COLORADO SPRINGS, Colo. -- Olympic athletes who suffer concussions should wait four days before resuming practice and six days before resuming game action, according to international standards endorsed by the U.S. Olympic Committee and prescribed for Olympic national governing bodies.
The "Sport Concussion Assessment Tool," invented by international experts in 2005 and updated in 2008, determines whether an injured athlete has suffered a concussion, with an evaluation of symptoms, cognitive assessments and a battery of physical examinations.
For athletes 10 and older, the concussion test, recommended by the International Olympic Committee, uses a mathematical formula to decipher how an athlete feels after an on-the-field incident, with numerical ratings for side effects including headaches, confusion and irritability. Athletes also are graded based upon eye response, verbal response and motor response, and they're subject to balance tests and upper-limb tests to gauge coordination.
For the cognitive part, athletes are asked easy questions. "Who scored last in this match?" is one. "Did your team win the last game?" is another. Then they're asked to recite words read in a grouping -- one set consists of "candle, paper, sugar, sandwich, wagon." And the test ends with number strings recited backward and the months recited in reverse order.
"Concussion can be exhibited in many different ways," said Bill Moreau, who has served as director of sports medicine clinics for the Colorado Springs-based USOC since 2009. "It's not just a loss of consciousness. It could be a loss of memory, a loss of balance, the inability to concentrate. ... Every concussion needs to be recognized as a brain injury."
Guidelines state that athletes must rest the day after a concussion, partake in light aerobic exercise on the second day, perform sport-specific exercise on the third day, participate in non-contact training drills on the fourth day and participate in full-contact training after medical clearance on the fifth day. A return to competition is permitted on the sixth day.
It's a drawn-out process that creates frustration for athletes during major events, like the Olympics and the world championships. That's why some athletes (in an attempt to stay on the field) don't disclose their symptoms. "That's definitely true," Moreau said, adding that his research has shown concussions are "multifold underreported throughout sport."
"If you have a concussion," Moreau said, "and it is not resolved and you sustain a second concussion, the effects are usually amplified. And you would be at much greater risk for sustaining a more dangerous injury. ... We work hard on educating all of our athletes."
A former Iowa chiropractor, Moreau leads a staff of 12 employees in the sports medicine clinics at the Olympic Training Center and at USOC-operated training facilities in Chula Vista, Calif., and Lake Placid, N.Y. He has managed more than 1,000 concussions in 25 years as a physician, and he concedes that "concussion management and guidelines are in transition. Best practices from even three years ago are already out of date and changing."
"The science isn't really hard yet," Moreau said. "It's still developing." The most drastic alteration in recent years? "The individual is treated as an individual," he said. "There are so many variables. For instance, a young person isn't the same as an adult."
Moreau will speak July 23 at a USOC sports medicine symposium on concussions at the OTC, planning on revealing statistics that display the highest incidence of concussions in collision sports, such as football, ice hockey, boxing, rugby and taekwondo. Concussions also can occur in sports in which contact isn't a necessity, like synchronized swimming, Moreau warned, "because they're so close together. They actually kick each other."
"Concussion is not just football and hockey," he said. "Any sport can have a concussion."