Taekwondo Canada

Medical

Concussions in Taekwondo

BY: DR. TERRY DE FREITAS MD CCFP (SEM)

The 5th International Symposium on Concussions was held in Berlin in the fall of 2016, and experts from all over the world shared their thoughts regarding recognition, assessment and management of concussion in sport.

For the details, please read the article in full. 

Concussion Recognition Tool 5th Edition or CRT5 - This tool is designed to help non-medically-trained individuals to recognize the signs and symptoms of possible sport-related concussion.

Published: BJSM Online First, April 26th 2017 as 10.1136/bjsports-2017-097508CRT5

The most important modifications to this tool are:

STEP 1: Recognize and Remove

When a non-medical person observes and injured athlete after an impact involving the head or neck the following red flags are important:

  • Neck pain or tenderness
  • Double vision
  • Weakness or tingling, burning to arms or legs
  • Severe or increasing headache
  • Seizure
  • Loss of consciousness
  • Deteriorating consciousness state
  • Vomiting
  • Increased restlessness or combativeness

IF ANY of these are present safely remove the individual from play immediately. If there is no qualified health care professional available call an ambulance.

If there are no red flags, then proceed to STEP 2: Observable signs

Examples of Observable signs: 

  • Slow to get up
  • Balance gait difficulties
  • Lying motionless
  • Disorientation
  • Blank look

STEP 3: Ask About Symptoms

There are 20 possible symptoms associated with concussion. The most common symptoms are: 

  • Headache
  • Pressire in the head 
  • Dizziness
  • Blurred vision
  • Sensitivity to light

STEP 4: Memory Assessment

Ask the invidual questions such as: 

  • What venue are we today?
  • What round is it?
  • How many matches have you had today?

Failure to correctly answer these types of questions, suggests a possible concussion. 

The tool provides recommendations to the non-medical person about removing the athlete from play and should not return to activity until assessed medically.


OTHER HIGHLIGHTS:


Prior to return to play, the group recommends a complete assessment by a medical doctor. 

The medical assessment should include a neurological exam, assessment of mental status, cognitive function, sleep, balance. The medical doctor may consider emergent imaging such as a CT scan ONLY if a more severe brain injury is suspected.

REST

The group recommends prescribed complete rest for 24-48 hours during the acute phase with a gradual and progressive increase in activity as long as the patient does not experience symptoms returning or worsening. The graduated return to play strategy remains a minimum 6-day process.

RETURN TO LEARN, BEFORE RETURN TO PLAY

Prior to returning to sport the child or adolescent must be gradually reintroduced to school. Patients may have to start with short periods of homework only before going to school, this may be increased to part-time attendance at school for a period of time, in order to ensure the patient’s symptoms do not worsen with the increased cognitive activity. Graduated return to learn strategy is Table 2 of the Consensus Statement on pg 4 of the document.

FOR MEDICAL PROVIDERS

When medical personnel are present, the Concussion Consensus group 5 recommends the use of the Sport Concussion Assessment Tool 5 for sideline assessment as one aspect of sideline evaluation. The group also recommends sideline video review as a helpful tool in the identification and evaluation of significant head impact events. For taekwondo competition it is extremely helpful to the medical staff if the referees can provide video replay of the head impact event.

The group also recommends that baseline or pre-season neuropsychological testing is not mandatory, and is not required for all athletes in the post-injury phase. If it is completed, it is recommended that a neuropsychologist is the best person to interpret the results.

In terms of diagnostic tests, the group does not recommend routine imaging or blood tests for athletes with a diagnosis of concussion. At this point, there are several tests being researched, but there is further investigation required before using these clinically. In some cases, an athlete who has severe symptoms may have a CT scan completed in an emergency. This test is not used to diagnose concussions, rather it is used to look for other structural brain or bony injuries to the head.

The group notes that the child and adolescent athletes have some differences in concussion when compared to adults.

  • A child age 5 to 12 may have symptoms for up to 4 weeks after concussion
  • Children and adolescents should not return to sport until they have successfully returned to school

To read the complete article:

“Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016” McCrory, P et. al. British Journal of Sport medicine; 2017;01-10, first published on April 28th 2017 as 10.1136/bjsports-2017

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