Sport-related concussions: time to diversify care and recommendation advice

Autor: Sanna Neselius, Helena Brisby
Rok vydání: 2013
Předmět:
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 22(2)
ISSN: 1433-7347
Popis: Concussions are one of the most common sport-related injuries, and they have reached increased attention in recent years, due to awareness of the risk of long-term effects. In November 2012, the 4th and latest Consensus Statement on Concussion in sports was held in Zurich [5]. Here, it was stated that concussions should be treated individually, based on the grade of concussion. At this meeting, the latest return-to-play protocol and the Sport Concussion Assessment Tool 3 were updated. To place the present recommendations in context, the actual damage, caused by a concussion, needs to be understood. Although the knowledge on the pathophysiology and neurobiological changes after a concussion is limited, it has become evident that an important type of change following concussion is axonal damage, often called diffuse axonal injury [7]. It is also likely that a concussion undergoes a healing process after an injury, just like other organs in the body, but on contrary to, e.g. a bone fracture, the healing process cannot be followed with simple objective investigations for healing. The ultimate would be to have one, or a panel, of quick and reliable diagnostic, as well as prognostic tool(s) to base recommendations for athletes upon, after a sport-related concussion. Since no such perfect tool today exists, we have to apply all present knowledge and combine available examinations and tests to present practical advice, for everybody involved in the care and training of athletes, at all levels, and those experiencing concussions. This applies to children and adults, elite athletes as well as non-elite athletes. The basics, before getting into medical advice, are of course to minimize the numbers and severity of concussions by critically reviewing each sport and adjust protection gear and rules to appropriate levels. Factors such as age and number of concussions need to be taken into account, since a young brain is more vulnerable and needs longer time for recovery after trauma [1] and multiple concussions lead to slower recovery [3]. Even though changes in risk situations and behaviours can have significant effects on the frequency of events, concussions will still appear in sport situations. The need for good medical advice when a concussion occurs is therefore fundamental, both to minimize acute phase symptoms and aiming to prevent the athletes from experiencing long-term effects and repeated injuries [2]. The paper by Collins and co-workers within this journal focus on the heterogeneity of sport-related concussions and the requirement of an individualized treatment approach. Collins and co-workers promote an approach by care givers where base-line is set by a review of each athlete’s risk factors. As a second step, they advocate a comprehensive clinical investigation, neurocognitive assessment and possibly also neuroimaging investigations. Based on the findings in each case, the authors thereafter recommend targeted treatment pathways. Beginning with the risk factors, it is worth to point out that like in many injuries, an incomplete healing before the return to sport activities increases the risk for re-injuries also in concussions. It has been shown that the brain is more susceptible to a second concussion within 10 days from the first one [3]. Contradictory to this statement, 80–90 % of all concussions heal within 7–10 days [4]. S. Neselius (&) H. Brisby Department of Orthopaedics, Sahlgrenska University Hospital, 413 45 Goteborg, Sweden e-mail: sanna.neselius@vgregion.se
Databáze: OpenAIRE
Externí odkaz: