The diagnosis and management of concussion

Many parents with high school sons will be receiving letters from their respective schools regarding computerised testing for the enhanced management of concussion should their son suffer a knock to the head on the sports field during 2012. The Discovery Sharksmart Pupil Wellbeing Survey conducted recently on 15000 KZN high school pupils showed that approximately 15% of respondents reported having being concussed in the previous twelve months. Being self reported, this figure is probably lower than it really is, and furthermore the incidence in rugby players alone is probably two to three times higher.

The diagnosis and management of concussion is primarily a clinical one and is conducted by doctors. However, decisions based on clinical symptoms and signs alone can be subjective. The global concussion management guidelines adopted by most of the major sports federations worldwide thus recommend computerised neurocognitive testing as an adjunctive to clinical management in order to provide a more objective assessment of a concussive injury to the brain.

Neurocognitive testing is computer based and measures functional brain parameters such as memory and reaction times. Typically a baseline test is completed at the school at the beginning of the year and the results of this are then used as an individualised benchmark against which future post concussion tests can be measured.

After a player is concussed, the test is repeated as soon as the patient reports that his concussive symptoms have resolved, and he is feeling completely better again. If the results of the test are the same as the individual's base line test, that player can then commence a graded five day return to play training protocol. The International Rugby Board earlier this year discarded the mandatory three week post concussion layoff for age grade rugby players in favour of this more individualised approach. This leaves the critical decision of when it is safe to return to play open to manipulation by players, making the use of neurocognitive testing all that more relevant.,

The management of a concussed player consists of complete mental and physical rest until such time that the player's symptoms have resolved completely. Once the patient reports absolutely no symptoms related to the concussion, and the results of the neurocognitive test are normal, he can then start light training , increasing in intensity daily for five days. If the symptoms do not recur during this process, the player is then declared fit to play and participate in contact activities. The duration of this process can vary from one week to several months depending on the severity of the concussion. These guidelines determining safe return to play are adopted worldwide, but are unfortunately not often followed.

Discovery Sharksmart uses Impact as the programme of choice as it appears to have the most research backing it, is most widely used in sport internationally at all levels, and is the only neurocognitive concussion test registered with the Health Professions Council of South Africa. Clearly its use it not restricted to rugby players, but can be of benefit to all sports men and women participating in any sporting activity where concussion can occur.