Sports-Related Concussion

Diagnosis and Management, Second Edition

Brian Sindelar, Julian E. Bailes

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781498764575
• eBook ISBN: 9781351649667
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This new edition reflects the explosion of knowledge in basic science and clinical care for athletes with mild traumatic brain injury or concussion. Interest in management and methodology for making diagnoses and improving the clinical outcomes have changed dramatically. All U.S. states have laws dictating how sports concussion patients are cared for and require return to play decisions be coordinated with best practice methods. Epidemiology, classification, and biology of sports concussion, as well as, brain imaging,assessment tests, neuropsychological measures, and management strategies are covered. Illustrative clinical cases, correlative examples, and historical insights are featured.

1
Introduction to sports related concussion

Introduction

Prior to diving into the complex physiology, presentation, and treatment of concussion, an initial introduction of the historical definition is required followed by its evolution into its current designation. Though our knowledge of concussion has deepened through advanced neuroimaging and preclinical animal research, there still remains shortcomings regarding our understanding of this topic which has led to challenges in providing a stable definition. We will present these changes in the definition of concussion, and how this has influenced the ability to accurately provide a concussion incidence in sports. Lastly, we will review how the epidemiology of various sports-specific concussive injuries has influenced game-play alterations in order to make the sport safer for athletes.

“What’s in a name?”

Concussion or mild traumatic brain injury?

Concussion comes from the Latin word “concutere” which means to shake violently. In the 1300s, Lanfrancus became the first modern physician to define concussion as a transient alteration in cerebral functioning.1 Since that time, numerous terminologies have been used in order to describe this injury: “mild traumatic brain injury (mTBI),” “mild brain injury,” “mild head injury,” and “ding.”2 Even within the medical community, mTBI and concussion is used synonymously to denote a similar injury, which is actually erroneous.3

The Glasgow Coma Scale, GCS, was originally developed as a clinical classification scheme to rapidly describe traumatically injured patients by evaluating their alertness, mentation, and functional abilities. This crude but easily communicated system is determined by the following patient characteristics–eye opening, verbal response, and motor activity–with a total score ranging from 3 to 15 (Table 1.1). Scores between 13 and 15 denote a mild traumatic brain injury, or “mTBI.” After a concussion, athletes are typically alert, communicative, and following commands. Therefore, in the majority of concussed athletes, the GCS scale would assign this player as having a “mTBI.”

Table 1.1Glasgow Coma Scale

		Eye Response		Verbal		Motor
1		Does not open		Non verbal		No movement
2		Opens to painful stimuli		Incomprehensible		De...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• Chapter 1 Introduction to sports related concussion
• Chapter 2 Biomechanics and pathophysiology of concussion
• Chapter 3 Acute assessment, diagnosis, and management of the concussed athlete
• Chapter 4 Severe head injuries
• Chapter 5 Postconcussive syndrome
• Chapter 6 Outpatient care of the concussed athlete: Gauging recovery to tailor rehabilitative needs
• Chapter 7 Return to activity following concussion
• Chapter 8 Neuroimaging in concussion
• Chapter 9 The advent of subconcussion and chronic traumatic encephalopathy
• Chapter 10 Promising advances in concussion diagnosis and treatment
• Index