Concussion

Updated December 2011

A concussion is an injury to the brain that results in temporary loss of normal brain
function. It usually is caused by a blow to the head. Cuts or bruises may be present on the
head or face, but in many cases, there are no sins of trauma. !any people assume that
concussions in"ol"e a loss of consciousness, but that is not true. In most cases, a person
with a concussion ne"er loses consciousness.
#he formal medical definition of concussion is$ a clinical syndrome characteri%ed by
immediate and transient alteration in brain function, includin alteration of mental status
and le"el of consciousness, resultin from mechanical force or trauma.
&eople with concussions often cannot remember what happened immediately before or
after the injury, and they may act confused. A concussion can affect memory, judment,
refle'es, speech, balance and muscle coordination. &aramedics and athletic trainers who
suspect a person has suffered a concussion may as( the injured person what year it is or
direct them to count bac(wards from 10 in an attempt to detect altered brain function.
)"en mild concussions should not be ta(en lihtly. *eurosureons and other brain+injury
e'perts emphasi%e that althouh some concussions are less serious than others, there is no
such thin as a ,minor concussion., In most cases, a sinle concussion should not cause
permanent damae. A second concussion soon after the first one, howe"er, does not ha"e
to be "ery stron for its effects to be deadly or permanently disablin.
Prevalence and Incidence
Accordin to the Uni"ersity of &ittsburh-s .rain #rauma /esearch Center, more than
000,000 sports+related concussions occur annually in the United 1tates, and the
li(elihood of sufferin a concussion while playin a contact sport is estimated to be as
hih as 12 percent per year of play. !ore than 32,000 concussions are sustained each
year in hih school contact sports, and amon collee football players, 04 percent ha"e
had one concussion and 20 percent ha"e endured multiple concussions. Concussions
often cause sinificant and sustained neuropsycholoical impairments in information+
processin speed, problem sol"in, plannin, and memory, and these impairments are
worse with multiple concussions.
/easonable estimates show that between four and 20 percent of collee and hih school
football players will sustain a brain injury o"er the course of one season. #he ris( of
concussion in football is three to si' times hiher in players who ha"e had a pre"ious
concussion.
A study conducted by !c5ill Uni"ersity in !ontreal found that 30 percent of collee
soccer players reported symptoms of a concussion at least once durin the season. #he
study also re"ealed that concussion rates in soccer players were comparable to those in
football. Accordin to this study, athletes who suffered a concussion were four to si'
times more li(ely to suffer a second concussion. /esearch such as this has led to reater
interest in de"elopin protecti"e headear for soccer participants.
Concussions also are commonly caused by automobile and bi(in accidents, and by falls
around the home, especially amon toddlers and older adults.
Symptoms
6i(e concussions, mild injuries to the brain may not be obser"able in routine neuroloical
e'aminations. Dianostic tests typically will not show any chanes. #herefore, dianosis
is based on the nature of the incident and the presence of specific symptoms, confusion
bein a primary one. #he three principal features of confusion are$
Inability to maintain a coherent stream of thouht
A disturbance of awareness with heihtened distractibility
Inability to carry out a se7uence of oal+directed mo"ements
#he followin are concussion symptoms$
&roloned headache
8ision disturbances
Di%%iness
*ausea or "omitin
Impaired balance
Confusion
!emory loss
/inin ears
Difficulty concentratin
1ensiti"ity to liht
6oss of smell or taste
If any of these occur after a blow to the head, a health+care professional should be
consulted as soon as possible.
Concussions and Head Injuries
#he brain normally floats inside the s(ull, cushioned ently by the surroundin spinal
fluid. #he brain consists of a elatin+li(e substance and is "ulnerable to outside trauma.
#he s(ull protects the brain aainst trauma, but does not absorb all the impact of a "iolent
force.
An abrupt blow to the head, or e"en a rapid deceleration, can cause the brain to bounce
aainst the inner wall of the s(ull. #here is a potential for tearin of blood "essels, pullin
of ner"e fibers and bruisin of the brain substance.
1ometimes the blow can result in microscopic damae to the brain cells without ob"ious
structural damae "isible on a C# scan. In se"ere cases, the brain tissue can bein to
swell. 1ince the brain cannot escape the riid confines of the s(ull, se"ere swellin can
compress the brain and its blood "essels, and limit the flow of blood. 9ithout ade7uate
blood flow, the brain does not recei"e the necessary flow of o'yen and lucose. A stro(e
can occur. .rain swellin after a concussion has the potential to amplify the se"erity of
the injury.
A blow to the head can cause a more serious initial injury to the brain. A contusion is a
bruise of the brain in"ol"in bleedin and swellin in the brain. It can be thouht of as a
bruise of the brain tissue.
A s(ull fracture occurs when the bone of the s(ull brea(s. A s(ull fracture by itself may
not necessarily be a serious injury. 1ometimes, howe"er, the bro(en s(ull bones cause
bleedin or other damae by cuttin into the brain or its co"erins.
A hematoma is a blood clot that collects in or around the brain. If acti"e bleedin persists,
hematomas can rapidly enlare. 6i(e brain swellin, the increasin pressure within the
riid confines of the s(ull due to an enlarin blood clot can cause serious neuroloical
problems and e"en be life+threatenin. 1ome hematomas are surical emerencies.
:ematomas that are small sometimes can o undetected initially, but may cause
symptoms and re7uire treatment se"eral days or wee(s later. #he warnin sins of a
serious brain injury are$
&ain$ Constant or recurrin headache
!otor dysfunction$ Inability to control or coordinate motor functions, or
disturbance with balance
1ensory$ Chanes in ability to hear, taste or see; di%%iness; hypersensiti"ity to
liht or sound
Coniti"e$ 1hortened attention span; easily distracted; o"erstimulated by
en"ironment; difficulty stayin focused on a tas(, followin directions or
understandin information; feelin of disorientation, confusion and other
neuropsycholoical deficiencies.
1peech$ Difficulty findin the ,riht, word; difficulty e'pressin words or
thouhts; dysarthric speech.
1ee( immediate medical attention if any of these warnin sins occur.
Grading Concussions
#here is no uni"ersal areement on the rades of se"erity for a concussion. #here are
many different uidelines for concussion e"aluation and return+to+play decisions in
athletes. !ost uidelines reconi%e three different rades of concussions and share
similar recommendations for return to play.
#he two sets of uidelines most followed in the U.1. were formulated by the American
Academy of *euroloy <AA*= and /obert C. Cantu, !D.
In 12>3, Cantu formulated a set of uidelines that became widely used; these were
subse7uently adopted by the American Collee of 1ports !edicine <AC1!=. In 1221, the
Colorado !edical 1ociety 5uidelines were formulated in response to se"eral deaths
related to head injuries in Colorado hih school football players. #hese uidelines are
more restricti"e than pre"ious "ersions and were subse7uently adopted by the *ational
Colleiate Athletic Association <*CAA=. !ore recently, the AA* proposed another set of
uidelines. Currently, there is no consensus within the sports medicine community as to
which set of uidelines is the most appropriate.
5radin the concussion is a helpful tool in the manaement of the injury <see Cantu,
below= and depends on$ 1= presence or absence of loss of consciousness, 2= duration of
loss of consciousness, 0= duration of posttraumatic memory loss, and 4= persistence of
symptoms, includin headache, di%%iness, lac( of concentration, etc.
1ome team physicians and trainers e"aluate an athlete-s mental status by usin a fi"e+
minute series of 7uestions and physical e'ercises (nown as the 1tandardi%ed Assessment
of Concussion <1AC=. #his method, howe"er, may not be comprehensi"e enouh to pic(
up subtle chanes.
#he Centers for Disease Control <CDC= offers a Concussion #ool ?it. It also offers a
:eads Up Concussion in @outh 1ports online trainin course for coaches.
Accordin to the Cantu 5uidelines, 5rade I concussions are not associated with loss of
consciousness, and post+traumatic amnesia is either absent or less than 00 minutes in
duration. Athletes may return to play if no symptoms are present for one wee(.
&layers who sustain a 5rade II concussion lose consciousness for less than fi"e minutes
or e'hibit posttraumatic amnesia between 00 minutes and 24 hours in duration. #hey also
may return to play after one wee( of bein asymptomatic.
5rade III concussions in"ol"e post+traumatic amnesia for more than 24 hours or
unconsciousness for more than fi"e minutes. &layers who sustain this rade of brain
injury should be sidelined for at least one month, after which they can return to play if
they are asymptomatic for one wee(.
Aollowin repeated concussions, a player should be sidelined for loner periods of time
and possibly not allowed to play for the remainder of the season.
NCAA Update
#he *CAA-s 2011+2012 1ports !edicine :andboo( includes a section called
,Concussion or !ild #raumatic .rain Injury <m#.I= in the Athlete,, which notes that ,In
the years 2004 to 2002, the rate of concussion durin ames per 1,000 athlete e'posures
for football was 0.1; for men-s lacrosse, 2.3; for men-s ice hoc(ey, 2.4; for women-s ice
hoc(ey, 2.2; for women-s soccer 2.2, for wrestlin, 1.4; for men-s soccer, 1.4; for women-s
lacrosse, 1.2; for field hoc(ey, 1.2; for women-s bas(etball, 1.2; and for men-s bas(etball,
0.3, accountin for between four and 13.2 percent of the injuries for these sports, as
reported by the *CAA Injury 1ur"eillance &roram by the Datalys Center., #he *CAA
defines concussion or mild traumatic brain injury as ,a comple' pathophysioloical
process affectin the brain, induced by traumatic biomechanical forces.,
#he handboo( also states that ,*CAA member institutions must ha"e a concussion
manaement plan for their student+athletes on file with specific components as described
in .ylaw 0.2.4.13 <see 5uideline 2i=., #he plan$
/e7uires student+athletes recei"e information about the sins and symptoms of
concussions. #hey also are re7uired to sin a wai"er that says they are responsible
for reportin injuries to the medical staff.
!andates institutions pro"ide a process for remo"in a student+athlete that
e'hibits sins of a concussion. 1tudent+athletes e'hibitin sins of concussions
must be e"aluated by a medical staff member with e'perience in the e"aluation
and manaement of concussions before they can return to play.
&rohibits a student+athlete with concussion symptoms from returnin to play on
the day of the acti"ity.
/e7uires student+athletes dianosed with a concussion be cleared by a physician
or a physician-s desinee before they are permitted to return.
#he sins of a concussion, accordin to the *CAA, are as follows$
Amnesia
Confusion
:eadache
6oss of consciousness
.alance problems
Double or fu%%y "ision
1ensiti"ity to liht or noise
*ausea
Aeelin sluish
Concentration or memory problems
1lowed reaction time
Aeelin unusually irritable
#he *CAA handboo( includes much more info on concussions startin on pae BB of
http$CCwww.ncaapublications.comCproductdownloadsC!D11.pdf. #he *CAA also
recommends "iewin the *ational Athletic #rainers- Association-s :eads Up "ideo, which
ta(es a closer loo( at the types of head injuries incurred and how they happen usin
footae from football ames, for e'ample.
Treatment
#he standard treatment for concussion is rest. Aor headaches, acetaminophen <#ylenol=
can be ta(en. &ostconcussi"e headaches often are resistant to stroner narcotic+based
medications.
Postconcussive Syndrome
&eople who suffer a head injury may suffer from side effects that persist for wee(s or
months. #his is (nown as postconcussi"e syndrome. 1ymptoms include memory and
concentration problems, mood swins, personality chanes, headache, fatiue, di%%iness,
insomnia and e'cessi"e drowsiness. &atients with postconcussi"e syndrome should a"oid
acti"ities that put them at ris( for a repeated concussion. Athletes should not return to
play while e'periencin these symptoms. Athletes who suffer repeated concussions
should consider endin participation in the sport.
Second-impact Syndrome
1econd+impact syndrome results from acute, often fatal brain swellin that occurs when a
second concussion is sustained before complete reco"ery from a pre"ious concussion.
#his is thouht to cause "ascular conestion and increased intracranial pressure, which
can occur "ery rapidly and may be difficult or impossible to control. #he ris( of second+
impact syndrome is hiher in sports such as bo'in, football, ice or roller hoc(ey, soccer,
baseball, bas(etball and snow s(iin.
#he CDC reports an a"erae of 1.B deaths per year from sports concussions. In most
cases, a concussion, usually undianosed, had occurred prior to the final one.
Head Injury Prevention Tips
.uy and use helmets or protecti"e head ear appro"ed by the American 1ociety for
#estin and !aterials <A1#!= for specific sports 100 percent of the time. #he A1#! has
"iorous standards for testin helmets for many sports; helmets appro"ed by the A1#!
bear a stic(er statin this. :elmets and head ear come in many si%es and styles for many
sports, and must properly fit to pro"ide ma'imum protection aainst head injuries. In
addition to other safety apparel or ear, helmets or head ear should be worn at all times
for$
.aseball and 1oftball <when battin=
Cyclin
Aootball
:oc(ey
:orsebac( /idin
&owered /ecreational 8ehicles
1(ateboardsC1cooters
1(iin
9restlin
:ead ear is recommended by many sports safety e'perts for$
!artial Arts
&ole 8aultin
1occer
Sports Tips
1uper"ise youner children at all times, and do not let them use sportin
e7uipment or play sports unsuitable for their ae.
Do not di"e in water less than nine feet deep or in abo"e+round pools.
Aollow all rules at water par(s and swimmin pools.
9ear appropriate clothin for the sport.
Do not wear any clothin that can interfere with your "ision.
Do not participate in sports when you are ill or "ery tired.
Dbey all traffic sinals, and be aware of dri"ers when cyclin or s(ateboardin.
A"oid une"en or unpa"ed surfaces when cyclin or s(ateboardin.
&erform reular safety chec(s of sports fields, playrounds and e7uipment.
Discard and replace sportin e7uipment or protecti"e ear that is damaed.
General Tips
9ear a seatbelt e"ery time you dri"e or ride in a motor "ehicle.
*e"er dri"e while under the influence of drus or alcohol, or ride as a passener
with anybody else who is under the influence.
?eep firearms unloaded in a loc(ed cabinet or safe, and store ammunition in a
separate, secure location.
/emo"e ha%ards in the home that may contribute to falls. 1ecure rus and loose
electrical cords, put away toys, use safety ates, and install window uards. Install
rab bars and handrails if you are frail or elderly.
Additional Notes:
1ports+related neurosurical injuries were the focus of the *o"ember 2011 issue of the
Journal of Neurosurgery <http$CCthejns.orCtocCfocC01CB=. It included the results of a study
of 4B1 patients about the mechanisms and conse7uences of head injuries
<http$CCthejns.orCdoiCfullC10.01E1C2011.10.ADCU1111>4=, which references an
anonymous sur"ey that found that more than 43 percent of uni"ersity soccer players
e'perienced a concussion in just one fall season, and almost two+thirds of the same roup
e'perienced a concussion o"er the 12+month period while playin soccer. Another article
described a new i&hone application desined to sideline concussion testin
<http$CCthejns.orCdoiCfullC10.01E1C2011.>.ADCU1111>3=.
!eanwhile, in 1eptember of 2011, the AA*1 issued a &owerpoint presentation entitled
Concussion and 1ports$ Useful pre"ention and treatment information for your community
from America-s neurosureons, to help prepare and educate the public on this critical
issue.
5ear
Diperbarui Desember 2011
5ear ota( adalah cedera pada ota( yan mena(ibat(an (eruian sementara funsi ota(
yan normal. Ini biasanya disebab(an oleh pu(ulan (e (epala. 6u(a atau memar mun(in
ada di (epala atau wajah, tetapi dalam banya( (asus, tida( ada tanda+tanda trauma.
.anya( oran beranapan bahwa ear ota( melibat(an (ehilanan (esadaran, tapi itu
tida( benar. Dalam (ebanya(an (asus, oran denan ear ota( tida( pernah (ehilanan
(esadaran.
Definisi medis formal ear ota( adalah$ sindrom (linis yan ditandai denan perubahan
seera dan sementara dalam funsi ota(, termasu( perubahan status mental dan tin(at
(esadaran, yan dihasil(an dari (e(uatan me(ani( atau trauma.
Dran denan ear ota( serin tida( dapat meninat apa yan terjadi seera sebelum
atau setelah cedera, dan mere(a dapat bertinda( binun. 1ebuah ear ota( dapat
mempenaruhi memori, penilaian, refle(s, berbicara, (eseimbanan dan (oordinasi otot.
&aramedis dan pelatih atleti( yan mendua seseoran telah menderita ear ota( dapat
meminta oran yan terlu(a tahun berapa itu atau menarah(an mere(a untu(
menhitun mundur dari 10 dalam upaya untu( mendete(si funsi ota( diubah.
.ah(an ear ota( rinan tida( boleh dianap enten. Ahli bedah saraf dan ota( lainnya
cedera ahli mene(an(an bahwa mes(ipun beberapa ear ota( (uran serius daripada
yan lain, tida( ada hal seperti itu sebaai ,ear ota( rinan., Dalam (ebanya(an (asus,
ear ota( tunal tida( harus menyebab(an (erusa(an permanen. 1ebuah ear ota(
(edua seera setelah yan pertama, baaimanapun, tida( harus sanat (uat untu( efe(
untu( menjadi memati(an atau permanen menona(tif(an.
&re"alensi dan Insiden
!enurut Uni"ersity of #rauma Center .rain &ittsburh /esearch, lebih dari 000.000 yan
berhubunan denan olahraa ear ota( terjadi setiap tahun di Ameri(a 1eri(at, dan
(emun(inan menderita ear ota( saat bermain olahraa (onta( diper(ira(an setini
12 persen per tahun bermain . 6ebih dari 32.000 ear ota( yan ber(elanjutan setiap
tahun dalam olahraa (onta( 1!A, dan di antara pemain sepa( bola peruruan tini, 04
persen telah memili(i satu ear ota( dan 20 persen telah menalami ear ota( anda.
5ear ota( serin menyebab(an anuan neuropsi(oloi sinifi(an dan ber(elanjutan
dalam pemrosesan informasi (ecepatan, pemecahan masalah, perencanaan, dan memori,
dan ini anuan lebih buru( denan beberapa ear ota(.
)stimasi yan memadai menunju((an bahwa antara empat dan 20 persen dari peruruan
tini dan se(olah tini pemain sepa( bola a(an mempertahan(an cedera ota( selama
satu musim. /isi(o ear ota( dalam sepa( bola adalah tia sampai enam (ali lebih
tini pada pemain yan memili(i ear ota( sebelumnya.
1ebuah studi yan dila(u(an oleh !c5ill Uni"ersity di !ontreal menemu(an bahwa 30
persen dari pemain sepa( bola peruruan tini melapor(an ejala ear ota( setida(nya
se(ali selama musim. &enelitian ini jua menun(ap(an bahwa ear ota( tin(at
pemain sepa( bola sebandin denan yan dalam sepa( bola. !enurut penelitian ini, atlet
yan menalami ear ota( empat sampai enam (ali lebih besar untu( menderita ear
ota( (edua. &enelitian seperti ini telah menyebab(an minat yan lebih besar dalam
menemban(an pelindun (epala bai peserta sepa( bola.
5ear ota( jua biasanya disebab(an oleh (ecela(aan mobil dan bersepeda, dan denan
jatuh di se(itar rumah, terutama di (alanan balita dan oran dewasa yan lebih tua.
5ejala
1eperti ear ota(, cedera rinan sampai ota( tida( dapat diamati dalam pemeri(saan
neurolois rutin. #es dianosti( biasanya tida( a(an menunju((an perubahan. Dleh
(arena itu, dianosis didasar(an pada sifat (ejadian dan adanya ejala yan spesifi(,
(ebinunan menjadi satu primer. #ia fitur utama dari (ebinunan adalah$
F ?etida(mampuan untu( mempertahan(an aliran pemi(iran yan (oheren
F 5anuan (esadaran denan distractibility tini
F ?etida(mampuan untu( mela(sana(an urutan tujuan+diarah(an era(an
.eri(ut ini adalah ejala ear ota($
F sa(it (epala ber(epanjanan
F 8isi anuan
F &usin
F !ual atau muntah
F 5anuan (eseimbanan
F ?ebinunan
F ?ehilanan memori
F derin telina
F ?esulitan ber(onsentrasi
F ?epe(aan terhadap cahaya
F ?ehilanan bau atau rasa
Gi(a salah satu terjadi setelah pu(ulan (e (epala, seoran profesional (esehatan harus
di(onsultasi(an secepatnya.
5ear ota( dan Cedera ?epala
Dta( biasanya menapun di dalam ten(ora(, bantalan lembut denan cairan tulan
bela(an se(itarnya. Dta( terdiri dari %at elatin+seperti dan rentan terhadap trauma luar.
#en(ora( melinduni ota( terhadap trauma, tetapi tida( menyerap semua dampa( dari
(e(uatan (e(erasan.
1ebuah pu(ulan mendada( (e (epala, atau bah(an perlambatan cepat, dapat
menyebab(an ota( untu( ban(it melawan dindin baian dalam ten(ora(. Ada potensi
untu( robe(nya pembuluh darah, menari( serabut saraf dan memar dari substansi ota(.
?adan+(adan pu(ulan itu bisa mena(ibat(an (erusa(an mi(ros(opis pada sel+sel ota(
tanpa (erusa(an stru(tur yan jelas terlihat pada C# scan. Dalam (asus yan parah,
jarinan ota( dapat mulai memben(a(. ?arena ota( tida( dapat melepas(an diri dari
(un(unan (a(u ten(ora(, pemben(a(an parah dapat memampat(an ota( dan
pembuluh darah, dan membatasi aliran darah. #anpa aliran darah yan memadai, ota(
tida( menerima aliran o(sien dan lu(osa. 1tro(e dapat terjadi. &emben(a(an ota(
setelah ear ota( memili(i potensi untu( memper(uat tin(at (eparahan cedera.
1ebuah pu(ulan (e (epala dapat menyebab(an cedera awal lebih serius (e ota(. !emar
adalah memar di ota( yan melibat(an perdarahan dan pemben(a(an di ota(. :al ini
dapat dianap sebaai memar pada jarinan ota(.
1ebuah patah tulan ten(ora( terjadi (eti(a tulan ten(ora( istirahat. 1ebuah patah
tulan ten(ora( denan sendirinya belum tentu cedera serius. ?adan+(adan,
baaimanapun, tulan ten(ora( patah menyebab(an perdarahan atau (erusa(an lainnya
denan memoton (e dalam ota( atau penutup nya.
:ematoma adalah umpalan darah yan ter(umpul dalam atau di se(itar ota(. Gi(a
perdarahan a(tif berlanjut, hematoma cepat dapat memperbesar. 1eperti pemben(a(an
ota(, menin(atnya te(anan dalam batas+batas yan (a(u dari ten(ora( (arena adanya
be(uan darah yan membesar dapat menyebab(an masalah neurolois yan serius dan
bah(an menancam nyawa. .eberapa hematoma adalah (eadaan darurat bedah.
:ematoma yan (ecil (adan+(adan bisa tida( terdete(si pada awalnya, tetapi dapat
menyebab(an ejala+ejala dan memerlu(an perawatan beberapa hari atau minu
(emudian. #anda+tanda perinatan dari cedera ota( serius adalah$
F *yeri$ sa(it (epala (onstan atau berulan
F !otor disfunsi$ ?etida(mampuan untu( menontrol atau men(oordinasi(an funsi
motori(, atau anuan denan saldo
F 1ensory$ &erubahan (emampuan untu( mendenar, merasa(an atau melihat, pusin,
hipersensiti"itas terhadap cahaya atau suara
F ?onitif$ !emperpende( rentan perhatian, mudah teranu, terlalu bersemanat oleh
lin(unan, (esulitan untu( tetap fo(us pada tuas, meni(uti arah atau memahami
informasi, perasaan disorientasi, (ebinunan dan (e(uranan neuropsi(oloi lainnya.
F &idato$ ?esulitan menemu(an yan ,benar, (ata, (esulitan mene(spresi(an (ata+(ata
atau pi(iran, ucapan dysarthric.
Carilah perhatian medis seera ji(a ada tanda+tanda perinatan terjadi.
5radin ear ota(
#ida( ada (esepa(atan uni"ersal pada nilai (eparahan untu( ear ota(. Ada pedoman
yan berbeda untu( e"aluasi ear ota( dan (embali untu( memutar (eputusan pada
atlet. ?ebanya(an pedoman mena(ui tia (elas yan berbeda dari ear ota( dan
re(omendasi serupa saham untu( (embali bermain.
Dua set pedoman yan palin dii(uti di A1 dirumus(an oleh American Academy of
*euroloy <AA*= dan /obert C. Cantu, !D.
&ada tahun 12>3, Cantu merumus(an seperan(at pedoman yan menjadi banya(
diuna(an, ini yan (emudian diadopsi oleh American Collee of 1ports !edicine
<AC1!=. &ada tahun 1221, Colorado !edical 1ociety &edoman tersebut disusun dalam
menanapi (ematian yan ter(ait denan (epala lu(a di se(olah Colorado pemain sepa(
bola yan tini. &edoman ini lebih (etat daripada "ersi sebelumnya dan (emudian
diadopsi oleh Athletic Colleiate *asional Association <*CAA=. .aru+baru ini, AA*
menusul(an satu set pedoman. 1aat ini, tida( ada (onsensus dalam (omunitas
(edo(teran olahraa untu( yan seperan(at pedoman adalah yan palin sesuai.
5radin ear ota( adalah alat yan bermanfaat dalam penelolaan cedera <lihat Cantu,
bawah= dan terantun pada$ 1= ada atau tida( adanya (ehilanan (esadaran, 2= durasi
(ehilanan (esadaran, 0= durasi (ehilanan memori pasca trauma, dan 4= (ete(unan
ejala, termasu( sa(it (epala, pusin, (uran (onsentrasi, dll
.eberapa do(ter tim dan pelatih mene"aluasi status mental atlet denan menuna(an
ran(aian lima menit dari pertanyaan dan latihan fisi( yan di(enal sebaai &enilaian
.a(u ?on(usi <1AC=. !etode ini, baaimanapun, mun(in tida( cu(up (omprehensif
untu( menambil perubahan halus.
#he Centers for Disease Control <CDC= menawar(an #ool ?it ?on(usi. Ini jua
menawar(an :eads Up ?on(usi di @outh 1ports (ursus pelatihan online untu( pelatih.
!enurut &edoman Cantu, 5rade I ear ota( tida( berhubunan denan (ehilanan
(esadaran, dan pasca+trauma amnesia adalah bai( tida( ada atau (uran dari 00 menit
durasi. Atlet dapat (embali bermain ji(a tida( ada ejala yan hadir selama satu minu.
&emain yan mempertahan(an ear ota( 5rade II (ehilanan (esadaran selama (uran
dari lima menit atau menunju((an amnesia pasca trauma antara 00 menit dan 24 jam
dalam durasi. !ere(a jua bisa (embali bermain setelah satu minu menjadi
asimtomati(.
?elas III melibat(an ear ota( pasca+trauma amnesia selama lebih dari 24 jam atau
tida( sadar(an diri selama lebih dari lima menit. &emain yan mempertahan(an (elas ini
cedera ota( harus absen setida(nya selama satu bulan, setelah itu mere(a dapat (embali
bermain ji(a mere(a tida( menunju((an ejala selama satu minu.
1etelah ear ota( berulan, seoran pemain harus absen selama wa(tu yan cu(up lama
dan mun(in tida( dii%in(an untu( bermain untu( sisa musim.
*CAA &embaruan
2011+2012 *CAA 1ports !edicine :andboo( termasu( baian yan disebut ,?on(usi
atau !ild #rauma Cedera Dta( <!#.I= di Dlahraawan,, yan mencatat bahwa ,Dalam
tahun 2004 sampai 2002, tin(at ear ota( selama pertandinan per 1.000 e(sposur atlet
untu( sepa( bola adalah 0,1, (arena lacrosse pria, 2.3, (arena la(i+la(i ho(i es, 2,4,
(arena perempuan ho(i es, 2.2, (arena perempuan sepa( 2.2, untu( ulat, 1,4; untu(
sepa( bola pria, 1,4; untu( lacrosse perempuan, 1,2; untu( ho(i lapanan, 1.2 , (arena
perempuan bas(et, 1.2, dan untu( bas(et pria, 0,3, a(untansi antara empat dan 13,2
persen dari cedera untu( olahraa ini, seperti yan dilapor(an oleh &roram 1ur"eillance
Cedera *CAA oleh &usat Datalys ,. #he *CAA mendefinisi(an ear ota( atau cedera
ota( rinan traumatis sebaai ,suatu proses patofisiolois yan (omple(s yan
mempenaruhi ota(, disebab(an oleh (e(uatan biome(ani( trauma.,
.u(u peanan jua menyata(an bahwa ,*CAA lembaa anota harus memili(i
rencana manajemen untu( ear ota( mere(a siswa+atlet pada file denan (omponen
tertentu seperti yan dijelas(an dalam &erda 0.2.4.13 <lihat &edoman 2i=., /encana$
F !embutuh(an siswa+atlet menerima informasi tentan tanda+tanda dan ejala ear
ota(. !ere(a jua diminta untu( menandatanani surat pernyataan yan menata(an
mere(a bertanun jawab untu( melapor(an lu(a pada staf medis.
F !andat lembaa menyedia(an suatu proses untu( menhapus siswa+atlet yan
menunju((an tanda+tanda ear ota(. 1iswa+atlet menunju((an tanda+tanda ear ota(
harus die"aluasi oleh anota staf medis denan penalaman dalam e"aluasi dan
penelolaan ear ota( sebelum mere(a dapat (embali bermain.
F !elaran siswa+atlet denan ejala ear ota( dari (embali untu( bermain pada hari
(eiatan.
F !embutuh(an siswa+atlet didianosis denan ear ota( dibersih(an oleh do(ter atau
yan ditunju( do(ter sebelum mere(a dii%in(an untu( (embali.
#anda+tanda ear ota(, menurut *CAA, adalah sebaai beri(ut$
F Amnesia
F ?ebinunan
F 1a(it (epala
F ?ehilanan (esadaran
F 1aldo masalah
F Double atau (abur "isi
F 1ensiti"itas terhadap cahaya atau suara
F !ual
F !erasa lesu
F ?onsentrasi atau memori masalah
F 9a(tu rea(si Diperlambat
F !erasa luar biasa mudah marah
.u(u peanan *CAA termasu( banya( info lebih lanjut tentan ear ota( mulai pada
halaman BB dari http$CCwww.ncaapublications.comCproductdownloadsC!D11.pdf. #he
*CAA jua mere(omendasi(an melihat Asosiasi Athletic #rainers *asional -:eads Up
"ideo, yan menambil melihat lebih de(at pada jenis cedera (epala yan terjadi dan
baaimana mere(a terjadi denan menuna(an cupli(an dari pertandinan sepa( bola,
misalnya.
&enobatan
&enobatan standar untu( ear ota( adalah istirahat. Untu( sa(it (epala, acetaminophen
<#ylenol= dapat diambil. 1a(it (epala &ostconcussi"e serin resisten terhadap (uat
nar(oti(a berbasis obat.
&ostconcussi"e 1yndrome
Dran yan menderita cedera (epala mun(in menderita efe( sampin yan bertahan
selama beberapa minu atau bulan. :al ini di(enal sebaai sindrom postconcussi"e.
5ejala termasu( masalah memori dan (onsentrasi, mood swins, perubahan (epribadian,
sa(it (epala, (elelahan, pusin, insomnia dan menantu( berlebihan. &asien denan
sindrom postconcussi"e harus menhindari (eiatan yan menempat(an mere(a pada
risi(o ear ota( berulan. Atlet tida( boleh (embali bermain sementara menalami
ejala ini. Atlet yan menderita ear ota( berulan harus mempertimban(an
mena(hiri partisipasi dalam olahraa.
?edua+dampa( 1yndrome
:asil sindrom ?edua+dampa( dari a(ut, ota( serin fatal pemben(a(an yan terjadi
(eti(a ear ota( (edua ber(elanjutan sebelum pemulihan len(ap dari ear ota(
sebelumnya. :al ini didua menyebab(an (emacetan pembuluh darah dan te(anan
intra(ranial menin(at, yan dapat terjadi sanat cepat dan mun(in sulit atau tida(
mun(in untu( menontrol. /isi(o (edua dampa( sindrom lebih tini dalam olahraa
seperti tinju, sepa( bola, ho(i es atau roller, sepa( bola, baseball, bola bas(et dan s(i
salju.
CDC melapor(an rata+rata 1,B (ematian per tahun dari ear ota( olahraa. Dalam
(ebanya(an (asus, ear ota(, biasanya terdianosis, telah terjadi sebelum yan tera(hir.
Injury &re"ention #ips ?epala
!embeli dan menuna(an helm atau pelindun (epala ii disetujui oleh American
1ociety untu( &enujian dan !aterial <A1#!= untu( spesifi( 100 persen dari wa(tu
olahraa. #he A1#! memili(i standar yan (uat untu( penujian helm untu( banya(
olahraa, helm disetujui oleh beruan A1#! sti(er yan menyata(an hal ini. :elm dan
(epala ii datan dalam berbaai u(uran dan aya untu( banya( olahraa, dan benar
harus sesuai untu( memberi(an perlindunan ma(simal terhadap cedera (epala. 1elain
pa(aian (eselamatan lainnya atau ii, helm atau peralatan (epala harus dipa(ai setiap
saat untu($
F .aseball 1oftball dan <(eti(a memu(ul=
F .ersepeda
F 1epa(bola
F :o(i
F :orsebac( /idin
F /e(reasi ?endaraan &owered
F 1(ateboards C 1e(uter
F 1(i
F 5ulat
?epala ii dianjur(an oleh para ahli (eamanan banya( olahraa untu($
F !artial Arts
F ?utub (ubah
F 1epa( .ola
Dlahraa #ips
F Awasi ana(+ana( muda setiap saat, dan janan membiar(an mere(a menuna(an
peralatan olahraa atau bermain olahraa tida( coco( untu( usia mere(a.
F Ganan menyelam dalam air (uran dari sembilan meter atau di atas tanah (olam.
F I(uti semua aturan di taman air dan (olam renan.
F ?ena(an pa(aian yan sesuai untu( olahraa.
F Ganan mema(ai pa(aian apapun yan dapat menanu penlihatan Anda.
F Ganan berpartisipasi dalam olahraa (eti(a Anda sa(it atau sanat lelah.
F &atuhi semua sinyal lalu lintas, dan menyadari dri"er saat bersepeda atau s(ateboard.
F :indari permu(aan yan tida( rata atau ta( beraspal saat bersepeda atau s(ateboard.
F 6a(u(an pemeri(saan (eamanan rutin bidan olahraa, taman bermain dan peralatan.
F .uan dan menanti peralatan olahraa atau alat pelindun yan rusa(.
5eneral #ips
F ?ena(an sabu( penaman setiap (ali Anda menemudi atau nai( (endaraan bermotor.
F Ganan pernah menemudi di bawah penaruh obat+obatan atau al(ohol, atau nai(
sebaai penumpan denan oran lain yan berada di bawah penaruh.
F Gauh(an senjata api dibon(ar di lemari ter(unci atau aman, dan amunisi to(o di tempat
yan terpisah dan aman.
F :apus bahaya di rumah yan dapat menyebab(an jatuh. ?arpet aman dan (abel listri(
yan lonar, menyin(ir(an mainan, menuna(an erban (eamanan, dan meninstal
penjaa jendela. Instal ambil bar dan peanan tanan ji(a Anda lemah atau lanjut usia.
#ambahan Catatan$
Dlahraa+ter(ait cedera bedah saraf adalah fo(us dari edisi 2011 *o"ember Gournal of
*eurosurery <http$CCthejns.orCtocCfocC01CB=. Ini termasu( hasil studi dari 4B1 pasien
tentan me(anisme dan (onse(uensi dari cedera (epala
<http$CCthejns.orCdoiCfullC10.01E1C2011.10.ADCU1111>4=, yan meruju( pada sebuah
sur"ei anonim yan menemu(an bahwa lebih dari 43 persen uni"ersitas pemain sepa(
bola menalami ear ota( hanya dalam satu musim uur, dan hampir dua pertia dari
(elompo( yan sama menalami ear ota( selama periode 12+bulan saat bermain sepa(
bola. Arti(el lain menambar(an sebuah apli(asi i&hone baru yan dirancan untu(
menesampin(an penujian ear ota(
<http$CCthejns.orCdoiCfullC10.01E1C2011.>.ADCU1111>3=.
1ementara itu, pada bulan 1eptember 2011, AA*1 meneluar(an presentasi &owerpoint
?on(usi berjudul dan Dlahraa$ penceahan yan beruna dan informasi penobatan
untu( masyara(at Anda dari ahli bedah saraf Ameri(a ,untu( membantu menyiap(an dan
mendidi( masyara(at tentan isu (ritis ini.