Concussion/ Head Bump Information

  • What is a concussion?

    Our brain is soft, sort of the consistency of gelatin. Cerebrospinal fluid surrounds the brain and acts like a cushion between the brain and skull.

    A blow to the head can cause the brain to hit the inside of your skull tearing nerve fibers and blood vessels, cause bleeding and/or bruising.

    All concussions interfere temporarily with the way the brain works. They can range in severity from mild to severe.

     

    What to do if your student has a diagnosed concussion

    Please notify the SC nurse - 206-393-4308 - if your student is diagnosed with a concussion. The past two years have demonstrated a much larger number of students being diagnosed with concussions. I don't think they are actually occurring more frequently, I think the medical community is being much more aware of head injuries and is assessing everyone more effectively.

    We have developed a notice that is given to teachers when parents let the nurse know their student has sustained a concussion. You can download that from the Documents section of this web page. The suggestions in it are taken from notices a variety of physicians have given us. It is intended to help teachers understand the impact of a concussion and provide guidelines to help them work with your student to help them in their individual recovery. We would certainly provide what your private physician would give if they have their own specific requests.

     

    What are some symptoms of a concussion?

    • "seeing stars", feeling dazed, dizzy, or lightheaded
    • memory loss, such as trouble remembering things that happened right before and/or after the injury. Asking the same question over and over that has already been answered.
    • Slow to answer questions, inability to focus or follow directions
    • Disorientation such as walking in the wrong direction, not knowing date and time
    • nausea or vomiting
    • headaches
    • blurred vision and sensitivity to light
    • slurred speech or saying things that don't make sense
    • difficulty concentrating, thinking, or making decisions
    • difficulty with coordination or balance, stumbling, not able to walk straight
    • feeling anxious or irritable or crying for no apparent reason
    • feeling overly tired

     

    What should I do if the nurse calls me and reports my student has had a blow to the head at school?

    It is never a bad idea to call your health care provider to talk to them about what happened at school and report what, if any symptoms, your student currently has. They can best advise you if your student should be seen immediately or if you can just watch for symptoms and report back to them.

    The nurse may or may not ask you to come and pick up your student. If there are no apparent symptoms, your student will be observed in the health office and then returned to class. If your student has a PE class, the nurse will excuse your student from participating that day just as a precaution. If your student returns to the nurse with any symptoms, you will be called immediately to pick your student up. 911 will be called if the symptoms are progressing.

    One never knows just what sort of blow may lead to a concussion. I strive to keep parents informed of any possible concussing blows that occur at school that students report. I call parents to inform them of the incident, remind them of what to look for and to seek medical attention immediately if symptoms appear or progress. I also encourage parents to call and let their health care provider know the incident happened and seek their advise if the student needs to be seen that day.

    If your student sees their health care provider and/or if they have increasing symptoms at home, PLEASE call the nurse and share that information before the student returns to school. I can best serve your student if I have current health information and appreciate being kept informed. We can discuss if the information should remain confidential or if your student would benefit having their teachers also be aware of what to look for and report or possible side effects that may impact their performance in class.

     

    There are 3 grades of concussions commonly used to describe severity.

     

    Grade 1

    • No loss of consciousness
    • Some confusion, not able to maintain a train of thought, inattentive
    • Grade 1 symptoms or mental status abnormalities resolve in less than 15 minutes

     

    Grade 2

    • No loss of consciousness
    • Some confusion, not able to maintain a train of thought, inattentive
    • The symptoms or mental status abnormalities including amnesia last more than 15 minutes

     

    Grade 3

    • ANY loss of consciousness
    • Seconds to minutes

     

    What if my student does have a concussion?

    Your health care provider is the best resource for treatment and any possible activity restrictions. If you do not have health insurance or a current health care provider, the nurse would be happy to give you a selection of possible resources and/or help you apply for health care. You may ALWAYS go to an emergency room to seek help if your student is having symptoms of a concussion. Please seek medical attention immediately even if you do not have the ability to pay at that time.

    The following is information should NOT be used to diagnose or treat your student. It is given only as a resource for general information about concussions and current information from studies and observations by health care providers and researchers.

    After a concussion, the brain needs time to heal. It's really important to wait until all symptoms of a concussion have cleared up before returning to normal activities. The amount of time someone needs to recover depends on how long the symptoms last. Healthy teens can usually resume their normal activities within a few weeks, but each situation is different. A doctor will monitor the student closely to make sure everything's OK.

    The Brain Injury Association has compiled recommendations for student athletes who sustain concussions. They recommend an evaluation of the student covering mental status, physical activity and neurological tests. The following are their suggested evaluations. There are many possible evaluation resources including a computer generated test. This example is given just to provide an idea of what an evaluation may look like.

    Mental status testing:

    • Orientation – time place, person and how they got injured
    • Concentration – Months of the year in reverse order. Saying numbers in reverse order
    • Memory – Recall of 3 words and 3 objects at 0 and at 5 minutes after the injury. Details of the game they are currently playing. Recent news items they would normally know

     

    Physical Tests:

    • 40 yard sprint
    • 5 push-ups
    • 5 sit-ups
    • 5 knee-bends

    Any appearance of associated symptoms is abnormal, e.g., headache, dizziness, nausea, being bothered by light, blurred or double vision, emotional and/or mental status change

    Neurological Tests:

    • Individual can perform finger-nose-finger exercise
    • Individual can perform tandem walking

     

    Sensation:

    • Individual performs finger-nose-finger exercise with eyes closed
    • Romberg – this is a test that has the student stand with their head tilted slightly back and their eyes closed. They are instructed to say stop when they think 30 seconds has passed after the tester says go. Most adults/high school students that are not impaired will simply count slowly to 30 and come very close to saying stop at exactly 30 seconds.

     

    Strength:

    • Individual is fully strong in all muscle groups. The tester will have them grip fingers, do some pushing exercises etc.

     

    Suggestions for when a student athlete may return to play:

     

    Grade 1

    • Grade 1 Concussion — 15 minutes
    • Multiple Grade 1 concussions — 1 week

     

    Grade 2

    • Grade 2 concussion — 1 week
    • Multiple Grade 2 concussions — 2 weeks

     

    Grade 3

    • Grade 3 Concussion — 2 weeks
    • Multiple grade 3 concussions — 1 month or longer based on the decision of the evaluating physician

    There are other opinions that greatly increase the amount of time a student should be out with an initial Grade 1 concussion – minimum of 1 week and Grade 2 for 2 weeks

    The recommendation for multiple concussions was doubled.

    All resources seemed to agree that having more than one concussion especially if they are close in time, greatly increases the negative effects on the brain and prolong recovery.

     

    Second Impact Syndrome

    Second impact syndrome occurs when the already swollen brain is re-injured and swells further.

    Repeat concussions significantly worsen the long-term outcomes. After a person sustains one concussion, they are 3 times more likely to sustain another compared to those who have never sustained one concussion. The brain has been rendered vulnerable to further injury.

    What may have been a Grade 1 injury now may go to a Grade 2 because the brain has already been injured with a second blow to the head. Headaches, memory loss and difficulty concentrating are much more at risk of happening with a second injury.

    The more concussions a person sustains, the higher the risk for long-term memory functions.

    Sustaining a second concussion within 2 weeks of the first also greatly increases the possibility for more severe symptoms.

    Tests have also been done showing those who have sustained multiple concussions are more likely to get Alzheimer’s Disease 8 years earlier than those who had no known earlier brain injury.

     

    Resources:

    Brain Injury Association

    kidshealth.org

    mayoclinic.com

    emedicinehealth.com