ATTENTION PARENTS AND ATHLETES!

CONCUSSION EVALUATION FORM FOR COACHES
This form is for use by coaches to assess the athlete for a concussion.

SCAT CARD: SPORT CONCUSSION ASSESSMENT TOOL
This card is for use by medical personnel to assess the athlete for a concussion.

Girls Are Often Neglected Victims of Concussions - N.Y. Times, October 2, 2007

"According to the Centers for Disease Control and Prevention, 20 percent of the brain injuries that occur yearly in the U.S. can be attributred to athletics. That is more than 300,000 concussions! High school, college and amateur athletes receive most of these injuries, because thee are so many more of these players than there are pros." 1 There are an estimated 62,800 concussions annually among high school students nationwide. 2 Data from the NCAA Injury Surveillance System for the perior 1994-1996 estimated that more than 1500 concussions occur annually in college football. 3

"'This is a major public health issue that's been geven short shrift,' says Michael W. Collins of the Henry Ford Hospital in Detroit. 'It's underrecognized, underdiagnosed and misdiagnosed. It's happening with alarming frequency at the high school, college, and professional levels." 1

"A single blow to the head can cause a whole range of symptoms, from problems with balance and coordination to impaired decision making, failing memory and personality changes. Unless the injury is severe, patients generally recover with time. But most athletes return to games or practices far to soon. A second blow before a consussion is fully healed has a far greater chance of imposing more serious, long-lasting harm." 1

393 college football players were studied and about one in three had suffered a concussion and one in five had suffered two or more. Those who had suffered two or more were significantly more likely to report continuing problems with headaches, sleep and concentration, and they scored significantly worse on tests of the ability to learn words, to think quickly and to handle complex tasks. 2

Players who had learning disorders fared even worse if they had two or more concussions, suggesting that the disorders make the brain especially vulnerable to jarring head injuries. 2

Another study in JAMA reported that amateur soccer players scored lower on tests of memory and planning than other amateur athletes did, and that repeated blows to the head may be the culprit. 2

WHAT IS A CONCUSSION?
"The definition of concussion is a post-traumatic impairment of neural status. While the loss of consciousness and amnesia may have been viewed as the primary components of this injury and have formed the basis for most grading scales, some of the mild concussions, the so called 'bell-rung' or 'ding,' with no resulting loss of consciousness or post-traumatic amnesia, may go unrecognized by coaches, athletic trainers, fellow players or team physicians." 3

The brain sits inside a bony encasement called the skull. A collision, abrupt stop or whiplash motion can cause the brain to slam up against the inside of the skull like a pinball. Most of the time the brain tissue itself is not damaged (except in the worst cases), but a devastating cascade of chemical reactions is unleashed. 1

This slamming of the brain causes the brain cells (neurons) to fire off sending the brain into a panic almost like a brief seizure. This sinister wave of extreme electrical activity spreads across the brain telling the neurons to keep firing. This excess firing clogs the mitochondria (energy producing part of the neuron) and prevents it from doing its job. This is a big problem because the neurons are attempting to regain a normal state so that they can fire again and this scramble consumes a lot of energy. So just when more energy is needed, the mitochondria cannot produce it. 1

To compound the problem, the brain's blood vessels constrict, preventing the blood from carrying glucose ("fuel")and thereby causing an energy crisis. This can kill brain cells and result in permanent brain damage. 1

To make matters even worse, extra sodium enters the neurons causing them to swell and push against the skull. If the swelling is severe, the brain can crush itself against the skull causing more cell to die. 1

These chemical reactions peak rapidly, but it takes a long time to settle the brain back to normal. Once the brain can meet the high energy demand and does return to normal it goes into a state of metabolic depression, i.e. exhaustion. The more severe the concussion, the longer this chemical cascade can continue. 1 "If a second concussion interrupts the brain's quest for equilibrium...a new cascade starts on top of the first one. The resulting damage is not just additive but multiplicative." 1

DANGEROUS SPORTS
The threat of concussion varies from sport to sport, but a 1999 study tracked varsity athletes from 235 Iowa high schools. The authors found football accounted for the most brain injuries, followed by wrestling, soccer and basketball. For all the sports except volleyball, the rate of concussion was up to 14 times greater during games than practice. Athletes "who sustained more than one concussion tended to get their second in the same season as the first, rather than later - perhaps because of the impairment from the first concussion." 1

CONCUSSION RECOGNITION AND MANAGEMENT
A concussion may or may not involve loss of consciousness. The following is a list of symptoms of concussion: 3

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