Information for Physicians

Sports Related Concussion Definition

Fourth International Conference on Concussion in Sport (November, 2012) defined a concussion as:

A concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathological and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:

» Concussions may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘'impulsive' force transmitted to the head.

» Concussions typically result in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.

» Concussions may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.

» Concussions results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged.


Department of Education Concussion Management Protocol

The Hawaii Department of Education High Schools and majority of the private schools have implemented a standard protocol to manage sport related concussions. This protocol is managed by the school's registered athletic trainer. The important points about the protocol are:

» During the pre-season, student-athletes involved in contact and collision sports take a baseline computer based neuropsychological test (ImPACT) AND a baseline postural stability test during freshman and junior years.

» When a student-athlete sustains a concussion, he or she:

  • Is mandated to be removed from play
  • Is required to be followed-up and evaluated by a medical doctor
  • Parent and student-athlete are educated and encouraged to do cognitive rest

» Post-Injury

» Parents are encouraged to notify the school about the concussion injury when the student-athlete returns to school for the following reasons:

  • In case complications arise during school
  • Student academic performance is not within their normal limits

» Student-athlete may start the Graduated Return to Play Protocol when:

  • Asymptomatic for more than 24 hours
  • Medical Referral Form for Concussed Student-Athlete from a medical doctor
  • Computer Based Neuropsychological Test (ImPACT) scores return back to baseline
  • Postural Stability Test scores return to baseline