By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
• The NCAA recently released a concussion guideline that presents clear definitions and processes for collegiate athletes in all sports
• The vast majority of concussions will not have a loss of consciousness
• In my opinion it would be helpful at the high school level for athletes to have preseason baseline concussion testing; suspected concussion in-season would be compared to the baseline
• Return to classroom function can also require individual decision making, and students with pre-existing conditions such as ADHD, migraines, or depression may require extended assistance to successfully return to academics
I hope that someday soon we won’t have to write as many posts and articles about concussion. But for now we still need to improve awareness about recognition, treatment, and long term effects from concussion.
In an attempt to bring a comprehensive and clear set of processes around sport related concussion for men and women in all sports, the NCAA recently released their “Diagnosis and Management of Sport Related Concussion Guidelines”. There are a number of excellent points raised in the guideline, many of which bear repeating as they are applicable in youth sports too.
One of the most important points is that our current understanding of concussion is evolving based upon available scientific evidence and consensus statements authored by concussion experts. As we gain more knowledge it’s become clear that the vast majority of concussions occur in awake individuals who do not lose consciousness. Furthermore, the symptoms of concussion often clear up very rapidly. In fact at the high school level I find that most of our concussed athletes have returned to their baseline level of cognitive and neurologic function within about 15 minutes from the concussion event. At the high school level it would be very helpful for the head trainer to have a preseason discussion with the parents and coaching staff about this important point.
A second important point is that in the NCAA they will require baseline concussion testing in the preseason for all athletes. The baseline testing could be computer based or paper based but the point is that the athlete with a suspected concussion would undergo the same testing as they had in the preseason and would be compared for differences, thus supporting the diagnosis of concussion. A return to baseline values on the testing would be required for the athlete to start a return to play process. This will be difficult to implement at the high school level due to cost and a number of logistical issues. However, I believe the rationale is clear and if a high school is able to have some form of preseason cognitive testing for their athletes then I believe they should do it.
Finally, the NCAA guidelines highlight the need for a stepwise progression not just for return to play, but also a return to academics. They refer to this as “return to learn”. Great phrase. Some students will have concurrent conditions such as ADHD, migraines, or depression that will contribute to a potentially slower recovery from concussion. The take home point here is that young athletes must have an individualized approach to return from concussion and that medical professionals may need to work with school administrators and counselors to ensure the best environment for the student to return to normal function.