Grades of concussion

The American Academy of Neurology defines concussion as an \”alteration of mental status due to biomechanical forces affecting the brain.\” This definition doesn\’t require a loss of consciousness. The American Academy of Neurology also breaks down concussion into three different grades. Unfortunately, there is no standard classification system for concussions that is used across the board or between countries. For this reason things can get a little confusing.

While the American Academy of Neurology uses three grades others will use four. In grade 0, injury is characterized by a headache and difficulty with concentration. The individual may not notice any other symptoms. A grade 1 concussion will result in the athlete appearing stunned or dazed but without loss of consciousness and sensory difficulties that clear within one minute a period of time. A grade 1 concussion usually results in a description of the athlete of \”I got my bell rung.\”

Grade 2 concussions are characterized by a headache, cloudy senses that last longer than a minute and no loss of consciousness. Individuals can have other symptoms which include ringing in the ears, post traumatic amnesia, irritability, confusion or dizziness. One or all of these symptoms can be present in a grade 2 concussion.

Although the Academy does not recognize loss of consciousness as happening during a concussion, physicians will often use grade three concussions as being characterized by loss of consciousness lasting less than one minute and exhibiting some of the same signs as a grade two concussion.

Other symptoms of a concussion will include seeing stars, feeling dazed or lightheaded, nausea or vomiting, sensitivity to light, slurred speech, difficulty concentrating, and difficulty with coordination and balance. Some individuals express the experience of feeling anxious or irritable without provocation or feeling very tired.

The American Academy of Neurology guidelines differ in that a grade 1 concussion will have symptoms clearing in less than 15 minutes and in a grade two concussion they last longer than 15 minutes. These guidelines also make it clear that permanent brain injury can occur with either a grade 2 or a grade 3 concussion.

It has been clear for many years now that a concussion can lead to subtle brain injury that has permanent consequences, leaving both the individual and their family with challenges for the remainder of their life. Fortunately, at this time, researchers have been able to objectively delineate at what point an individual may be at greater risk for developing a permanent brain injury and therefore should be admitted into a traumatic brain injury rehabilitation program designed specifically for individuals who have had a mild injury and require cognitive rehabilitation.

Head injury is one of the more serious sports related injuries and mild traumatic brain injuries are more common during a sporting event than they are during a motor vehicle accident. The highest risk sports are contact sports such as basketball, field hockey, football, ice hockey, martial arts, ski jumping, soccer and wrestling.

Using the American Academy of Neurology\’s concussion grading scale, physicians are also able to assist coaches and parents to determine when it is most appropriate and safe for the individual to return to their sport. Children with a grade 1 concussion require close observation at home. Individuals who suffer a grade 2 or 3 concussion should be taken to the nearest emergency room to undergo prolonged observation or special imaging studies.

There are different recommendations made by physicians based on the grade of concussion. Some believe that a grade 1 concussion should sideline the athlete only until the symptoms have resolved while other physicians and professionals believe that any concussion should sideline in athlete for at least a week in order to ensure that the brain has appropriately healed.

It is easy to get caught up in the excitement of sport and play and allow children to return too quickly after a mild traumatic brain injury. This can happen, especially if they seem \”fine\”. But, ultimately it is better to be out of play for a week or a month than to suffer the cognitive consequences of a head injury which will negatively impact the ability of individual to hold down a job and maintain close relationships for the rest of their life.

RESOURCES

American Academy of Neurology: Practice Parameters: https://www.aan.com/

American Academy of Neurology Practice Guidelines