Mild traumatic brain injury, or concussion, is a common consequence of collisions, falls and other forms of contact in sports. Concussion may be defined as an acute trauma-induced alteration of mental function lasting fewer than 24 hours, with or without loss of consciousness. Concussion is placed in the mild head injury category. It has taken many years for it to be recognised as a condition, particularly in the sporting world where the sports persons drive to return to their chosen sport over rides their awareness that they may be experiencing some ongoing symptoms. It is easy to trivialise these in the first instance but eventually a person will recognise the need to seek medical attention. It is of course preferable if they recognize their symptoms and report these early. If it occurs to a colleague on the sports field always treat it seriously.

It is estimated that 2/3rds of all people defined as sustaining a mild TBI will experience some post concussion symptoms. Most of these will recover within three months post injury. Approximately 30% have persisting symptoms, with 8% still reporting significant symptoms one year post injury.
An athlete should not be allowed to resume sports participation until all symptoms of a concussion have resolved.

Though not always visible and sometimes seemingly minor, head injury is complex. It can cause physical, cognitive and social, changes. Depending on the extent and location of the injury, impairments caused by a head injury can vary widely. The irony of mild head injuries, such as concussion, is that often, such injuries do not even require a hospital stay, yet they result in changes so profound that lives are forever changed.

Some common impairment includes difficulties with memory, mood, and concentration. Others include significant deficits in organizational and reasoning skills, learning, cognitive, and executive functions.

Signs and symptoms of a concussion may immediately follow the head trauma or evolve gradually over several minutes to hours. Early symptoms may include headache, dizziness, nausea or vomiting, slurred or incoherent speech, and imbalance or in-coordination. Signs of confusion may include a vacant stare, disorientation, delayed ability to follow instructions or answer questions, and poor concentration or attention. Signs of disorientation include a loss of sense of time or place. For example, signs would be evident in a dazed-appearing athlete walking in the wrong direction on the playing field.
There is a growing body of evidence that indicates that a person is at greater risk of sustaining a second concussion injury after their first injury. Repeated concussion injuries can lead to greater symptoms that persist for a prolonged period of time. These people should not return to sport until medically cleared.
If concussion symptoms do not resolve within three weeks it may be advisable to be reassessed by a medical practioner. Trained Neuro-rehabilitation physiotherapists and OTs can then begin the process of rehabilitation for the various symptoms, such as fatigue; dizziness; poor concentration and memory; reduced balance and high level co-ordination issues.

ACC have developed some good flow charts for sports coaches and other parties are able to access from their web site.

Lynda Wheeler is a neurophysiotherapist working at Synergistics Wellness Centre.