Dynamic Chiropractic REPORTS HERE that "concussions are getting much-needed attention in the press, especially given the short- and long-term cognitive loss, early-onset dementia, physical disability and even death resulting from traumatic brain injury (TBI). Chronic traumatic encephalopathy is a chronic, degenerative neurologic disease linked to repetitive head trauma and is known as an invisible killer that can make a 35-year-old brain look more like 80 years old."

T"here are 250,000 concussions annually in football alone. The prevalence in high-school and college athletics is a major concern, especially considering how big, fast and strong high-school and college athletes have become, and how their play emulates the professionals. This "evolution" is exacting a terrible toll regarding TBI in not only football, but also soccer, hockey, wrestling, water polo and cheerleading."

A concussion can be defined as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces" or "an immediate and transient loss of neuronal function secondary to trauma." Signs and symptoms include but are not limited to thinking deficits, lack of sustained attention; amnesia; confused mental status; dazed look / vacant stare; slurred or incoherent speech; vomiting; nausea; emotional liability; slow motor or verbal response; memory deficits; poor coordination; dizziness; headache; restlessness; nervous weakness; exhaustion; and irritability."

"For many chiropractic doctors, it is more likely to see an athlete in your office after injury occurs. Recognizing post-concussion signs and symptoms that can occur days or weeks after initial injury is crucial. These signs and symptoms include but are not limited to persistent low-grade headache; lightheadedness; poor attention and concentration; memory dysfunction; unusual fatigue; irritability and low frustration tolerance; intolerance of bright lights and difficulty focusing vision; intolerance of loud noises; tinnitus; anxiety and or depressed mood; and sleep disturbances."

"The brain heals slowly; if a patient or athlete presents to you with even minor head trauma, the first thing to recognize is that there is no "minor" head trauma. The million-dollar question to ask your patient is, "Have you ever hurt your head before? Asking them if they have had a concussion before is not effective because they may not know what a concussion is. Second-impact syndrome is defined as even a minor head injury to an athlete recovering from a previous concussion, mild to severe, and can lead to brain swelling or even death."

"One of the most common ways to categorize concussion is the ACSM/Cantu Guidelines developed by neurologist Robert Cantu. These guidelines have three grades as follows:
Grade 1 or mild concussion includes no loss of consciousness combined with post-traumatic amnesia (PTA) lasting less than 30 minutes. Identifying PTA includes digit recall, simple arithmetic, reverse numbering, and word pairs asked immediately and at 1, 3 and 5 minutes. Orientation to time including who the president is, who their principal is and today's date are useful questions for evaluation.

Grade 2 or moderate concussion includes loss of consciousness for less than 1 minute or PTA that lasts for more than 30 minutes and less than 24 hours. Post-concussion signs and symptoms that last for more than 24 hours, but less than six days, are also considered to be Grade 2.

Grade 3 or severe concussion occurs with loss of consciousness exceeding 1 minute, PTA for more than 24 hours or post-concussion signs and symptoms (PCSS) for more than seven days. Depending on the number of concussions and grade severity, referral for neurologic evaluation and brain imaging will be required. If you are a doctor on the field of play, remember, "When in doubt, keep them out!" Nothing is worth chancing the devastating consequences of head injury."

"Treatment of concussion includes cognitive and physical rest until symptoms resolve, followed by a graded program of exertion prior to medical clearance and return to play. Special consideration to treating each person with concussion as an individual is necessary. The recovery and outcome of concussion depends on a variety of factors that may require a sophisticated treatment and management strategy that includes a step-by-step progression. Working with a team of other doctors proficient in this process will enhance your patient care."

"Guidelines are used as a standardized reference, but observation, clinical skill and common sense are always better than a standardized guideline. Evaluations and recommendations need to be individualized for the individual, keeping in mind that the effect of concussion on children can be much more damaging than adults since neurophysiologic maturity is not reached until the mid-20s."

"The use of doctors of chiropractic in high-school, college, amateur, and professional athletics is growing rapidly. Whether you are a team chiropractor for the Olympics, a professional football team or your child's soccer or Pop Warner team, or have patients who play contact sports, knowledge of sports injuries and especially evaluation of concussion is vital to your role as a health care provider."