What is concussion? Concussion is a disturbance of brain function caused by a direct or indirect force to the head. Concussion results in a temporary loss of brain function such as memory and thinking. Usually the changes are temporary and complete recovery is expected when treated correctly. Concussion does not involve structural damage or any permanent injury to the brain. How common is concussion? Concussion is common in sports that involve body contact, collision or high speed. Concussion is more common in children than any other age group - usually due to underdeveloped neck muscles and body control during trauma, head to neck ratio and brain cells and pathways that are still under development. There is a difference in management between adults and children because: Children’s brains are still developing, are more easily concussed, experience more symptoms and take longer to recover. Signs and symptoms of concussion: Concussion can affect any area of the brain and signs and symptoms can vary depending on the affected area. It is important that any signs of concussion are reported on and any injury that may potentially cause concussion is reported using Delta Gymnastics Incident reporting system and contact of parents. If seizure activity (uncontrollable shaking of limbs, unresponsiveness, or wetting self) noted, or loss of consciousness then immediate medical attention should be sought. What can be observed (visual):

• Holding or clutching head
• Slow to get up- appears stunned
• Slow to verbally respond or Unresponsiveness – even briefly
• Unsteady on feet/balance problems
• Disorientation- confused about what is happening/can’t recall events prior
• Slow to respond to questions or instructions
• Slurred speech
• Moves clumsily
• Shows mood, behavior or personality changes
• Loss of consciousness (only seen in 10-20% of cases)
• Upper limb muscle rigidity

What can be reported:

• Headache or pressure in the head
• Dizziness
• Nausea/Vomiting
• Neck Pain
• Blurred or double vision
• Balance problems or dizziness
• Confusion or memory loss
• Sensitivity to light and/or noise
• Feeling tired or drowsy – concentration or memory problems
• Reduced ability to think clearly and process information: irritability
• Feeling emotional
• Not quite feeling right (feeling in a fog)

RED FLAGS: If any of the below symptoms are displayed then immediate transfer to medical attention via ambulance should be sought:

• Neck/spinal tenderness
• Increased confusion/irritability
• Repeated vomiting
• Seizure or convulsion
• Weakness or tingling in arms or legs
• Deteriorating conscious state
• Severe or worsening headache
• Unusual behavior
• Double vision

Immediate Management: Any person with a suspected concussion must be withdrawn from training/competition immediately and require assessment by a medical doctor. Urgent transfer to hospital is required if the gymnast displays any of the following:

• Loss of consciousness or seizure
• Increasing confusion or irritability
• Deterioration after the injury (e.g an increase in drowsiness, headache or vomiting)
• Neck pain or spinal cord symptoms (e.g numbness, tingling or weakness in arms and/or legs)

First steps:

1. Recognising the injury:

Check gymnast for visual or reportable signs.

2. Remove the gymnast from training/competition:

Adhere to general first aid rules: including airway, breathing, circulation and spinal immobilization.

The gymnast must be removed from activity immediately.

The gymnast must not be allowed to return to training/competing on the same day.

3. Inform the gymnasts parents or guardians about the possibility of concussion and give them a fact sheet when having the incident report signed.
4. Refer the gymnast to a medical doctor for assessment:

All gymnasts with suspected concussion should have their parents notified and be referred to their local doctor for assessment. Recovery: In most cases recovery will occur within 10-14 days. Complications are uncommon however the risk of complications is increased by premature return to training due to:

• Higher risk of injury or repeated concussion
• Prolonged symptoms
• Depression and other mental health issues (irritability)
• Severe brain swelling

Return to training: The gymnast should not return to training until completely asymptomatic. If medical attention was sought then training cannot recommence until medically cleared. If any time off school is required due to memory and processing problems then sport cannot resume until successful return to school without worsening of symptoms. For example:

• Rest until all symptoms resolve
• Light aerobic activity 24hrs after symptoms resolve
• Light non contact training
• Full contact training if no return of symptoms
• Return to full training
• If the gymnast redevelops symptoms at any stage then they should drop back to the last symptom free activity - retry to progress again after 24 hours of being asymptomatic
• If symptoms continue to reappear after 10 days then re review by a medical doctor and clearance to restart training needs to be obtained

Adapted from Sports Medicine Australia (Department of Sports and Recreation) Concussion Policy and Information.   APPROVAL AND REVIEW Approved By: John Mitchell, Director, Delta Gymnastics Review Date: March 2021 Policy Owner: Club Director, Delta Gymnastics Contact Details: jmitchell@deltagym.com.au