Concussion Management

A concussion is a traumatic brain injury that causes an alteration in brain function. During a concussion, rotation or shaking of the brain can create tiny areas of damage, releasing chemicals that may worsen symptoms over the following days. Imaging studies, such as CT scans or MRIs, can appear normal initially, but different areas of the brain may still be affected.

Concussions can result from many types of injuries, both on and off the playing field. While bumping the head can cause a concussion, a collision is not necessary; rotational and whiplash injuries are also common causes. Sports such as football, hockey, soccer and lacrosse, as well as activities like rock climbing, horseback riding and car accidents, are frequent sources of concussion injuries.

Educators and school staff play a crucial role in concussion management. Many children have difficulty returning to their previous level of activity, including cognitive and academic activities. A child’s primary focus is learning and achieving their highest potential, so returning to school safely should come before returning to sports.

In Montana, the Dylan Steigers Protection of Youth Athletes Act requires school districts to ensure that each coach, athletic trainer, and official participating in organized youth athletics completes a concussion training program at least once per year. Save the Brain strongly encourages educators, coaches, and athletic staff to attend our no-charge concussion management training sessions.

If a concussion is suspected, children should be removed from play immediately and evaluated by their school athletic trainer. If a school does not have an ATC, care is available with one of our concussion-trained specialty providers, with telemedicine appointments offered for families outside the local area.

If you think you or your child has had a concussion, it is recommended to see a licensed healthcare professional within 72 hours.

If you think you or your child has had a concussion, you should see a licensed health care professional within 72 hours.

Signs observed by bystanders (usually parents or coaches):

• Appears dazed or stunned.
• Is confused about events.
• Answers questions slowly.
• Repeats questions.
• Can’t recall events after the hit, bump or fall.
• Loses consciousness (even briefly).
• Shows behavior or personality changes.
• Forgets class schedule or assignments.
• May be uncharacteristically irritable, sad or nervous.
• Tends to be more emotional than usual.

Symptoms reported by the athlete or injured individual:

• Difficulty thinking clearly
• Difficulty concentrating or remembering
• Feeing more “slowed down”
• Feeling sluggish, hazy, foggy or groggy
• Headache or “pressure” in head
• Nausea or vomiting
• Fatigue or feeling tired
• Uncoordinated, dizzy
• Difficulty focusing or concentrating on a skill or task
• Blurry or double vision
• Sensitivity to light or noise
• Numbness or tingling
• Does not “feel right”

Some symptoms can be an indication that a more severe traumatic brain injury occurred. If any of these symptoms are present, the athlete should be evaluated by a qualified medical or emergency professional without delay:

• Loss of consciousness
• Severe or increasing neck pain
• Increasing confusion
• Increasing irritability
• Vomiting, seizure
• Weakness in arms or legs
• Tingling or burning in arms or legs
• Decreasing level of consciousness
• Severe or increasing headache
• Unusual behavior change
• Double vision
• One pupil larger than the other

In Montana, the Dylan Steigers Protection of Youth Athletes Act requires each organized youth athletic activity to adopt policies and procedures to inform athletic trainers, coaches, officials, youth athletes and parents/guardians about the nature and risk of brain injuries. This information must be consistent with current medical knowledge and guidelines. The below concussion education video and quiz help to fulfill this mandate.

Start the Quiz

To start the quiz click HERE.

If you need to print the results or proof that you took the quiz for your coach/club/league, you will need to screenshot the results grading page or you can print a PDF of the quiz and your answers to turn in.

For questions, please contact savethebrain@logan.org

In Montana, the Dylan Steigers Protection of Youth Athletes Act requires school districts to ensure that each coach, athletic trainer, and official participating in organized youth athletics completes a concussion training program at least once per year. Save the Brain strongly encourages educators, coaches and athletic staff to attend our no-charge concussion management training sessions.

If a concussion is suspected, children should be removed from play immediately and evaluated by their school athletic trainer. If a school does not have an ATC, care is available with one of our concussion-trained specialty providers, with telemedicine appointments offered for families outside the local area.

If you think you or your child has had a concussion, it is recommended to see a licensed healthcare professional within 72 hours.

To schedule an appointment with a concussion management specialist please call (406) 758-7035.

Please consider attending a training session to learn more about concussion management. We have events open to all members of the community.

Validated Tools Recommended by Save the Brain Providers

Return to play protocol includes six graduated steps of recovery for returning to activity after a concussion. The return to play protocol should be monitored by a licensed health care provider who has been trained in concussion management.

Return to learn is recommended as a guide for successfully resuming learning after concussion. Concussed students should undergo a period of cognitive rest followed by a gradual, staged increase in cognitive activity before resuming a normal academic schedule.

Sport Concussion Assessment Tool, 5th Edition (SCAT5 and Child SCAT5), is a standardized tool for evaluating athletes before and after injury.

For more information, please email savethebrain@logan.org.

 Current Save the Brain Concussion Management Forms

• STB Concussion Pathway
• CRT6
• SCAT 6
• Save the Brain Recovery and Activity Log
• Return to Learn
• School Recommendations Following Concussion
• Return to Play
• Release to Participate Form
• Return to Work
• Concussion Care and Recovery
• ER Concussion Handout

Baseline Concussion Testing – What does the current evidence say?

Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in the scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC.

The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline.  Growing evidence suggests that this premise may not be accurate and research shows that athletes may be reliably performing at levels lower than their best effort would produce when taking the baseline test.

A recent study showed that a high rate of athletes had invalid and sandbagging scores which raised concern that the underperformance of baseline testing occurs more commonly than is probably realized.  Baseline testing may be useful in some cases but is not necessary, required, or an accepted standard of care for the appropriate management of SRC.  The findings suggest that incorporating baseline assessments does not significantly increase diagnostic yield for acute concussion. Computerized neurocognitive tests are used frequently in high school athletes, often within a model of baseline testing of asymptomatic individuals before the start of a sporting season. Current evidence suggests that in this population such testing may lack sufficient reliability to support clinical decision making. Furthermore, given the high and fluctuating test performance failure across validity indicators and cutoffs, the validity of baseline data has become a source of concern. Increased caution is called for in employing the baseline-to-post-concussion paradigm when return-to-play decisions are made.

References

1. Higgins KL, Caze T, Maerlender A. Validity and Reliability of Baseline Testing in a Standardized Environment. Arch Clin Neuropsychol. 2018 Jun 1;33(4):437-443.
2. Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane S, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO. American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clin J Sport Med. 2019 Mar;29(2):87-100
3. Tsushima WT, Yamamoto MH, Ahn HJ, Siu AM, Choi SY, Murata NM. Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes? Appl Neuropsychol Child. 2021 Jul-Sep;10(3):209-218.
4. MacDonald J, Duerson D. Reliability of a Computerized Neurocognitive Test in Baseline Concussion Testing of High School Athletes. Clin J Sport Med. 2015 Jul;25(4):367-72.
5. Abeare CA, Messa I, Zuccato BG, Merker B, Erdodi L. Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator. JAMA Neurol. 2018 Jun 1;75(6):697-703
6. Ferris LM, Kontos AP, Eagle SR, Elbin RJ, Collins MW, Mucha A, McAllister TW, Broglio SP, McCrea M, Pasquina PF, Port NL. Utility of VOMS, SCAT3, and ImPACT Baseline Evaluations for Acute Concussion Identification in Collegiate Athletes: Findings From the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022 Mar;50(4):1106-1119.

Logan Health Concussion Program

Save the Brain

When in doubt, take them out! If a concussion is suspected, the athlete should be removed from play immediately and referred to emergency medical care or a licensed health care provider trained in concussion management.

Before returning to athletic activity, the athlete must be symptom-free, able to tolerate a full day of school, complete Return to Play protocol, and be cleared by a concussion trained licensed health care professional.*

* A licensed health care professional is a registered, licensed, certified, or otherwise statutorily recognized provider whose training includes concussion evaluation and management consistent with current medical knowledge. Please note, if your school has a Logan Health Certified Athletic Trainer, completion of our return to play protocol and final clearance must come from the athletic trainer to allow return to participation in sports.

Additional Resources 

• Centers for Disease Control (CDC)
• Brain Injury Association of America  
• Brain Injury Alliance of Montana 

Coffee With Survivors of Traumatic Brain Injury and Other Injuries
Gateway Community Center
1203 US-2
Kalispell, MT 59901
Phone: (406) 871-2942

Hours: Saturdays at 10 a.m.

Brain Injury Helpline:  1-800-241-6442