Recognize

Concussions are the most common form of head injury caused by an impact or forceful motion of the head or other part of the body, resulting in rapid movement of the brain within the skull.

A concussion can happen to anyone at any time. Common causes include falls, motor vehicle crashes, and sports and recreational activities.

MYTH: If the person was not hit in the head or did not lose consciousness, they do not have a concussion.  

FACT: A blow to the head is not the only way someone can sustain a concussion—a concussion may be caused by a direct blow to the head, face, neck, or a blow elsewhere on the body with an ‘impulsive’ force transmitted to the head. Concussions occur from blows to different parts of the body of varying magnitude. A relatively minor impact may result in a concussion, while a high-magnitude hit may not. There is therefore no way to know for certain whether a particular blow will lead to a concussion.

NOTE: Most concussions DO NOT include a loss of consciousness. Loss of consciousness occurs in less than 10% of diagnosed concussions.

The types of activities that can cause a concussion include falls, collisions with people or objects, and motor vehicle crashes. Concussions can happen at home, school, or work; or during sports or recreational activities. If there is a history of concussion, even a minor hit to the head or body can trigger symptoms.

MYTH: The person is not showing any signs or symptoms of a concussion.

FACT: Signs and symptoms of a concussion can be delayed for several hours or even a few days following an incident.

NOTE: Following a potential concussion causing event, the person should be observed for signs and symptoms for 48 hours before assuming that a concussion has not occurred.

The following is a list of signs and symptoms consistent with a concussion. If any of these signs or symptoms are present, medical attention should be sought.

Image courtesy of Holland Bloorview Kids Rehabilitation Hospital

Signs and Symptoms of a Concussion in an Infant or Toddler

Concussion signs and symptoms to watch for in an infant/toddler include:

  • Crankiness and irritability (beyond their usual)
  • Any sudden changes in sleeping patterns, eating or playing pattern
  • Not interested in their favourite toys or activities
  • Forgets a new skill (e.g. toilet training)
  • Listless
  • Loss of balance, unsteady walking
  • Not eating or nursing
  • Cannot be comforted

Seek medical attention if the person is showing behaviour that is unusual for them or concerns you.

Any head injury needs to be taken seriously. Most concussions, managed appropriately, resolve without complications. On some occasion, concussion injuries can be more serious and result in long-term disabilities.

The real danger of most concussions occur when the injury is not recognized or is managed incorrectly. Returning to activities too early can put a person at increased risk for future concussions, prolonging their symptoms and potentially leading to serious complications.

Second Impact Syndrome is a rare but typically fatal injury that may result if a person sustains another concussion before their brain has healed.

MYTH: Concussions aren’t a big deal, and a person with a concussion or a suspected concussion doesn’t need to go to the Emergency Room.

FACT: If the person shows any of the Red Flag Symptoms call 911 IMMEDIATELY.

  • Neck pain or tenderness
  • Double vision
  • Weakness or tingling/burning in arms or legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 immediately.

  • Neck pain or Tenderness
  • Double vision
  • Weakness or tingling/burning in arms/legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative

Respond

Refer to the red flag symptoms on the sidebar. If there are no Red Flag symptoms:

  • Notify an emergency contact person, parent or guardian
  • Do not leave the person alone
  • Continue to monitor for Red Flag and signs of a concussion
  • Do not let the person return to the activity or sport
  • Do not give the person any immediate medication
  • Do not let the person leave alone
  • Do not let the person drive or ride a bike

MYTH: A person with a potential concussion can return to sport, play, or normal activity the same day. 

FACT: If a person has a suspected concussion, they should NOT return to sport or activity and should be seen by a medical professional and/or monitored for delayed symptoms for 48 hours.

A person with a suspected concussion should not be left alone initially. The person should NOT BE woken up, but should be monitored throughout the night for anything out of the ordinary. Only wake the person if you have concerns about the person’s breathing, changes in skin colour, or how they are sleeping. Call 911 if the person is slow to wake or shows any of the Red Flag symptoms. If sleeping normally, let them sleep to allow the brain to rest. Sleep is an important part of the recovery process.

If no signs or symptoms appear within the first 48 hours, the person can return to normal activities but should be monitored for several days. If no signs or symptoms appear, chances are that no concussion was sustained. If unsure, please see your medical professional for clearance.

Depending on the circumstance, the emergency contact person, parent, or guardian should take the person to a medical professional and/or monitored for delayed symptoms for 48 hours.

If you are going to see your medical professional, the following forms may be useful:

Questions to Ask Your Doctor

Concussion Response Tool (CRT)

The Concussion Response Tool was developed to guide you in responding to a potential concussion causing incident. It outlines how to respond to a potential concussion at the time of the incident, and provides important information on caring for the person at home.

NOTE: It is important to know that any advice or directions given to the person at the time of incident may not be remembered. The Concussion Response Tool can also serve as an important communication tool for sharing information from the scene of the incident.

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 immediately.

  • Neck pain or Tenderness
  • Double vision
  • Weakness or tingling/burning in arms/legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative

Manage

MYTH: Complete recovery from a concussion only takes 2 to 3 days.

FACT: Children and youth tend to experience a longer recovery period than adults. On average, an adult takes 7 to 10 days to recover, whereas children and youth may take 2 to 4 weeks to heal. Most concussion cases (about 85%) will fully recover within 3 months; however, some symptoms can last for months and have the potential to cause long-term difficulties.

MYTH: A person needs to stay in bed and rest for at least a week to recover from a concussion.

FACT: The recovery process for concussion begins with resting the brain for up to 2 days, followed by a gradual and well-managed return to activity. This is best done in collaboration with key individuals in the person’s life such as health care providers, family members (parent/partner/caregiver), friends, employers, teachers and school staff, coaches, etc.

Recovery from concussion spans the home and work/school/sport settings. It starts immediately following the concussion causing incident and ends when the person has gradually returned to normal activities including school, work, and physical activity.

A concussion can have a significant impact on someone’s physical, cognitive, and emotional functioning. The recovery process involves balancing activity levels so that the person does not do too much or too little. It is a fluctuating process where the person can be doing well one day but not the next. Having had a previous concussion increases the chance a person will have a delayed recovery.

The recovery period may be negatively influenced by many factors including:

  • Prior concussions
  • History of headaches or migraines
  • Learning disabilities
  • Mental health issues
  • Use of drugs or alcohol
  • Return to activities too soon
  • Lack of family or social supports
  • ADHD

Symptoms should decrease over the course of time. Follow-up with a medical professional if you are worried that the person is not improving or that symptoms are prolonged.

The Recovery Process

The first and most important step in a person’s recovery from a concussion is REST for a maximum of 2 days. The person will need both physical and cognitive rest after sustaining a concussion to allow the brain to heal. The goal is to not trigger or worsen symptoms.

Physical activity after 2 days means participation in daily life activities that do not result in an increased heart rate or breaking a sweat. Restrict: exercise, sports, running, biking, rough play.

Cognitive activity after 2 days means limiting activities that require concentration and learning. Restrict: reading, electronics (computers, smartphones, video games, TV), work/schoolwork, playing musical instruments, listening to loud music, socializing.

Once symptoms start to improve, or the person has rested for 2 days maximum, the person can begin to increase activities and focus on returning to school, work, sports, etc. Symptoms may return, worsen, or new symptoms may appear as new activity levels are introduced. If this happens, return to a lower level of activity that does affect or bring on new symptoms.

It is important that the person has successfully returned to school or work before fully returning to sports or physical activities. Returning to physical activity too early may result in more severe or potentially long-term problems.

For more information, please review the following resources:

Mental Health

Social interactions are important in preventing social isolation, depression, and anxiety. Some suggestions of low-level social interactions include short conversations on the phone with friends and family, meeting someone for coffee or a short visit.

A concussion can cause emotional or behavioural changes. It is normal to be anxious, irritable, angry, or depressed after sustaining a concussion. The person may worry about school, work, or social isolation and being away from their peers. Offer encouragement and support as the person works through the graduated stages of return to activity.

Depression can be a long-term consequence of concussion. The person may feel depressed due to a loss of place at work, school, on a team, or in a social group. Depression in some children and youth can be the result of physical changes in their brain associated with the injury itself.

Seek medical attention or counselling for support in dealing with emotional or behavioural difficulties.

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 immediately.

  • Neck pain or Tenderness
  • Double vision
  • Weakness or tingling/burning in arms/legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative

Prevent

MYTH: There is nothing a person can do to prevent a concussion.

FACT: Although not all concussions can be prevented, there are steps you can take to decrease the risk of sustaining one or reducing the severity of a potential concussion.

Educate: Learn more about concussions
Educating yourself is the first step in preventing concussions and reducing associated risks in yourself and others. You can further educate yourself by taking the CATT training and visiting the Resources [LINK] section, where you will find concussion information, including videos, reports, handouts, and articles.

Promote: Fair play
Behaviour and attitude have a major impact on concussion causing incidents. You can encourage fair play by modelling respect and sportsmanship in the presence of others.

Equip: Ensure you use the right equipment
Helmets DO NOT prevent concussions. Helmets and mouth-guards are vital pieces of equipment that protect from serious skull and dental injuries, but they do not prevent the brain from moving around when there is an impact to the head.

Ensuring that you have the required equipment for the sport or activity, that it is in good condition and fits correctly, could decrease the severity of a head injury, such as a skull fracture.

Note: Current research is focusing on helmet modifications to reduce rotational forces on the brain; however, these products are still undergoing testing and not readily available at this time

Encourage: Support concussion reporting
People will often hide symptoms of concussion because they don’t want to fall behind or disappoint their parents, coaches, and/or teammates. Supporting a positive environment for reporting concussion symptoms sooner can make the biggest difference in preventing more serious concussion outcomes and associated risks.

Awareness: Educating yourself and others
Learning about concussions helps to understand how serious a concussion can be. It also provides the tools to recognize and report a concussion if suspected. An informed person is more likely to follow the guidelines during the recovery process.

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 immediately.

  • Neck pain or Tenderness
  • Double vision
  • Weakness or tingling/burning in arms/legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative

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