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Concussion Classification: Ongoing Controversy

  • Robert Cantu

Abstract

The major objective of this chapter is to elaborate on the importance of comprehensive assessment and development of a robust grading system to identify concussion and to predict athletes at risk for brain re-injury due to premature return to sport participation. There is a growing body of knowledge accumulating in the literature and in clinical practice indicating the danger of long-term residual dysfunctions in athletes suffering from even single mild traumatic brain injury. It should be noted that several position statements elaborated by the mutual effort of numerous prominent leaders in this field have been recently proposed. These documents in general, and my contribution to this book, in specific, may assist team physicians, athletic trainers and coaches in providing optimal care for athletes who have sustained a concussion. So, possible long-terms abnormalities should not be overlooked while assessing brain injured athletes at the site of injury and monitoring these athletes during their course of recovery. Overall, to accomplish this goal, the medical professionals shouldhave knowledge of and be involved with epidemiology, pathophysiology, evaluation/and treatment, post game-day evaluation/and treatment, diagnostic imaging, management principles, return-to-play criteria, complications of concussion, and prevention. Most importantly, one must understand that an athlete, while still symptomatic at either rest or exertion should not be allowed to return to competition. No athlete who has experienced loss of consciousness or amnesia should be allowed to go back into the event that same day. The general tenor is “if in doubt, sit them out. Additional factor that need to be considered is the athlete’s total concussion history; including the number and the severity of those prior concussions. Moreover, the temporal proximity of concussions and the severity of the blow causing the concussion need to be assessed. Minor blows causing serious concussions should make a physician more hesitant to return an athlete to competition. The exact mechanisms of both short term_and long lasting abnormalities in the brain’s functional, behavioral, cognitive abilities and many other overseen abnormalities as a result of concussion in athletes still remains to be elucidated. This chapter is complementary to other chapters in this book to fully realize the ongoing controversies and problems with evaluation and treatment of sport-related traumatic brain injuries.

Keywords

Concussion Grading scales Return-to-play guidelines 

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References

  1. Cantu, R.C. (2002). Neurologic Athletic Head and Spine Injuries Philadelphia, W.B. Saunders Company.Google Scholar
  2. Entire July 2001 issue Clinical Journal of Sports Medicine, 11(3), 131–209.CrossRefGoogle Scholar
  3. Entire October 2001 issue Journal Athletic Training, 36(3), 213–348.Google Scholar
  4. National Athletic Trainers’ Association Position Statement: Sport-Related Concussion. (2004). Journal of Athletic Training, 39, 280–295.Google Scholar
  5. Summary and Agreement Statement of the 1st International Conference on Concussion in Sport. Vienna — November 2–3, 2001. (2002). Published simultaneously in British Journal of Sports Medicine, and Physician and Sports Medicine.Google Scholar
  6. Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport. Prague 2004. (2005). British Journal of Sports Medicine, 39(4), 196–205, Clinical Journal of Sport Medicine, (2005), 15(2), 48–56, Physician and Sports Medicine, (2005) 33(4), 29–44.Google Scholar
  7. Nelson, W.E., Jane, J.A., Gieck, J.H. (1984). Minor head injury in sports: a new system of classification and management. Physician Sportsmedicine, 12(3), 103–10.Google Scholar
  8. Ommaya, A.K. Biomechanics of Head Injury: Experimental Aspects. In Nahum AM, Melvin J (eds), Biomedics of Trauma. Appleton & Lange, pp 245–269. 1985.Google Scholar
  9. Cantu, R.C. (1986). Guidelines for return to contact sports after a cerebral concussion. Physician Sportsmedicine, 14, 76–79.Google Scholar
  10. From Report of the Sports Medicine Committee. (1990). Guidelines for management of concussion in sports. Colorado Medical Society, (revised May 1991). Class III.Google Scholar
  11. Jordan, B.J., Tsairis, P.T., Warren, R.F. (eds), Head Injury in Sports: Sports Neurology. Aspen Publications, p 227. 1989.Google Scholar
  12. Torg, J.S. Athletic Injuries to the Head, Neck, and Face. St. Louis, MO: Mosby-Year, 1991.Google Scholar
  13. Roberts, W.O. (1992). Who plays? Who sits? Managing concussion on the sidelines. Physician Sportsmedicine, 20, 66–76.Google Scholar
  14. Kelly, J.P., Rosenberg, J.M. (1997). The diagnosis and management of concussion in sports. Neurology, 48, 575–580.PubMedGoogle Scholar
  15. Cantu, R.C. (2001). Post-tramatic (retrograde and anterograde) amnesia: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training 36(3), 244–248.PubMedGoogle Scholar
  16. Cartidge, N.E.F., Shaw, D.A. Head Injuries. London 1981, WB Saunders, p.53. 1981.Google Scholar
  17. Tassi, P., Muzet, A. (2001). Defining the states of consciousness. Neuroscience and Biobehavioral Reviews, 25, 175–191.PubMedCrossRefGoogle Scholar
  18. Shaw, N.(2002). The neurophysiology of concussion. Progress in Neurobiology, 67, 281–344.Google Scholar
  19. Plum, F., Posner, J.B.(1980). The diagnosis of stupor and coma, 3d edition, F.A., Davis, Philadelphia.Google Scholar
  20. Erlanger D Kushik T Cantu R Barth J Broshek D Freeman J Kroger D. Symptom-Based Assessment of Concussion Severity. J Neurosurg. (2003).Google Scholar
  21. Lovell M Collins M Iverson G Field M Maroon J Cantu R Podell K Powell J Fu F. Recovery From Concussion in High School Athletes J Neurosurgery 98:296–301,2003.CrossRefGoogle Scholar
  22. Guskiewicz, K., Ross, S., Marshall, S. (2001). Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36(3), 263–273.PubMedGoogle Scholar
  23. Saunders RL, Harbaugh RE: The second impact in catastrophic contact-sports head trauma. JAMA 1984;252(4):538–539PubMedCrossRefGoogle Scholar
  24. Schneider RC: Head and Neck Injuries in Football: Mechanisms, Treatment and Prevention. Baltimore, Williams & Wilkins, 1973Google Scholar
  25. Kelly JP, Nicholas JS, Filley CM, et al. Concussion in sports: Guidelines for the prevention of catastrophic outcomes. JAMA 1991; 266–2867; Report of the Sports Medicine Committee for the management of concussion in sports. Colorado Medical Society, 1990 (revised May 1991). Class IIIGoogle Scholar
  26. Umphred DA. Neurological Rehabilitation p 426, USA 1995. Mosby-Year Book:Outcomes From the 2005 Team Physician Consensus Conference. MSSE in Press.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Robert Cantu
    • 1
    • 2
  1. 1.Emerson HospitalConcord
  2. 2.Brigham and Women’s HospitalBoston

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