SUBACUTE CONCUSSION INJURY GUIDELINE:
SUBACUTE CONCUSSION GUIDELINE
- Rest: avoid watching TV, using your computer, driving and reading.
- If there is any deterioration in symptoms, seek medical assessment immediately.
- While symptomatic – fill in the ‘SCAT3 Symptom Evaluation’ scale twice/day and test balance with the ‘BESS’ score. Start this as soon as possible/practical following the concussion. (NB. Can also use SCAT2 app for iPhone, which has the ability to email the results directly and covers both SCAT3 and BESS).
- Patients that are recovering need scores of 0-1 on the “post concussion symptom scale” before progressing rehabilitation.
- Nutrition is important for recovery and injuries in particular. Liquid intake, vitamins and protein intake is to essential and beneficial for better recovery from injuries. Some researchers suggest high amount of the essential vitamins and protein for recovery, as both seem to help recovery of brain injuries. Some herbs could benefit the recovery as well (see addendum).
- Each concussion is different and the length of time to full recovery is variable. It may take days to weeks to months to make a full return to sport depending on severity of symptoms.
Nutrition Supplementation in Sports Concussion Treatment Although there is no clear evidence nutrition supplements can improve concussion symptoms, there are some nutritional supplements, which improve brain function in general and might do the same for patients suffering concussion. Omega-3 fatty acid, curcumin, resveratrol, melatonin, creatine and Vitamine C, D and E have shown improvement in animal studies, as well as among patients suffering traumatic brain injury. - Omega-3 can protect against reduced plasticity and impaired learning and provide resistance to oxidative stress created from a concussion. (found in nuts and fatty fish) - Curcumin supplementation have shown improved membrane function, restoration of homeostasis, neuronal plasticity and signalling. Also it reduces the level of microglia and macrophages that aid in neuronal apoptosis. But is has only been shown in animal studies so far. (found in the root curcumin) - Resveratrol supplementation in animal studies after concussion can increase cell survival, by suppressing the apoptosis and glutamate toxicity. (Found in nuts, plants). - Melatonin hormone helps the sleep circle, and supplementation can reduce cytokines and restore the oxidative stress level markers, which can damage the brain. (found in green leaves and nuts). - Creatine has shown to improve cognition, communication, self-care, personality and behaviour, and decrease headaches, dizziness and fatigue, among children suffering Traumatic brain Injury. - Vitamin C, D and E supplementation increases brain levels. Both Vit C and E decreases oxidative stress levels, and improve the score on the Glasgow Coma Scale. Vit D in combination of progesterone improves brain function significantly. (fatty fish, fruits, green leaves).“WHEN IN DOUBT SIT THEM OUT”
- Any loss of consciousness or amnesia should warrant removal from sport on the day of injury.
- Any loss of consciousness or amnesia lasting longer than 15 minutes should be referred to a physician.
- Any previous history of concussion should warrant more conservative management.
| ▸ Physical | ▸ Cognitive |
| – Headache – Nausea – Vomiting – Balance problems – Dizziness – Visual problems – Fatigue – Sensitivity to light – Sensitivity to noise – Numbness/tingling – Dazed – Stunned | – Feeling mentally ‘foggy’ – Feeling slowed down – Difficulty concentrating – Difficulty remembering – Forgetful of recent information and conversations – Confused about recent events – Answers questions slowly – Repeats questions |
| ▸ Emotional | ▸ Sleep |
| – Irritable – Sadness – More emotional – Nervousness | – Drowsiness – Sleep more than usual – Sleep less than usual – Difficulty falling asleep |
| Step | Rehabilitation stage | Objective of Stage |
| 2A | Subacute Management | · Rest: avoid watching TV, using your computer, driving and reading. · Nutrition: optimal liquid, vitamins and protein intake. · If there is any deterioration in symptoms, seek medical assessment immediately. |
| 2B | Subacute Assessment | · While symptomatic – fill in the ‘SCAT3 Symptom Evaluation’ scale twice/day and test balance with the ‘BESS’ score. Start this as soon as possible/practical following the concussion. (NB. Can also use SCAT2 app for iPhone, which has the ability to email the results directly and covers both SCAT2 and BESS).
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RETURN TO PLAY GUIDELINE
| Step | Rehabilitation stage | Objective of Stage |
| 1 & 2 | No Activity | · Recovery |
| 3A | Light aerobic exercise | · Increase heart rate |
| 3B | Sport specific exercise | · Add movements |
| 3C | Non-contact training drills/ no race simulation | · Exercise, coordinaton and cognitive load increases |
| 3D | Full contact practice | · Restore athlete’s confidence, coaching staff and parents. Assess functional Skills |
| 4 | Return To Play / full sport activity | · Symptoms free |
- Patients that are recovering need scores of 0-1 on the “post concussion symptom scale” before progressing rehabilitation.
- To proceed to the next step, the SCAT 3 and other monitoring protocols need to score lower and reduce while progressing to the next step. If symptoms increase, a step back should be taken.
- SCAT 5: http://www.sportphysio.ca/wp-content/uploads/SCAT-5.pdf
