Abstract
An estimated 1.6–3.8 million sport-related concussions (SRCs) occur annually in the United States [1], and there has been a rise in the number of athletes seeking treatment for this injury in recent years [2]. A concussion is defined as a transient neurometabolic crisis in the brain that is induced by a traumatic biomechanical force to the head or body. The mechanical trauma to the brain results in a distortion and stretching of neuronal structures allowing for unregulated ionic fluctuations that initiate a series of complex neurometabolic events disruptive to brain function [3, 4]. These pathophysiological changes are not detectable with conventional neuroimaging techniques (e.g., computed tomography [CT], magnetic resonance imaging [MRI]) [5] but can result in a myriad of neurological signs (e.g., loss of consciousness [LOC], posttraumatic amnesia [PTA]), symptoms (e.g., headache, blurred vision), and impairments (e.g., cognitive deficits, oculomotor abnormalities).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.
Bakhos LL, Lockhart GR, Myers R, Linakis JG. Emergency department visits for concussion in young child athletes. Pediatrics. 2010;126(3):e550–6.
Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury. Clin Sports Med. 2011;30(1):33–48, iii–vii.
Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–35.
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5.
Schatz P, Sandel N. Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes. Am J Sports Med. 2013;41(2):321–6.
Mucha A, Collins MW, Elbin RJ, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479–86.
McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47. https://doi.org/10.1136/bjsports-2017-097699.
McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: the 3rd international conference on concussion in sport held in Zurich, November 2008. Br J Sports Med. 2009;43(Suppl 1):i76–90.
Van Kampen DA, Lovell MR, Pardini JE, Collins MW, Fu FH. The “value added” of neurocognitive testing after sports-related concussion. Am J Sports Med. 2006;34(10):1630–5.
Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concussions among university football and soccer players. Clin J Sport Med. 2002;12(6):331–8.
Henry LC, Elbin RJ, Collins MW, Marchetti G, Kontos AP. Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach. Neurosurgery. 2016;78(2):232–41.
Collins MW, Kontos AP, Okonkwo DO, et al. Statements of agreement from the Targeted Evaluation and Active Management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15–16, 2015. Neurosurgery. 2016;79(6):912–29.
Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):235–46.
Barth JT, Alves W, Ryan T, Macciocchi SN, Rimel RW, Nelson WE. Mild head injury in sports: neuropsychological sequelae and recovery of function. Mild head injury. New York: Oxford University Press; 1989. p. 257–75.
Elbin RJ, Kontos AP, Kegel N, Johnson E, Burkhart S, Schatz P. Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: evidence for separate norms. Arch Clin Neuropsychol. 2013;28(5):476–84.
Zuckerman SL, Lee YM, Odom MJ, Solomon GS, Sills AK. Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disability. J Neurosurg Pediatr. 2013;12(2):103–9.
Schatz P, Robertshaw S. Comparing post-concussive neurocognitive test data to normative data presents risks for under-classifying “above average” athletes. Arch Clin Neuropsychol. 2014;29(7):625–32.
Schatz P, Glatts C. “Sandbagging” baseline test performance on ImPACT, without detection, is more difficult than it appears. Arch Clin Neuropsychol. 2013;28(3):236–44.
Cantu RC, Gean AD. Second-impact syndrome and a small subdural hematoma: an uncommon catastrophic result of repetitive head injury with a characteristic imaging appearance. J Neurotrauma. 2010;27(9):1557–64.
McCrory P, Davis G, Makdissi M. Second impact syndrome or cerebral swelling after sporting head injury. Curr Sports Med Rep. 2012;11(1):21–3.
Elbin R, Sufrinko A, Schatz P, et al. Removal from play after concussion and recovery time. Pediatrics. 2016:e20160910.
Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med. 2003;13(4):222–9.
Meehan WP 3rd, Mannix RC, Stracciolini A, Elbin RJ, Collins MW. Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. J Pediatr. 2013;163(3):721–5.
Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011;39(11):2311–8.
National Institute of Neurological Disorders and Stroke. Sport-related concussion common data elements. 2017. https://www.commondataelements.ninds.nih.gov/SRC.aspx#tab=Data_Standards. Accessed 27 Mar 2017.
McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport—the 4th international conference on concussion in sport held in Zurich, November 2012. J Sci Med Sport. 2013;16(3):178–89.
McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998;13(2):27–35.
Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med. 1995;5(1):32–5.
National Conference of State Legislatures (2014) Traumatic brain injuries among youth athletes. Retrieved Februrary 14, 2019, from http://www.ncsl.org/research/health/traumatic-brain-injuries-among-youth-athletes.aspx
Elbin R, Knox J, Kegel N, et al. Assessing symptoms in adolescents following sport-related concussion: a comparison of four different approaches. Appl Neuropsychol Child. 2016;5(4):294–302.
Lau B, Lovell MR, Collins MW, Pardini J. Neurocognitive and symptom predictors of recovery in high school athletes. Clin J Sport Med. 2009;19(3):216–21.
Lau BC, Collins MW, Lovell MR. Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery. 2012;70(2):371–9; discussion 379.
Meehan WP, Mannix R, Monuteaux MC, Stein CJ, Bachur RG. Early symptom burden predicts recovery after sport-related concussion. Neurology. 2014;83(24):2204–10.
Fazio VC, Lovell MR, Pardini JE, Collins MW. The relation between post concussion symptoms and neurocognitive performance in concussed athletes. NeuroRehabilitation. 2007;22(3):207–16.
Collins M, Lovell MR, Iverson GL, Ide T, Maroon J. Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery. 2006;58(2):275–86; discussion 275–286.
Cole WR, Arrieux JP, Schwab K, Ivins BJ, Qashu FM, Lewis SC. Test-retest reliability of four computerized neurocognitive assessment tools in an active duty military population. Arch Clin Neuropsychol. 2013;28(7):732–42.
Sandel NK, Worts PR, Burkhart S, Henry L. Comparison of baseline ImPACT performance in amateur motocross riders to football and basketball athletes. Brain Inj. 2018;32(4):493–7.
Kontos AP, Elbin RJ, Schatz P, Covassin T, Henry L, Pardini J, Collins MW. A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375–84.
Guskiewicz KM. Balance assessment in the management of sport-related concussion. Clin Sports Med. 2011;30(1):89–102.
Guskiewicz KM. Postural stability assessment following concussion: one piece of the puzzle. Clin J Sport Med. 2001;11(3):182–9.
Anzalone AJ, Blueitt D, Case T, et al. A positive vestibular/ocular motor screening (VOMS) is associated with increased recovery time after sports-related concussion in youth and adolescent athletes. Am J Sports Med. 2017;45(2):474–9.
Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87–93.
Alsalaheen BA, Whitney SL, Mucha A, Morris LO, Furman JM, Sparto PJ. Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion. Physiother Res Int. 2013;18(2):100–8.
Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain Inj. 2015;29(2):238–48.
Sufrinko AM, Kegel NE, Mucha A, Collins MW, Kontos AP. History of high motion sickness susceptibility predicts vestibular dysfunction following sport/recreation-related concussion. Clin J Sport Med. 2017.
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders 2013. Cephalalgia 33(9):629–808.
Kontos AP, Elbin RJ, Lau B, et al. Posttraumatic migraine as a predictor of recovery and cognitive impairment after sport-related concussion. Am J Sports Med. 2013;41(7):1497–504.
Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC. Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg. 2005;102(5):850–5.
Rains JC, Poceta JS. Headache and sleep disorders: review and clinical implications for headache management. Headache. 2006;46(9):1344–63.
Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41(6):554–8.
Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache. 2004;44(9):885–90.
Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16(4):257–63.
Snow V, Weiss K, Wall EM, Mottur-Pilson C. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002;137(10):840–9.
Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of concussion and post-concussion syndrome. Sports health. 2012;4(2):147–54.
Goldberg JM, et al. The vestibular system: a sixth sense. New York: Oxford University Press; 2012.
Aligene K, Lin E. Vestibular and balance treatment of the concussed athlete. NeuroRehabilitation. 2013;32(3):543–53.
Gurley JM, Hujsak BD, Kelly JL. Vestibular rehabilitation following mild traumatic brain injury. NeuroRehabilitation. 2013;32(3):519–28.
Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, Han ME, Craig S. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007;78(4):155–61.
Capó-Aponte JE, Urosevich TG, Temme LA, Tarbett AK, Sanghera NK. Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury. Mil Med. 2012;177(7):804–13.
Master CL, Scheiman M, Gallaway M, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr. 2016;55(3):260–7.
Pearce KL, Sufrinko A, Lau BC, Henry L, Collins MW, Kontos AP. Near point of convergence after a sport-related concussion: measurement reliability and relationship to neurocognitive impairment and symptoms. Am J Sports Med. 2015;43(12):3055–61.
Master CL, Master SR, Wiebe DJ, et al. Vision and vestibular system dysfunction predicts prolonged concussion recovery in children. Clin J Sport Med. 2018;28(2):139–45.
Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatr. 2015;16(3):248–55.
Thiagarajan P, Ciuffreda KJ, Capo-Aponte JE, Ludlam DP, Kapoor N. Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI): an integrative approach. NeuroRehabilitation. 2014;34(1):129–46.
Smyth K, Sandhu SS, Crawford S, Dewey D, Parboosingh J, Barlow KM. The role of serotonin receptor alleles and environmental stressors in the development of post-concussive symptoms after pediatric mild traumatic brain injury. Dev Med Child Neurol. 2014;56(1):73–7.
Chen J-K, Johnston KM, Petrides M, Ptito A. Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms. Arch Gen Psychiatry. 2008;65(1):81–9.
Sandel N, Reynolds E, Cohen PE, Gillie BL, Kontos AP. Anxiety and mood clinical profile following sport-related concussion: From risk factors to treatment. Sport Exerc Perform Psychol. 2017;6(3):304.
Ponsford J, Cameron P, Fitzgerald M, Grant M, Mikocka-Walus A, Schonberger M. Predictors of postconcussive symptoms 3 months after mild traumatic brain injury. Neuropsychology. 2012;26(3):304–13.
Carroll LJ, Cassidy JD, Peloso PM, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004;(43 Suppl):84–105.
Comper P, Bisschop S, Carnide N, Tricco A. A systematic review of treatments for mild traumatic brain injury. Brain Inj. 2005;19(11):863–80.
Cooper DB, Bunner AE, Kennedy JE, et al. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav. 2015;9(3):403–20.
Hopko DR, Lejuez CW, Hopko SD. Behavioral activation as an intervention for coexistent depressive and anxiety symptoms. Clin Case Stud. 2004;3(1):37–48.
Mazzucchelli T, Kane R, Rees C. Behavioral activation treatments for depression in adults: a meta-analysis and review. Clin Psychol Sci Pract. 2009;16(4):383–411.
Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol. 2001;23(6):829–36.
Hsieh M-Y, Ponsford J, Wong D, Schönberger M, Taffe J, Mckay A. Motivational interviewing and cognitive behaviour therapy for anxiety following traumatic brain injury: a pilot randomised controlled trial. Neuropsychol Rehabil. 2012;22(4):585–608.
Ponsford J, Lee N, Wong D, et al. Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury. Psychol Med. 2016;46(5):1079–90.
Jorge RE, Acion L, Burin DI, Robinson RG. Sertraline for preventing mood disorders following traumatic brain injury: a randomized clinical trial. JAMA Psychiat. 2016;73(10):1041–7.
Fann JR, Uomoto JM, Katon WJ. Sertraline in the treatment of major depression following mild traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2000;12(2):226–32.
Sufrinko A, Johnson EW, Henry LC. The influence of sleep duration and sleep-related symptoms on baseline neurocognitive performance among male and female high school athletes. Neuropsychology. 2016;30(4):484.
Reddy CC, Collins M, Lovell M, Kontos AP. Efficacy of amantadine treatment on symptoms and neurocognitive performance among adolescents following sports-related concussion. J Head Trauma Rehabil. 2013;28(4):260–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 ISAKOS
About this chapter
Cite this chapter
Sherry, N., Collins, M.W. (2019). Concussion. In: Rocha Piedade, S., Imhoff, A., Clatworthy, M., Cohen, M., Espregueira-Mendes, J. (eds) The Sports Medicine Physician. Springer, Cham. https://doi.org/10.1007/978-3-030-10433-7_31
Download citation
DOI: https://doi.org/10.1007/978-3-030-10433-7_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-10432-0
Online ISBN: 978-3-030-10433-7
eBook Packages: MedicineMedicine (R0)