Hockey season is getting ready to start and the sport of hockey can be quite dangerous. It is important for players to know how to prevent and treat injuries that occur during games. Unfortunately, these injuries leave us with some questions with descriptions such as “lower-body” and “upper-body” injuries. These injuries are purposely vague to leave some question as to the exact nature of the injury.
The accompanying infographic gives players an assist by listing off some common “upper body injuries.” It features tips and tricks to remain healthy both on and off the ice. The following should ease the minds of players who want to play the game as safely as they possibly can.
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All head injuries should be treated seriously. While most won’t cause lasting effects, if improperly treated, they can lead to long-term disabilities or even death.
The most common type of head injury is a concussion. It is a jarring trauma to the brain that can cause a person to lose consciousness or have amnesia.
What do you do if you are around someone who experiences a serious head injury or concussion? You may have heard that you should not let the person go to sleep, but is this true? Most health professionals don’t think so. It is generally considered safe for people with head injuries or concussions to go to sleep. In some cases, a doctor may recommend waking the person regularly to make sure his or her condition has not worsened.
Evidence for the Health Claim
Many people will go to great lengths to keep a person who has had a head injury from falling asleep. They argue that keeping the person awake will decrease the risk that he or she slips into a coma.
This misunderstanding probably stems from hearing about a rare occurrence known as a lucid interval that has been associated with certain types of severe head injuries. A lucid interval occurs when the initial bleeding in the brain does not cause loss of consciousness. The bleeding eventually worsens and brain structures become compressed. The person’s condition can rapidly deteriorate, requiring emergency brain surgery.
Evidence Against the Health Claim
Most medical professionals say it is fine—sometimes even advised—to let people sleep after incurring a head injury.
The American Academy of Family Physicians states it is not necessary to keep a person awake after a head injury. If a person needs to be watched that closely, a doctor will most likely admit him or her to the hospital. The Dartmouth College of Sports Medicine advises that it is fine to go to sleep after a concussion so long as someone wakes you up every two hours. They are to check to make sure you can be easily awakened and aren’t displaying symptoms of a worsening condition.
In a study in the September-October 2005 issue of the Journal of Head Trauma Rehabilitation, researchers reported greater levels of fatigue in people who have had head injuries, compared with those who have not. The researchers concluded that regular rest breaks and increasing intervals of restful sleep should be a part of the rehabilitation from head injury.
If you are around someone who has a head injury or possible concussion, monitor the symptoms closely. It is important to call a doctor or go to a hospital immediately if the person has worrisome symptoms such as:
• Open wound in the scalp or misshapen deformity of the skull
• Severe or progressive worsening headache
• Changes in behavior (eg, confusion, restlessness, irritability, lethargy)
• Dilated pupils or pupils of different sizes
• Convulsions or seizures
• Difficulty waking from sleep
• Trouble walking or speaking
• Bleeding or drainage of fluids from nose or ears
• Unusual sleepiness or decreasing alertness
• Severe or persistent nausea, or vomiting more than twice
• Weakness or numbness in the arms or legs
When a head injury is serious enough to require medical care, a doctor will give you instructions on how to monitor and treat the injury once the person is released from the hospital or clinic. These instructions will generally not include keeping the person awake and alert.
More PTandMe articles about concussions can be found here:
Head injuries. KidsHealth.org website. Available at: http://www.kidshealth.org/parent/firstaid_safe/emergencies/head_injury.html. Accessed November 5, 2008.
Head injuries: what to watch for afterward. Familydoctor.org website. Available at: http://familydoctor.org/084.xml. November 5, 2008.
Head injury: concussion. Dartmouth College of Sports Medicine website. Available at: http://www.dartmouth.edu/~sportmed/concussion.html. November 5, 2008.
Radiology for traumatic brain injury. Trauma.org website. Available at:http://www.trauma.org/neuro/neuroradiology.html. Accessed July 23, 2006.
Subjective reports of fatigue during early recovery from traumatic brain injury. Journal of Head Trauma Rehabilitation. 2005;20:416-425.
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Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious.
Once an athlete has been suspected of having a concussion… when is it safe to go back to play? The answer is different for everyone, but there are few baseline tests that medical professionals can administer to make sure that a gradual return to play, work and activity is safe and won’t lead to further damage.
When an athlete has a concussion, it’s important to know how much their functional and cognitive abilities have been affected. With a baseline test you give medical professionals an accurate starting point to correctly evaluate the impact of the injury.
FAQs about Concussion Baseline Testing
Concussion baseline testing is a pre-season exam conducted by a trained health care professional. Baseline tests are used to assess an athlete’s balance and brain function (including learning and memory skills, ability to pay attention or concentrate, and how quickly he or she thinks and solve problems), as well as for the presence of any concussion symptoms. Results from baseline tests (or pre-injury tests) can be used and compared to a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion.
Baseline testing generally takes place during the pre-season—ideally prior to the first practice. It is important to note that some baseline and concussion assessment tools are only suggested for use among athletes ages 10 years and older.
How is baseline testing information used if an athlete has a suspected concussion?
Results from baseline testing can be used if an athlete has a suspected concussion. Comparing post-injury test results to baseline test results can assist health care professionals in identifying the effects of the injury and making more informed return to school and play decisions.
Education should always be provided to athletes and parents if an athlete has a suspected concussion. This should include information on safely returning to school and play, tips to aid in recovery (such as rest), danger signs and when to seek immediate care, and how to help reduce an athlete’s risk for a future concussion.
What should be included as part of baseline testing?
Baseline testing should include a check for concussion symptoms, as well as balance and cognitive (such as concentration and memory) assessments. Computerized or paper-pencil neuropsychological tests may be included as a piece of an overall baseline test to assess an athlete’s concentration, memory, and reaction time.
During the baseline pre-season test, health care professionals should also assess for a prior history of concussion (including symptoms experienced and length of recovery from the injury). It is also important to record other medical conditions that could impact recovery after concussion, such as a history of migraines, depression, mood disorders, or anxiety, as well as learning disabilities and Attention Deficit/Hyperactivity Disorder.
Baseline testing also provides an important opportunity to educate athletes and others about concussion and return to school and play protocol.
Who should administer baseline tests?
Baseline tests should only be conducted by a trained health care professional such as a physician, physical therapist or trained ATC.
Who should interpret baseline tests?
Only a trained health care professional with experience in concussion management should interpret the results of a baseline exam. When possible, ideally a neuropsychologist should interpret the computerized or paper-pencil neuropsychological test components of a baseline exam. Results of neuropsychological tests should not be used as a stand-alone diagnostic tool, but should serve as one component used by health care professionals to make return to school and play decisions.
How often should an athlete undergo concussion baseline testing?
If baseline testing is used, research suggests that most components of baseline testing be repeated annually to establish a valid test result for comparison. Baseline computerized or paper-pencil neuropsychological tests may be repeated every 2 years. However, more frequent neuropsychological testing may be needed if an athlete has sustained a concussion or if the athlete has a medical condition that could affect results of the test.
Many physical therapy clinics have therapists that have been trained in baseline testing software and techniques. Physical therapists can also specialize in return to sport programs for athletes that have experienced concussions. The decision of when you go back to your sport can be a critical one… especially if you go back to soon. Prevent this by having an accurate baseline available for your healthcare professionals.