Concussion in school sport is not uncommon. It is, however, very serious. While some symptoms may be temporary, there is an increasing concern about the long-term consequences of concussion for athletes. Therefore, recognising, treating, and managing concussion is important. This article, which refers to the Australian Concussion Guidelines for Youth and Community Sport (Guidelines) published by the Australian Institute of Sport, Australasian College of Sport & Exercise Physicians, Sports Medicine Australia and Australian Physiotherapy Association, will outline what concussion symptoms to look for after a student has received an injury and how to integrate the student back to school and sport.
A concussion is a type of brain injury that occurs when there is a knock to the head or the body that transfers to the brain, causing a temporary neurological impairment. It can result in several physical and mental symptoms.
Researchers at the University of Queensland have reported that “most concussion cases occur in young people aged 5 to 14.” They have also noted that damage to the still-developing areas of the brain could leave students at risk of detrimental long-term consequences.
Although concussions can result from relatively minor collisions, concussions are more likely to occur during high-impact activities such as sport. For this reason, schools should always monitor students when they are participating in physical activities and act immediately if they appear to receive any type of head injury.
Some obvious symptoms that a student may be concussed are:
However, symptoms will not always be obvious, and it’s important to recognise less obvious signs such as:
Severe symptoms that will need immediate medical attention can include:
The Australian Institute of Sport (AIS) provides a detailed list of symptoms here. You can also use the Concussion Recognition Tool (designed for non-medical users) to help you recognise concussion.
Concussion is an evolving condition which means that symptoms can change or be delayed, making the condition difficult to detect. It may take up to 48 hours following a collision to exclude a diagnosis of concussion.
As soon as you notice any concussion symptoms, you should remove the student from the sports activity and apply standard first aid procedures. For any critical symptoms, you should immediately refer the student to an emergency department, otherwise, the student should be referred to a medical practitioner as soon as practicable. The student’s parents should also be notified.
Staff should ensure that students:
The Guidelines also recommend that students should not use any medications that have not been prescribed by their healthcare practitioner. The AIS website mentions that athletes with suspected or confirmed concussion should check their medications with their doctor and specifically avoid drugs such as aspirin, anti-inflammatories, sleeping tables and sedating pain medications. Unfortunately, because the Guidelines and the AIS website express different recommendations, it is not clear what a student should do if they have been prescribed one of these drugs. Accordingly, it is imperative that students exhibiting concussion symptoms receive medical attention as soon as possible.
If you have identified any concussion symptoms in the student, you should also make note of the following to assist the health practitioner treating the student:
This will guarantee that the treating health practitioner will have the most accurate information possible so that the practitioner can properly treat the student. If you suspect that a student has a concussion, you should also report this internally to the person in charge of coordinating the management of concussion at your school. The AIS recommends appointing a “concussion officer” for this purpose. It should be noted that the role of the concussion officer will most likely include working with the student’s parents/carers to ensure that the student returns to school under appropriate medical guidance from a doctor, physiotherapist, specialist and/or another practitioner with appropriate training and experience in concussion assessment and management.
Following the initial response above, students should undertake a period of cognitive and physical rest for around 24 to 48 hours. This means, for instance, that the student should not engage in activities that require concentration such as reading or using screens. After this time has passed, the student can generally commence their return to daily activities and begin both a gradual return to learning activities and sport. The Guidelines, however, recommend that returning to learning activities take priority over a return to sport.
When the student is ready to go back to school, they should be given a reduced workload or frequent breaks so that their concussion symptoms don’t increase. The NSW Department of Education provides examples of what this may look like. For instance, the student may only come to school three half-days a week and work their way up from there.
After their initial period of cognitive and physical rest, the student can usually also commence low-intensity exercise, provided that resuming these activities does not make their symptoms worse. Much like cognitive activity, physical activity should be gradual. For more details on returning to school sport, you should consult the Graded Return to Sport Framework for Community and Youth in the Guidelines. The student should not return to sport until they have made a complete return to learning activities and have been cleared by a medical practitioner.
It is important that you regularly monitor the student’s symptoms as they return to school. While mild and brief (terms that are both defined in the Guidelines) exacerbation of symptoms may be manageable while the students is at school, the student should resume resting and seek medical advice as appropriate if their symptoms are above these thresholds. In any case, the student’s progress should be discussed with parents/carers.
The Guidelines state that athletes who suffer from multiple concussions within a short period of time (for example, two concussions in three months, or three concussions in a year) should usually follow a more conservative return to sport protocol. Schools should be mindful of this as they work with parent/carers to ensure that the student returns to sport safely.
While the Guidelines note that the timeframe for returning to sport following multiple concussions will vary according to factors such as the severity of the most recent injury, the number of previous concussions and the general medical history of the athlete, they do recommend that the starting point for returning to sport after suffering a second concussion within three months would be 28 days symptom-free before returning to contact training and a minimum of six weeks from the time of the most recent concussion until return to competitive contact sport.
There is no definite way to guarantee that a concussion won’t occur during sport activities. However, there are several things that you can do to manage concussion to avoid further risk of harm to students. This includes: