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What Is a ConcussionSimply put a concussion is a “brain sprain.” When an athlete hits an object or is hit, their brain moves around inside the skull stretching and twisting the cells and fibers causing a transient disruption in brain functioning. The energy created when the head makes contact with something pulses through the brain distorting the shape of the cells that also disrupts brain functioning. Less than 10% of concussions have loss of consciousness.

What Happens During a ConcussionOur brain cells maintain a delicate chemical balance. During a concussion the brain cells’ membrane (the outer layer) is distorted; disrupting its chemical balance. This leads to a disruption in blood flow and the brain’s ability to get oxygen and glucose that it desperately needed for recovery. This mismatch between supply (up to 50% decline) and demand (up to 150% of normal) causes concussion symptoms.

Types of Sports ConcussionsPresently, sports concussions are divided into simple and complex. A simple concussion is when there is no overt or detectable damage to the brain itself and recovers in 7-10 days. A complex concussion is one that takes more than 10 days to recover. Upwards of 10% of concussions can take more than one month to heal. Formally popular grading systems, such as Grades 1, 2, & 3 are no longer useful. They are not designed for teenagers or younger brains and do not guide treatment.

Epidemiology of Sports ConcussionAn estimated >350,000 sports related concussions occur annually (there is a total of 1.7 – 3.6 million brain injuries in the US annually). Several factors determine the rate of concussions in a given sport. However, American style football has the highest rate with other sports like ice hockey, soccer, lacrosse and field-hockey not far behind. Gender and age are also important factors with younger athletes being more vulnerable and women are more likely to suffer concussions compared to males. In general, the research suggests about a 10-15% (some as high as 20%) rate of concussions in contact sports.

What to Expect If You/Your Child Has a ConcussionImmediately: Loss of consciousness (LOC) occurs in only 10% of concussions. However, a LOC; even if only momentarily, indicates a concussion. Immediately after a concussion one can be confused and disoriented with difficulties recalling events immediately before or after. Their balance can be off and they can repeat themselves. Irritability is common as well as headache and sensitivity to light and sound. Below are common symptoms that can follow after a concussion:

HOUSTON METHODIST CONCUSSION CENTER

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• Headache• Poor balance• Nausea/Vomiting• Fatigue• Irritability

• Tearfulness/Sadness• Feeling slowed down• Increased sleep• Decreased appetite• Feeling “foggy”

• Sensitivity to light or noise• Blurred vision• Poor memory/concentration• Dizziness• Decreased sleep

After: Symptoms can linger for several days (and in some cases longer). Headaches, fatigue, irritability, fogginess, and memory problems are common, but not the only symptoms. Sometimes there can be whiplash (neck injury) and poor balance (vestibular problems).

For more information please call 713.441.8277 or visit houstonmethodist.org/concussion

What to Do If Your Child Sustains a ConcussionTypically concussions are transient injuries that do not require extensive medical treatment. However, they must be monitored closely and often soon after the actual event to detect any medical complications that may develop and require urgent medical attention. Your child should not continue to play if he/she has a concussion. Your child should be evaluated immediately after the concussion (i.e., coach or athletic trainer) with close monitoring for any signs of worsening symptoms. If there is evidence of worsening symptoms (such as lethargy, severe headache, repeated vomiting, stiff neck, slurred speech, and confusion, difficulty walking or numbness/weakness/loss of sensation) then immediate medical care is required. If you child was not evaluated on the field/ice/court, then contact your child’s physician for advice or seek an emergency room evaluation. Often brain imaging such as brain CT is not required and can be determined by a physician. When in doubt check it out. Do not use aspirin or NSAIDs for the first 48 hours after a concussion. Tylenol for pain is acceptable.

Why All the ConcernIt is important not to return an athlete to play before they have fully recovered from a concussion. The human brain has not fully matured until the early 20’s. Younger brains take longer to recover from a concussion and may be more vulnerable to the effects of another concussion, within the first few days or when it has not healed or fully recovered from the previous one – called second impact syndrome (SIS). SIS occurs when the brain losses its ability to control blood flow and the pressure builds up to unsafe levels and damages the brain. SIS happens in response to a second concussion before the athlete has been able to heal from the previous one. SIS is extremely rare, but can lead to rapid, severe and permanent brain injury. It is crucial to make sure a young athlete fully recovers before returning to play.

When an Athlete Is Ready To ReturnA gradual, incremental approach is recommended. First an athlete must be symptom free, cognitively intact (e.g., memory or concentration) without school problems, and good balance. Then a return to play (RTP) exercise protocol can begin. This is when an athlete is slowly reintroduced to competitive athletics with exertional testing, then non-contact practice, contact practice, and game play. There should be approximately 24 hours between each step and the athlete cannot have any return of concussion symptoms following each step. If concussion symptoms return the athlete must rest (no exercising) until all symptoms have resolved. Then the RPP can be re-initiated.

The Best Method for Determining Recovery The best method for determining recovery from a sports concussion is through assessing performance sensitive to the effects of a concussion: namely symptoms, cognitive abilities, and balance. Tasks such as memory, concentration, reaction time, and how quickly you think are the most sensitive measures of a concussion, while neurological examinations, neuroimaging (CT and MRI) are notoriously insensitive in detecting a sports concussion. The best method for measuring the effects of sports concussion is through baseline testing of an athlete. This way one can directly compare testing after a concussion to how the same individual performed before he/she was concussed. Thus, baseline testing has become the “corner stone” of any sports concussion safety program. Innovative computerized testing has been developed specifically for this and takes 30 minutes to complete. The testing is simple, easy to understand, and can be administered in small group settings. We recommend ImPACT as it is the most widely used sports concussion software. It has been extensively researched and Dr. Podell was instrumental in its original development.

HOUSTON METHODIST CONCUSSION CENTER

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For more information please call 713.441.8277 or visit houstonmethodist.org/concussion

HOUSTON METHODIST CONCUSSION CENTER Know the Signs and Symptoms

What is a concussion?A concussion is a mild brain injury. Concussions are caused by a bump, blow or jolt to the head or body. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can lead to a concussion and should be considered serious.

What are the signs and symptoms?You can’t see a concussion. Signs and symptoms of concussion can appear immediately after the injury or may evolve over time. If your athlete reports one or more symptoms listed below, or if you notice the signs and symptoms yourself, keep your athlete out of action and seek medical attention immediately.

Observable signs• Appears dazed or stunned• Confused about assignment or position• Forgets an instruction• Unsure of game, score or opponent• Moves clumsily• Answers questions slowly• Loses consciousness (even briefly)• Shows mood, behavior and personality changes• Can’t recall events prior to or after a hit or fall• Loses balance or is unsteady when walking

Symptoms reported by athlete• Headache or “pressure” in head• Nausea or vomiting• Balance problems or dizziness• Double or blurry vision• Sensitivity to light or noise• Feeling sluggish, hazy, foggy or groggy• Concentration or memory problems• Confusion• Just not “feeling right” or is “feeling down”

Danger signsBe alert for symptoms that worsen over time. The student or athlete should be seen in the emergency department right away if he or she has:

The center’s experts serve as team concussion consultants for professional athletes including the Houston Texans, Houston Astros, Houston Dash, Houston Dynamo, Rice University Athletics, RodeoHouston®, Houston Ballet, and Shell Houston Open as well as numerous collegiate, high school and youth teams.

For referrals or appointments, please visit houstonmethodist.org/concussion or call 713.441.8277.

• One pupil is larger than the other• Drowsiness or becomes unconscious• A persistent headache that gets worse• Weakness, numbness or decreased coordination• Repeated vomiting or nausea• Slurred speech• Convulsions or seizures

• Difficulty recognizing people or places• Increasing confusion, restlessness or agitation• Unusual behavior• Loss of consciousness (even a brief loss of

consciousness should be taken seriously)• Moderate or severe neck pain

Danger signs ‒ Seek medical care immediately if symptoms worsen

Common signs & symptoms ‒ It is common to have one or many concussion symptoms.

Concussion management recommendations

• Headaches that worsen• Seizures• Neck pain• Unusual behavior change

• Very drowsy, can’t be aroused• Repeated vomiting• Slurred speech• Significant irritability

• Can’t recognize people and places

• Increasing confusion• Weakness/numbness in

arms/legs

• Less responsive than usual• Pupils are uneven• Difficulty walking

• Headache• Nausea/vomiting• Dizziness• Balance problems• Visual problems• Fatigue• Sensitivity to light or noise

• Feeling “foggy”• Feeling “slowed down”• Difficulty remembering• Difficulty concentrating

• Irritability• Sadness• Nervousness

• Drowsiness• Sleeping less• Sleeping more• Trouble falling asleep

• Take acetaminophen for pain• Use ice pack on head and neck

for comfort• Sleep (rest is very important)• Eat a light diet• Get mental and physical rest

IT’S OK TO: NO NEED TO: DO NOT:• Stay in bed• Wake up every hour• Check eyes with light • Test reflexes

• Take aspirin, ibuprofen or naproxen for first 48 hours

• Drive until cleared by medical provider• Use guns or machinery until cleared by

medical provider

How do you recover from a concussion?• Your brain needs time to heal. Rest is the

best medicine.

• Until you completely heal, you will be restricted from exercise and cognitive activity.

• You should NOT participate in any activities that could result in another head injury (e.g. sports, physical education, riding a bike, horseback riding, roller coasters, etc.) or physical activities that increase your heart rate. While recovering, you are more vulnerable to have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death.

• Avoid activities that may cause symptoms to worsen:– Listening through headphones or ear buds– Loud or bright environments, such as movie theaters and live concerts– Reading books or online for extended periods– Texting

may cause concussion symptoms (such as headache or tiredness) to reappear or worsen.• Do not drive unless cleared to do so by

your health care provider.

• Get adequate sleep. Extend your usual sleep time. Nap earlier in the day if needed.

• Students may need to miss a few days of school or postpone tests. Adults may need to miss a few days of work.

• If you are an athlete, when your symptoms are completely gone, you will perform a stepwise supervised return to play protocol. Before returning to your sport, you must be re-evaluated by your physician or neuropsychologist and cleared for return.

For referrals or appointments, please visit houstonmethodist.org/concussion or call 713.441.8277.

PHYSICAL COGNITIVE EMOTIONAL SLEEP

HOUSTON METHODIST CONCUSSION CENTER Post Concussion Home Instructions

You need to be observed for a few hours to make sure symptoms do not worsen and you remain conscious.

Most CT and/or MRI scans appear normal after a concussion.

After you have seen a medical professional, remember

Take aspirin, ibuprofen or naproxen (NSAIDS) for the first 48 hours

Operate heavy machinery, motor vehicle or firearms (unless cleared by a medical provider)

Sleep is a very important part of recovery

Use acetaminophen for headaches

DO’S DON’TS

LIGHT ACTIVITYLEVEL

INCREASE ACTIVITYLEVEL

MODERATE ACTIVITYLEVEL

50-60%MHROF YOUR 60-70%MHR

OF YOUR 70-80%MHROF YOUR

15 min 25-30 min20 min KEEP YOUR HEARTRATE BETWEEN

ACTIVITY LEVEL

For referrals or appointments, please call 713.441.8277 or visit

houstonmethodist.org/concussion

Maximum Heart Rate (MHR) = 220 - your age

After you have been cleared by a doctor, you can begin with light activity, which can include the following exercises, but no weight lifting.

STARTING PHYSICAL ACTIVITY

Depending on how you feel, you can increase activity level once per day. If your symptoms come back or increase, modify your time and intensity to keep your heart rate lower.

Use the tips of your first two fingers (not your thumb) to press lightly over the blood vessels on your wrist or neck. Count your pulse for 10 seconds and multiply by six to find your heart rate (beats per minute).

MONITOR YOUR HEART RATE

HOUSTON METHODIST

CONCUSSION CENTERTREATMENT AND RECOVERY

FOR THE FIRST FEW DAYS LIMIT ANY PHYSICAL AND MENTAL ACTIVITYTHAT INVOLVES A LOT OF CONCENTRATION OR NOISE.

No medication will cure a concussion, only treat the symptoms such as headache or nausea.Rest! It’s the best medicine. You may miss a few days of school or work.

YOUR BRAIN NEEDS TIME TO HEAL

You need to be observed for a few hours to make sure symptoms do not worsen and you remain conscious.

Most CT and/or MRI scans appear normal after a concussion.

After you have seen a medical professional, remember

Take aspirin, ibuprofen or naproxen (NSAIDS) for the first 48 hours

Operate heavy machinery, motor vehicle or firearms (unless cleared by a medical provider)

Sleep is a very important part of recovery

Use acetaminophen for headaches

DO’S DON’TS

LIGHT ACTIVITYLEVEL

INCREASE ACTIVITYLEVEL

MODERATE ACTIVITYLEVEL

50-60%MHROF YOUR 60-70%MHR

OF YOUR 70-80%MHROF YOUR

15 min 25-30 min20 min KEEP YOUR HEARTRATE BETWEEN

ACTIVITY LEVEL

For referrals or appointments, please call 713.441.8277 or visit

houstonmethodist.org/concussion

Maximum Heart Rate (MHR) = 220 - your age

After you have been cleared by a doctor, you can begin with light activity, which can include the following exercises, but no weight lifting.

STARTING PHYSICAL ACTIVITY

Depending on how you feel, you can increase activity level once per day. If your symptoms come back or increase, modify your time and intensity to keep your heart rate lower.

Use the tips of your first two fingers (not your thumb) to press lightly over the blood vessels on your wrist or neck. Count your pulse for 10 seconds and multiply by six to find your heart rate (beats per minute).

MONITOR YOUR HEART RATE

HOUSTON METHODIST

CONCUSSION CENTERTREATMENT AND RECOVERY

FOR THE FIRST FEW DAYS LIMIT ANY PHYSICAL AND MENTAL ACTIVITYTHAT INVOLVES A LOT OF CONCENTRATION OR NOISE.

No medication will cure a concussion, only treat the symptoms such as headache or nausea.Rest! It’s the best medicine. You may miss a few days of school or work.

YOUR BRAIN NEEDS TIME TO HEAL

CONCUSSION CENTERHOUSTON METHODIST

A “ding”, “getting your bell rung”, or what seems to be a mild injury caused by a bump, blow, or jolt to the head or body can lead to a concussion and should be considered significant.

90% of concussions DO NOT have a loss of consciousness.

Concussions accounted for about 8% of all injuries in high school sports.

It’s estimated that up to

MILLION concussions occur each year.

What is a Concussion?A disruption of brain

functioning caused by a chemical

imbalance.

Symptoms are often immediate, but can develop over several hours.

COMMON CAUSES OF CONCUSSION IN CHILDREN AND TEENAGERS:

SYMPTOMS OF A CONCUSSIONHeadacheMood and behavior changesDouble or blurry visionConfusion & forgetfullnessNausea or vomiting

FatigueLoss of balanceLight & noise sensitivityDifficulty concentratingDisturbed sleep

For referrals or appointments, please call 713.441.8277 or visit

houstonmethodist.org/concussion

DANGER SIGNS Symptoms getting worse =

One pupil is larger than the

other

A headache that gets progressively

worse

Weakness, numbness, or decreased coordination

Vomiting more than two times

Confusion and slurred speech

Females have a higher rate of post-concussive symptoms.

Females are more likely to have cognitive problems.

HOUSTON METHODISTCONCUSSION CENTER

houstonmethodist.org/concussion | 713.441.8277

Kenneth Podell, PhD – Texas Medical Center Director, Houston Methodist Concussion Center, Neuropsychologist Dr. Kenneth Podell is an associate professor of neurology at Weill Cornell Medical School, an adjunct associate professor at the University of Houston Department of Psychology, and a member of the NCAA Concussion Task Force. Dr. Podell specializes in the assessment and treatment of individuals who have sustained brain injury or disease, with particular expertise in sports concussion, traumatic brain injury and dementia. He serves as an independent neuropsychology consultant for the Houston Astros, Houston Dash, Houston Dynamo, Houston Texans, RodeoHouston® and Rice University Athletics.

Howard S. Derman, MD – Texas Medical Center Founder and Medical Director, Houston Methodist Concussion Center, Neurologist Dr. Howard Derman a founding member of the Houston Methodist Neurological Institute. He has a special interest in the treatment of migraine headaches, concussions and other pain syndromes affecting the nervous system. Dr. Derman serves as an independent neurology consultant for the Houston Texans.

Nader Ayub, DO – Sugar Land Primary Care Sports Medicine Dr. Nader Ayub is dual certified in family medicine and sports medicine. He focuses on managing both medical and non-surgical orthopedic conditions. He is a team physician for Rice University and Fort Bend ISD schools.

David Braunreiter, MD – Sugar Land Primary Care Sports Medicine Dr. David Braunreiter has dual certifications in both sports medicine and family medicine providing him with unique qualifications to manage a wide array of medical and orthopedic conditions in the athletic arena. He is a team physician for the Houston Dynamo and a member of the Major League Soccer Concussion Committee.

Veronica Burton, PhD – Texas Medical Center Neuropsychologist Dr. Veronica Burton specializes in the assessment and treatment of patients with neurological and psychological disorders. Dr. Burton is board certified in neuropsychology and fluent in Spanish.

Vijay Jotwani, MD – Baytown / Houston Sports Park / Texas Medical Center / Timmons Primary Care Sports Medicine Dr. Vijay Jotwani focuses on the medical care, concussion management and non-operative orthopedic care of athletes and active people. Dr. Jotwani is board certified in both family practice and sports medicine. He serves as a team physician for the Houston Astros, Houston Ballet, Houston Dash, RodeoHouston® and Rice University.

Scott Rand, MD – Willowbrook Primary Care Sports Medicine Dr. Scott Rand specializes in concussion management, medical care of athletes and endurance athlete injuries. Dr. Rand serves as a consulting team physician for many area high schools and is a team physician for Rice University Athletics.

Javier Rios, MD – St. John Primary Care Sports Medicine Dr. Javier Rios provides non-operative care for a wide variety of musculoskeletal conditions and injuries including concussion. Dr. Rios serves as a team physician for several high schools in the Bay Area.

Alysia Robichau, MD – The Woodlands Primary Care Sports Medicine Dr. Alysia Robichau is a board-certified family medicine physician and is fellowship trained in primary care sports medicine, specializing in fractures, non-operative treatments of musculoskeletal injuries, and concussions. For the past decade, Dr. Robichau has enjoyed working with student athletes in Montgomery and Harris County school districts.

Christian Schupp, MD – Willowbrook Primary Care Sports Medicine Dr. Christian Schupp performs routine family medical care, provides concussion testing and management, and treats a broad range of overuse injuries and arthritic conditions. Dr. Schupp serves as team physician to high school and college sports teams, as well as an advisor to professional sports groups.

Gregory M. Seelhoefer, MD – Willowbrook Primary Care Sports Medicine Dr. Gregory Seelhoefer specializes in the treatment of athletes and active people at all performance levels and ages. He treats a broad range of injuries and conditions with the primary goal of returning patients to play and their active lives.

M. Nameer Sidiquee, MD – French Quarter/ Willowbrook Primary Care Sports Medicine Dr. Nameer Sidiquee is board certified in family medicine and sports medicine. His philosophy about patient care is centered upon a strong patient-doctor relationship. He believes this approach to care allows patients to return to a healthy and active lifestyle faster.

P. Tim Sprockel, MD – West Primary Care Sports Medicine Dr. Tim Sprockel’s medical focus is in concussion management, sports physicals, musculoskeletal injuries (sprains, strains, fractures) and joint injections. He is a board-certified family and sports medicine physician and is fluent in Spanish.

Todd W. Trask, MD – Texas Medical Center Neurosurgeon Dr. Todd Trask specializes in the treatment of spinal and cerebrovascular disorders. He serves as the medical director of the Houston Methodist Neurological Intensive Care Unit and is an assistant professor of clinical neurosurgery at Weill Cornell Medical College.

HOUSTON METHODIST CONCUSSION CENTER

TEXAS MEDICAL CENTERHouston Methodist Concussion CenterScurlock Tower6560 Fannin St., Suites 802 & 1840Outpatient Center6445 Main St., Suite 2500Houston TX 77030713.441.8277

BAYTOWN 4000 Garth Road, Suite 200 Baytown, TX 77521 713.441.8850

FRENCH QUARTER (SPRING)7105 FM 2920Spring, TX 77379281.737.0902

HOUSTON SPORTS PARK12131 Kirby Drive, Suite 200Houston, TX 77045713.441.8850

ST. JOHN2020 NASA Pkwy., Suite 180Nassau Bay, TX 77058281.523.3355

SUGAR LAND16811 Southwest Frwy., Suite 200Sugar Land, TX 77479281.690.4678

THE WOODLANDS 3115 College Park Drive, Suite 112 The Woodlands, TX 77384 281.737.2630

TIMMONS (GREENWAY PLAZA)3100 Timmons Ln., Suite 120Houston, TX 77027713.441.8850

WESTMedical Office Building One18400 Katy Frwy., Suite 200Houston, TX 77094832.522.2663

WILLOWBROOK13802 Centerfield Drive, Suite 300Houston, TX 77070281.737.0902

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