I would share some resources with you also and save you some time locating them yourself.
A key point in this discussion is that research is not finalised in this area (what area is!!) and continues to evolve. So even with the latest information in hand, a degree of common sense is still important and apply the "if in doubt, check it out" principal. In the case of children the guidelines take a more conservative approach, because of their immature neurology and the longer term time frames.
Due to an increased head to neck ratio and poorer developed cervical musculature, the same impact force will result in greater injury to a child than an adult.
It is generally accepted that less than 20% children experiencing concussion are diagnosed, and less than this seek medical attention. Recovery from concussion also generally takes longer in children.
What is Concussion?
The concussion can occur from a direct trauma to the head, or a jarring indirect impact through the body. Loss of consciousness is not required for a concussion to have taken place, something that I had not considered. With an estimated rate of probability of 1 in 7 players, the average football team can expect 2-3 concussions per season and more sports concussions occur in the pediatric age group than any other group.
Initial on field Assessment: while LOC is generally easy to determine (however it only occurs in approximately 10-20% of concussions), concussion should be suspected if the following symptoms are also present;
- Lying motionless on ground / Slow to get up
- Unsteady on feet / Balance problems or falling over / In coordination
- Grabbing / Clutching of head
- Dazed, blank or vacant look
- Confused / Not aware of plays or events / Altered personality
Remove from Field of Play
Following the initial on field assessment, if concussion is suspected the child should be removed from the field and located in a quite environment and the childSCAT3 (aged from 5-12 years) or SCAT3 (aged from 13-17 years) performed (see Resources section for free download links) by health staff. If no medically trained staff is present, the Pocket Concussion Recognition Tool is available for parents, helpers and other lay people to use (see Resources).
Some other concussion assessment tools are discussed here
Referral for Medical Management
The key components of management of a child suffering or suspected of suffering a concussion include:
- Must be medically assessed as soon as possible (Hospital or GP) after the injury and must not be allowed to return to play in the same game or on the same day
- Must not be allowed to return to school or return to training or playing before having a formal medical clearance
Return to Activity
- It is reasonable for a child to miss a day or two of school after concussion, but extended absences are uncommon. The best things to do initially are to rest from physical and mental activity
- Children are not to return to play or sport, until they have successfully returned to school/learning, without worsening of symptoms. Symptom assessment in the child often requires the addition of parent and/or teacher involvement
After medical clearance for sport is obtained, a graduated return to sport is recommended with the following progression;
There should be at least 24 hours (or longer) for each stage and if symptoms recur the athlete should rest until they resolve once again and then resume the program at the previous asymptomatic stage. Resistance training should only be added in the later stages.
If the athlete is symptomatic for more than 10 days, then consultation by a medical practitioner who is expert in the management of concussion, is recommended.