I. What is Concussion?
Concussion is the most common form of head injury for athletes. It is associated with disorientation, and sometimes with loss of consciousness (LOC) followed by amnesia (forgetting) of what happened both immediately before and after the injury. However, it is important to note that it is not necessary to lose consciousness to have a concussion. Mild confusion or disorientation about who or where you are, what the time or date is, what you were doing when the injury happened, or a persistent headache can be signs of concussion.

II. How do concussions occur?
Our brains are protected inside a hard outer covering of bone, the skull, which is our own natural helmet. Between the skull and the brain is a layer of cerebrospinal fluid (CSF) that suspends the brain inside the skull. The CSF acts as a shock absorber, allowing for some movement of the brain before it bumps into the bone. There are two common types of injury to the brain in sports: Acceleration-Deceleration and Rotational. Acceleration-Deceleration Injury usually happens when the athlete's head is traveling at a certain speed and then abruptly stops. When this happens, the brain can hit the inside of the skull and brush against bony structures damaging delicate brain tissue. Rotational Injury happens because the brain is attached at its base where it joins the spinal column. Hits to the head or body may cause rotational motion of the brain within the CSF. This type of injury often leads to shearing of the brain nerve cells. So, you don’t have to hit your head to sustain a concussion.

III. Second Impact Syndrome
A rare, yet serious and possibly fatal, disorder, Second Impact Syndrome, occurs when a young athlete has not yet recovered from a concussion and then within a short period of time (usually within one week) receives a second blow to the head. In such cases, it is possible for rapid brain deterioration and even death to occur as the brain is not yet fully recovered from the first injury and the second injury causes rapid swelling in the skull.

IV. Post Concussion Syndrome
Following a concussion, especially repeated or successive concussions, the athlete may experience many different kinds of symptoms, which may last for days, weeks, months, or longer. These are generally problems with thinking, sense of well-being, and mood. Headaches are a frequent complaint, as well as difficulty with memory, poor concentration and attention, fatigue, dizziness, anxiety, depression, and irritability. Sometimes, symptoms include "not feeling as quick or clear- thinking" as usual.

V. Evaluation of the Effects of Concussion
When concussion is suspected, medical evaluation and treatment should be sought as soon as possible. If there are continued complaints of attention/concentration/memory difficulties, irritability, fatigue, lowered performance in school, headache, dizziness, emotional or other symptoms, it is highly recommended that the athlete receive a neuropsychological examination. A neuropsychological examination can measure brain functioning in ways that a neurological exam, MRI, CT scan cannot. In cases of mild concussion and post-concussion syndrome, it is very common for results of neurological exams and tests to be normal. whereas the neuropsychological evaluation is able to identify the brain dysfunction. The neuropsychologist can help determine a plan of treatment and identify when the athlete is ready to return to sports.

VI. What can parents and athletes do to prevent the lasting effects of concussion?
Youth are the most vulnerable to concussion and often don’t recognize that they have experienced one. Immediate removal from physical activity and plenty of rest after a concussion is crucial until all symptoms are gone. As is now mandatory in the NHL and NFL, we recommend that athletes receive preseason baseline cognitive testing before concussions occur. Then, if an athlete sustains a concussion, his/her progress can be followed by re-testing, comparing post concussion test results to baseline results, to help make the proper decision about when to return to sports.