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Knocking Heads

Tuesday, March 29, 2005; Page HE03

The Problem As parents of aspiring hockey stars and football heroes especially know, concussions are a hazard, particularly in contact sports. Some physicians judge a concussion's severity by initial symptoms. But those signs don't reliably predict how long problems will last, and damage can escape notice for weeks. To standardize care, a group of experts, including medical representatives of international groups for hockey, soccer and the Olympics, last week revised one of several sets of guidelines for concussions.

Wait to Play The new guidelines urge doctors and coaches not to rely on immediate symptoms for judging how long to bench an athlete. Any athlete with a suspected concussion -- often signaled by a headache, momentary loss of consciousness, disorientation or inability to recall events near the time of impact -- should not play or practice until medically evaluated, the experts advise. After a concussion, an athlete should rest -- physically and mentally -- until all symptoms, including difficulties with memory, attention and sensitivity to lights and sounds, disappear. For students, that could mean missing school for days. Returning to sports could take longer and should be gradual, starting with non-contact exercise. Playing too soon can raise the risk of subsequent concussions. The guidelines authors also developed a pocket guide that can be used, ideally by a doctor, to judge how much a concussion has affected cognition and to monitor cognitive recovery.

Sore Spot Since the pocket guide is aimed at competitive athletes, it contains diagnostic questions about subjects, such as the game's score, that won't apply to all people with head injuries. The guide is available online at bjsm.bmjjournals.com/content/vol39/issue4/images/large/sm18614.f1.jpeg. The study appears in the March/April issue of the Clinical Journal of Sport Medicine, as well as in three other journals: The Physician and Sportsmedicine, Neurosurgery and the British Journal of Sports Medicine.

-- Ben Harder

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