A concussion is a type of mild traumatic brain injury that can occur if you suffer a blow to the head or hit your head after a fall. Concussion results in a short-term loss of normal brain function in response to this head injury.
Concussion: What do we need to know?
Anyone who knocks their head, (be it playing sport, in a fight or accident) and gets up straight away, still needs to be closely watched. If they show any of the danger signs below, they should receive immediate medical attention.
Likewise, anyone who is knocked out, meaning they are unconsciousness and can't be woken up, even if only for a minute or so needs urgent medical care to exclude a skull fracture or serious brain injury.
After a concussion, you may have a headache or neck pain. You may also experience nausea, ringing in your ears, dizziness, or tiredness. You may feel dazed or not your normal self for several days or weeks after the injury.
The following video by Dr Mike Evans provides a useful summary of the key points to know.
(Dr Mike Evans, 2014)
Concussions are a common type of sports injury. Higher risk sports for concussion include contact activities such as boxing and rugby, but can also occur with virtually any sport with fast movement or balls including cycling, equestrian activities, cricket, hockey and more.
Symptoms
Symptoms of concussion or mild traumatic brain injury (mTBI) may not appear for hours, days or until you are challenged (physically or mentally) following a head injury.
If you have one or more of the following, check with a doctor as you may have concussion.
vision changes
sensitive to light or noise
feeling sluggish or groggy
confusion
difficulty concentrating or remembering
headache
pressure in the head
nausea or vomiting
sleep changes
dizziness
mood changes
behaviour or personality changes
being knocked out (even briefly)
answers questions slowly
moves clumsily.
Call Healthline on 0800 611 116 if you are unsure what you should do.
Treatment
Treatment for a concussion depends on the severity of your symptoms. See your health professional if you notice any of your symptoms getting worse, or if you have more serious symptoms such as seizures, feeling drowsy, have trouble walking or sleeping.
For people with ongoing symptoms, referral through ACC to a Concussion Service may be needed.
ACC’s Concussion Service provides early intervention rehabilitation services for ACC clients with a mild to moderate traumatic brain injury.
The referral form (ACC883) can be downloaded from the ACC website.
Referrers are recommended to send the referral directly to the client’s nearest ACC Short Term Claims Centre.
Return to play
If you have suffered a blow to your head or concussion, it is very important to seek medical advice and NOT to return to sports activities or work (where any further injury is a risk) before you have been cleared as safe to do so.
Athletes have ended up with permanent brain damage or died from returning to sport too soon.
See the poster opposite for some minimum stand down times.
Talk with your doctor about what is safest for you.
Daneshvar DH, Baugh CM, Nowinski CJ, et al. Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clinics in Sports Medicine, 2011; 30 (1): 145-163. [PDF]
Gavett BE, Stern RA, McKee AC. Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma. Clinics in Sports Medicine, 2011; 30(1): 179-188. [PDF]
Chapter 4: Treatment and Management of Prolonged Symptoms and Post-Concussion Syndrome. Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Institute of Medicine; National Research Council. National Academies Press (US); 2014 Feb 4. [link to chapter]
Credits: Adapted from National Institute of Neurological Disorders and Stroke, USA & NZ information.
Concussion information for health professionals
This section is designed for health professionals though anyone interested in more detail may also find it of interest.
Assessment of concussion
The proper assessment of anyone with a blow to their head is critical to their safety and wellbeing. Even a mild hit can result in concussion and put them at risk of severe injury or even death if another injury occurs before the brain has recovered.
Too many children, teenagers and adults have died or suffered permanent brain damage from head injuries thought to be a 'mild concussion' and not stood down from all play or practice for an adequate period of time.
Resources
"A medical doctor must provide assessment and diagnosis of concussion because the diagnosis may be difficult and relies on clinical judgement.
It is unanimously agreed that no return to sport/activity on the day of concussive injury should occur.
It may take several hours (or even days) post injury for some or all of the symptoms of concussion to emerge.
Extra caution is required for child and adolescent athletes
The effects of a concussion can interfere with the athlete’s ability to learn in the classroom or to function well at work.
Return to school/work may need to be graduated and demands altered to reflect the level of function, guided by a medical practitioner experienced in this area. Return to school/work and social activities should be achieved before return to sport/activity."
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
Gravel J, D'Angelo A, Carriere B, Crevier L, Beauchamp MH, Chauny JM, Wassef M, Chaillet N. Interventions provided in the acute phase for mild traumatic brain injury: a systematic review. Systematic Reviews.2013;2:63. [Abstract Cochrane Library]
Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC.The Epidemiology of Sports-Related Concussion. Clinics in Sports Medicine, 2011; 30(1): 1-17. [PDF]
Daneshvar DH, Riley DO, Nowinski CJ, et al. Long-Term Consequences: Effects on Normal Development Profile After Concussion. Phys Med Rehabil Clin N Am, 2011; 4(22): 603-670. [PDF]
Benson BW, Hamilton GM, Meeuwisse WH, McCrory P, Dvorak J. Is protective equipment useful in preventing concussion? A systematic review of the literature. British Journal of Sports Medicine.2009;43(Supplement 1):i56‐i67 [Structured abstract Cochrane Library]
Rugby Coaches & Referees
Concussion is the most common head injury in sport and may occur with or without loss of consciousness.
When a player receives an impact to the head or body, this can result in the brain being shaken inside the skull.
If a player receives any knock or contact with their head, suspect concussion and as the coach, you have a key responsibility to make sure the affected person is given the help they need.
Within parts of New Zealand, new Concussion Management Procedures are being introduced.
For Auckland, the procedure will be implemented in March 2017 and will apply to all grades of Adult Rugby and Secondary School rugby where a registered and trained referee is officiating.
Concussion Management Procedure
"A player is shown a Blue Card if, during the course of a match, a referee identifies they have suffered a blow and consequently show indications to suggest that they may be suffering from concussion. The issuing of a Blue Card triggers a formal off-field follow up procedure.
At the conclusion of the match the referee will inform the Union person responsible for the Blue Card procedure.
The provincial union will draft a letter to the club/school and player concerned confirming that the player has been stood down from playing rugby because of concussion or suspected concussion. This letter outlines the process by which they can ultimately return to play.
Please click on the picture to find a 3 part video series about concussion made by NZRugby 2016.
Concussion Education
This is a free online concussion education programme developed for coaches, students and parents by the team at University of Michigan NeuroSport. The goal is "to educate those around the athletes so they can better understand, prevent and recognise concussions earlier."
The programme is made up of 4 modules resulting in a Concussion Action Plan. They are interactive and include a range of resources. While designed for an American audience, the programme has been endorsed by a number of national organisations and is still useful for NZ.
Seven years after Zackery Lystedt suffered multiple concussions that lead to severe brain trauma, the teenager recounts his goals, successes, and dreams.
Treatment
