Concussion guide for doctors provides 6-step recovery plan

The author of a new six-step plan for Canadian doctors treating concussion patients warns that many people are unaware you don't need to hit your head to get a concussion.

Dr. Charles Tator of the neurosurgery division at the University of Toronto wrote in Monday's Canadian Medical Association And for doctors and other trained health professionals in remote regions who have the responsibility for diagnosing concussions, Tator's primer summarizes how to detect and assess the injury.

Concussions are the most common traumatic brain injury, often occurring during vehicle collisions, work activities, sports, recreation and falls in seniors.

It's now clear concussion can occur without direct impact to the head. For instance, a blow to the chest can cause a whiplash effect on the brain that jiggles the organ.

Everyone who is involved in sports should be aware of the importance of recognizing concussions, he said. 

The most frequent symptoms are headache, dizziness, nausea and imbalance. Only one symptom is needed for the diagnosis.

"The importance of accurate and timely recognition and management stems from the consequences of misdiagnosis or faulty management that can lead to major disability or death, in both the short and  long term," Tator wrote.

The six-step plan includes:

• No activity: complete physical and mental rest from play, work or school.
• Light exercise: walking, swimming, stationary cycling.
• Sport-specific exercise but no head-impact sports.
• More vigorous but non-contact training drills.
• Full-contact practice: normal activities after medical clearance.
• Return to full game play including contact.

The earliest that a concussed athlete can return to play is one week, the primer noted, adding most experts lengthen the period for children and youth.

Research suggests that the brains of young people are more susceptible to concussions than those of adults.

Female may be more prone to concussions

Females may be more prone to the brain injury than males, especially girls who play hockey and basketball, Tator said. It's suspected that women are more susceptible because their neck muscles aren't as developed as men's.

Kat Noh, 15, enjoys playing soccer, volleyball and basketball. The Toronto girl gave up basketball about 18 months ago after she fell and hit her head during a high school game. Her doctor told her she had a concussion.

"I'm really stubborn so he told me to stay out for the year, but I kind of made it into half the year," said Noh, who is back to informally playing soccer.

Neurosurgeons caution that when an athlete with a concussion returns to play before he or she recovers completely and has a second injury, "second-impact syndrome" can occur. While rare, a second concussion can lead to brain swelling that can result in major neurological effects or death.

While it's still not clear where in the brain concussion occurs, technologies like X-rays, CT scans and MRI cannot be used as stand-alone diagnostic tests.

In November 2012, Tator co-authored the consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich.