# Concussions in high school sports

A traumatic brain injury (TBI) is a blow, jolt or penetration to the head that disrupts the function of the brain. Most TBIs are caused by falls, jumps, motor vehicle traffic crashes, being struck by a person or a blunt object, and assault. Student-athletes may be put at risk in school sports, creating concern about concussions and brain injury. A concussion can be caused by a direct blow to the head, or an indirect blow to the body that causes reactions in the brain. The result of a concussion is neurological impairment that may resolve spontaneously but may also have long-term consequences.

## Background

Many teens engage in extracurricular activities including sports that can pose risk of injury. Some sports that create a more significant risk of a head injury or concussion include basketball, cheerleading, soccer, and football.
High school football accounts for a significant percentage of head injuries that result from high school sports. While performing intense physical activity the brains' structure and functionality can be changed. This alteration in the brain may be a reason athletes in contact sports have concussions at higher. In combination with the contact and altered brain structure this can potentially lead to more severe concussions.

## Effects

The symptoms of concussion may be physical, cognitive and emotional in nature. Symptoms vary between affected individuals, and symptoms immediately or be delayed.

### Short-term

Possible signs of concussion that may appear in a student-athlete after a jolt to the head or body include:
* a dazed appearance
* confusion
* forgetfulness
* lack of confidence in actions
* clumsiness
* slower than normal
* loss of consciousness
* changes in mood, behavior, or personality, and
* inability to remember events prior to, or after the hit
An injured student may report any of these signs as well as sensitivity to light or sound, double vision, a headache, or other abnormal feelings. A student who has been diagnosed with a concussion may become frustrated, impatient, and angry about the situation.

### Long-term

Concussions may have consequences that are not immediately apparent. Concussions can affect sleep quality and may cause sleep patterns to become inconsistent. Some nights an individual may sleep for an extended period of time whereas in others sleep time can be short. With acute concussions, sleep occurs for longer durations when compared to subacute. These irregular sleep patterns can have major health effects by making an individual susceptible to health concerns later on (Raikes, Schaefer, 2016, p. 2145). Concussions have also been shown to increase the risk for mental issues such as depression, CTE, dementia, and other cognitive issues (Guskiewicz et al., 2005).
Concussions may also have long term effects on the ability to learn and execute motor patterns. As compared to an individual with no concussions, due to damage to the brain resulting from concussion, a concussed individual may have reduced motor learning speeds and ability to progress in activity.
A term known as Post-concussive Symptoms, or PCS, can be found in many children at or under 18 years of age. PCS can impact the psychosocial functions and overall quality of life of the individual. Symptoms (headaches, dizziness, memory problems, etc) can last from weeks to months. It is important to note that PCS is difficult to diagnose, so awareness for this syndrome is very necessary.

## Prevention

Formal concussion plans that include elements of education, prevention, recognition, evaluation and management, both reduce the chance of concussion and ensure that concussions are promptly diagnosed.
Efforts to teach children about concussion and brain safety include the CDC's HEADS UP app, designed for children between the ages of six and eight.
According to Hon, from Concussion: A global perspective, there are recommendations to add an age limit on high contact sports -- such as football -- in order to prevent traumatic brain injuries from happening at young ages. This would allow the brains of younger children to develop more before experiencing concussions, which ultimately leads to long term effect when they arrive to High School.

### Training and conditioning

Concussions may be reduced through physical conditioning, and the teaching and practice of techniques that reduce the chance of injury. For example, a football player who learns the proper way to tackle, spends time in the weight room, and maintains overall good health choices is more likely to avoid situations which put them in harm's way. Helping athletes improve their neck strength may also reduce the probability of concussion.

### Protective gear

In the game of football, pads and helmets provide significant protection from head injuries, but are less effective at preventing mild traumatic brain injury and concussion. Due to the physicality of the sport, concussion or other head injuries are inevitable. Chin strap monitors may be added to an athlete's helmet to assess the force of blows to the head, and to determine if an athlete has experienced a blow severe enough to warrant assessment for brain injury.

## Response

Concussion response programs should take concussions seriously, limit the number of concussions a student may have while continuing to participate in a sport, and that monitor for recovery and residual effects of concussion. Proper care for a concussed player involves providing proper medical treatment and exclusion from practices and games until the individual is cleared to play by a qualified medical professional.
After a concussion, protocols for safe return to sports practice and competition involve gradual return to play with an appropriate level of medical supervision. To ensure player safety and reduce potential liability, school concussion plans should also have a formal system for tracking compliance, and for identifying and responding to any deviations from the plan's standards.