1. HB 2038 Coaches Training July 2012

2. Objectives DefinitionDefinition Natashas Law (HB 2038)Natashas Law (HB 2038) Concussion Oversight TeamConcussion Oversight Team Sign/Symptoms of ConcussionSign/Symptoms of Concussion Return to PlayReturn to Play Coaching/Administration RoleCoaching/Administration Role

4. Coaches Concussion Training HB 2038~Natashas LawHB 2038~Natashas Law Named after Natasha Helmick, a soccer player who sustained at least 5 concussionsNamed after Natasha Helmick, a soccer player who sustained at least 5 concussions Signed into law September 1, 2011Signed into law September 1, 2011 Goal is to reduce injuries from second impact syndromeGoal is to reduce injuries from second impact syndrome Allen, TXAllen, TX

5. The Law The new law applies to all interscholastic athletic activity, including practice and competition sponsored or sanctioned by the UILThe new law applies to all interscholastic athletic activity, including practice and competition sponsored or sanctioned by the UIL All schools are required to take a training course in the subject of concussions-must be completed no later that September 1, 2012All schools are required to take a training course in the subject of concussions-must be completed no later that September 1, 2012

6. What the law does! Concussion Management TeamConcussion Management Team Removal from PlayRemoval from Play Waiver and Graded Protocol to Return to PlayWaiver and Graded Protocol to Return to Play Specific Education/Training for all HCPsSpecific Education/Training for all HCPs State Wide Tracking/Logging of ConcussionsState Wide Tracking/Logging of Concussions

7. What is the Concussion Oversight Team The governing body of each school district and open- enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team.The governing body of each school district and open- enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team. Who is the COT-at least one member, a Texas licensed physician, Texas licensed athletic trainer or Texas licensed health care professional.Who is the COT-at least one member, a Texas licensed physician, Texas licensed athletic trainer or Texas licensed health care professional. Steve Jones MD-Required to take additional trainingSteve Jones MD-Required to take additional training Tom Lewis-Required to take additional trainingTom Lewis-Required to take additional training

8. Concussion Oversite Team Each concussion oversight team shall establish a return-to-play protocol, based on peer- reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.

9. Additional Information: Required! Each student athlete and their parent/guardian will be required to sign, for that school year, a form acknowledging that both the student athlete and guardian have received and read written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion.Each student athlete and their parent/guardian will be required to sign, for that school year, a form acknowledging that both the student athlete and guardian have received and read written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion.

10. What do you know about concussions?

11. Concussion Quiz You have to be knocked out to have a concussion.You have to be knocked out to have a concussion. TrueTrue FalseFalse

12. False Most kids who have a concussion are never knocked out.Most kids who have a concussion are never knocked out.

13. What is a concussion? A complex pathophysiological process affecting the brain, induced by traumatic biomechanical force or An injury to the brain that effects function.A complex pathophysiological process affecting the brain, induced by traumatic biomechanical force or An injury to the brain that effects function. Usually no damage to brain anatomy Usually no damage to brain anatomy -as far as we can tell Disturbance in brain metabolism Disturbance in brain metabolism Common features: Common features: Direct blow to the head or body Direct blow to the head or body Loss of consciousness not necessary Loss of consciousness not necessary Rapid onset of symptoms (usually) Rapid onset of symptoms (usually) Traditional medical test usually normal (CT/MRI) Traditional medical test usually normal (CT/MRI).

14. CONCUSSIONS

16. Its a Chemical Thing!

17. Phone Disconnect

18. You dont have to be knocked out to get a concussion

19. Concussion Quiz Concussions are only a problem for boys, and girls dont need to worry about it.Concussions are only a problem for boys, and girls dont need to worry about it. TrueTrue FalseFalse

20. False Girls have concussions at least as often as boysGirls have concussions at least as often as boys

21. Heres the Problem

22. The Facts A concussion is a brain injuryA concussion is a brain injury All concussions are seriousAll concussions are serious Concussions can occur without loss of consciousness or other obvious signsConcussions can occur without loss of consciousness or other obvious signs Concussions can occur from blows to the body as well as to the headConcussions can occur from blows to the body as well as to the head Concussions can occur in any sportConcussions can occur in any sport Recognition and proper response to concussion when they first occur can help prevent further injury or deathRecognition and proper response to concussion when they first occur can help prevent further injury or death Athletes may not report their symptoms for fear of losing playing timeAthletes may not report their symptoms for fear of losing playing time Athletes can still get a concussion even if they are wearing a helmetAthletes can still get a concussion even if they are wearing a helmet Data from the NCAA injury surveillance system suggest that concussion represent 5 to 18 percent of all reported injuries, depending on the sportData from the NCAA injury surveillance system suggest that concussion represent 5 to 18 percent of all reported injuries, depending on the sport

23. The Facts A concussion can occur in any sport and all concussions are serious.A concussion can occur in any sport and all concussions are serious. 10% of all contact sports sustain concussions10% of all contact sports sustain concussions 63% of all concussions occur in football.63% of all concussions occur in football. Girls soccer report second highest # of concussions.Girls soccer report second highest # of concussions.

24. The Facts An athlete who sustains a concussion is 4-6 times more likely to sustain a 2 nd concussion.An athlete who sustains a concussion is 4-6 times more likely to sustain a 2 nd concussion. Bell ringers account for 75% of all concussive injuries.Bell ringers account for 75% of all concussive injuries. Effects of concussions are cumulative in athletes who return to play prior to complete recovery.Effects of concussions are cumulative in athletes who return to play prior to complete recovery.

25. The Facts 80% of all concussions get better in one week; 20% usually takes 3 weeks or longer to recover.80% of all concussions get better in one week; 20% usually takes 3 weeks or longer to recover. Repeat concussions can result in brain swelling, permanent brain damage, and even death.Repeat concussions can result in brain swelling, permanent brain damage, and even death.

26. Can you which kid has a concussion?

27. Does Age Matter? Children may be less prepared for a blow to the headChildren may be less prepared for a blow to the head Parents may be inclined to believe child is fine due to negative imagining and the he looks fine to me factor.Parents may be inclined to believe child is fine due to negative imagining and the he looks fine to me factor. Other concerns may override safety issues, and often youth sports may not have a protocol in place for dealing with concussionOther concerns may override safety issues, and often youth sports may not have a protocol in place for dealing with concussion Children may underreport symptoms to go back to play sooner for fear of appearing weak, losing position, feeling invulnerableChildren may underreport symptoms to go back to play sooner for fear of appearing weak, losing position, feeling invulnerable Concussion MAY be 10-20 X more prevalent in childrenConcussion MAY be 10-20 X more prevalent in children Children are more at risk for second impact syndromeChildren are more at risk for second impact syndrome

28. Concussion Quiz A concussion can make school work harder.A concussion can make school work harder. TrueTrue FalseFalse

29. True After have a concussion, kids often cant concentrate as well and reading and doing math can cause headaches.After have a concussion, kids often cant concentrate as well and reading and doing math can cause headaches.

30. Recovery of the Young Athlete Kids are not the same as PROSKids are not the same as PROS The brain of athletes under the age of 18 heals at a slower rate than older athletes following a concussionThe brain of athletes under the age of 18 heals at a slower rate than older athletes following a concussion

31. Prevention Helmets decrease risk of skull fractures and intracranial hemorrhage.Helmets decrease risk of skull fractures and intracranial hemorrhage. Mouthguards decrease dental and oral trauma.Mouthguards decrease dental and oral trauma. Role of protective equipment in prevention of concussion not establishedRole of protective equipment in prevention of concussion not established

32. Recovery and Return to Play-Grades and Guidelines Are not scientifically basedAre not scientifically based Assumes standard use for gender and age groupsAssumes standard use for gender and age groups Poor job distinguishing mild concussionPoor job distinguishing mild concussion Assigns too much importance in LOCAssigns too much importance in LOC Did not provide useful prognostic informationDid not provide useful prognostic information Did no account for risk factors/individuals factorsDid no account for risk factors/individuals factors

33. Commonly Reported Symptoms High School & College athletes – within 3 days of injuryHigh School & College athletes – within 3 days of injury 1.Headache 71% 2.Feeling slowed down58% 3.Difficulty concentrating57% 4.Dizziness55% 5.Fogginess 53% 6.Fatigue 50% 7.Visual blurring/double vision 49% 8.Light sensitivity 47% 9.Memory dysfunction 43% 10.Balance problems 43%

34. Factor Analysis, post-concussion symptom scale (Pardini et al 2004) N=327 High school and University Athletics witin 7 Days of Concussion Emotionality -More emotional -Sadness -Nervousness -Irritability Cognitive symptoms -Attention problems -Memory dysfunction -fogginess -Fatigue -Cognitive slowing Somatic Symptoms -Visual problems -Dizziness -Balance difficulties -Headaches -Light sensitivity -Nausea Sleep Disturbance -Difficulty falling asleep -Sleeping less than usual

35. Symptom Evaluation Concussion Signs Concussion Signs Appears dazed Appears dazed Confused about play Confused about play Moves clumsily Moves clumsily Answers questions slowly Answers questions slowly Personality/behavior change Personality/behavior change Forgets plays prior to hit Forgets plays prior to hit Anterograde amnesia Anterograde amnesia Loses consciousness Loses consciousness Concussion symptomsConcussion symptoms HeadacheHeadache NauseaNausea Balance problemsBalance problems Double visionDouble vision PhotosensitivityPhotosensitivity Feeling sluggishFeeling sluggish Feeling foggyFeeling foggy Change in sleep patternChange in sleep pattern Cognitive changesCognitive changes

36. Concussion Quiz If I feel ok right after a hit, it means I am fine and do not have a concussionIf I feel ok right after a hit, it means I am fine and do not have a concussion TrueTrue FalseFalse

37. False Many athletes dont have a headache or other symptoms for hours after a concussion.Many athletes dont have a headache or other symptoms for hours after a concussion.

39. Later Signs of Concussion Post- Concussion Syndrome Decreased Processing SpeedDecreased Processing Speed Short-term Memory ImpairmentShort-term Memory Impairment Concentration DeficitConcentration Deficit Irritability/DepressionIrritability/Depression Fatigue/Sleep DisturbanceFatigue/Sleep Disturbance General Feeling of fogginessGeneral Feeling of fogginess Academic DifficultiesAcademic Difficulties

40. Relative Impacts video video video

41. Second Impact Syndrome Occurs in athletes with prior concussion following often relatively minor second impact Occurs in athletes with prior concussion following often relatively minor second impact Athlete returns to competition before resolution of symptoms Athlete returns to competition before resolution of symptoms Catastrophic increase in intracranial pressure Catastrophic increase in intracranial pressure vasomotor paralysis, edema, massive swelling, herniation, death vasomotor paralysis, edema, massive swelling, herniation, death Neuro-chemical processes appear to differ in developing brain Neuro-chemical processes appear to differ in developing brain

43. Second Impact 2 nd IMPACT USUALLY OCCURS WITHIN 14 DAYS OF THE FIRST CONCUSSION AND UNDER AGE 212 nd IMPACT USUALLY OCCURS WITHIN 14 DAYS OF THE FIRST CONCUSSION AND UNDER AGE 21

45. On field assessment card Signs and symptoms evaluation Signs observed by staff: Signs observed by staff: Appears to be dazed or stunned Appears to be dazed or stunned Unsure of game score or opponent Unsure of game score or opponent Lack of coordination Lack of coordination Poor reaction time Poor reaction time Losses consciousness (even temporarily) Losses consciousness (even temporarily) Shows behavior, mod or personality change Shows behavior, mod or personality change Forgets events prior to injury (retrograde) Forgets events prior to injury (retrograde) Unequal or dilated pupils Unequal or dilated pupils Bleeding or clear fluid coming from nose or ears Bleeding or clear fluid coming from nose or ears Symptoms reported by athlete:Symptoms reported by athlete: HeadacheHeadache Nausea or vomitingNausea or vomiting Balance problems or dizzinessBalance problems or dizziness Double or fuzzy visionDouble or fuzzy vision Sensitivity to light or noiseSensitivity to light or noise Feeling sluggishFeeling sluggish Feeling foggyFeeling foggy Change in sleep patternChange in sleep pattern Concentration or memory problemsConcentration or memory problems LightheadednessLightheadedness Easily fatiguedEasily fatigued confusionconfusion

46. Symptoms may worsen with exertion. Athlete should not return to play until symptom-free

47. On-field Cognitive testing Orientation Orientation Ask the athlete the following questions: Ask the athlete the following questions: What stadium is this? What stadium is this? What city is this? What city is this? Who is the opposing team? Who is the opposing team? What month is it? What month is it? What day is it? What day is it? Anterograde amnesia Anterograde amnesia Ask the athlete to remember the following words: Ask the athlete to remember the following words: Girl, dog, green Girl, dog, green Retrograde amnesia Retrograde amnesia Ask the athlete the following questions: Ask the athlete the following questions: What happened in the prior quarter/period? What happened in the prior quarter/period? What do you remember just prior to the hit? What do you remember just prior to the hit? What was the score of the game prior to the hit? What was the score of the game prior to the hit? Concentration Concentration Ask the athlete to do the following: Ask the athlete to do the following: Repeat the days of the week backwards Repeat the days of the week backwards Repeat these numbers backwards: 63 (36 is correct): 419 (914 is correct) Repeat these numbers backwards: 63 (36 is correct): 419 (914 is correct) Word list memory Word list memory Ask the athlete to repeat the three words from earlier Ask the athlete to repeat the three words from earlier

48. SCAT II SCAT II FormSCAT II FormSCAT II FormSCAT II Form

49. Concussion Management Rule out more serious intracranial pathologyRule out more serious intracranial pathology CT, MRI, neurologic examination primary diagnostic testCT, MRI, neurologic examination primary diagnostic test Prevent second impact syndromePrevent second impact syndrome Prevent presence of post-concussion syndrome (Home Program)Prevent presence of post-concussion syndrome (Home Program) Avoid video gamesAvoid video games Text messagesText messages Watching tvWatching tv Playing or doing homework on computerPlaying or doing homework on computer Long periods of readingLong periods of reading

50. Return to Play Protocol Exercise ProgressionsExercise ProgressionsExercise ProgressionsExercise Progressions

52. Return To Classroom Protocol Classroom ProgressionsClassroom ProgressionsClassroom ProgressionsClassroom Progressions

53. What do we need to do as football coaches Teach proper technique-UIL requires that all football coaches teach there athlete about Heads UP in FootballTeach proper technique-UIL requires that all football coaches teach there athlete about Heads UP in Football Before-Mid-seasonBefore-Mid-season Heads-Up in Football VideoHeads-Up in Football VideoHeads-Up in FootballHeads-Up in Football

54. Home with a Concussion A person with a concussion may: A person with a concussion may: Use acetaminophen (Tylenol) for headachesUse acetaminophen (Tylenol) for headaches Use ice pack on head and neck as needed for comfortUse ice pack on head and neck as needed for comfort Eat a light dietEat a light diet Go to sleepGo to sleep Rest (no strenuous activity or sports)Rest (no strenuous activity or sports)

55. Home Care There is no need to: There is no need to: Wake up every hourWake up every hour Test reflexesTest reflexes Stay in bedStay in bed Observe and monitor athlete. If there is a decline in symptoms, see physicianObserve and monitor athlete. If there is a decline in symptoms, see physician

56. Home Care Do not: Drink alcohol Drive while symptomatic Exercise or lift weights Use a computer or test message Watch TV for long periods of time Take Ibuprofen, aspirin, naproxen or other non-steroidal anti-inflammatory medications

57. ImPACT ImPact TestImPact TestImPact TestImPact Test ImPact Test ModulesImPact Test ModulesImPact Test ModulesImPact Test Modules

58. High School vs Pros

59. Long Term Research

60. Long Term

61. Long Term Research

62. Concussion Quiz The brain needs to rest after a concussion.The brain needs to rest after a concussion. TrueTrue FalseFalse

63. True The Brain needs a lot of rest after a concussion and you may need to sleep more than usual. You should not play video games, read a lot, or do other things to make your brain work hard. If you rest, you will be able to return to normal activities quicker! If you try to go back playing a sport too soon, your concussion could take longer to get better.The Brain needs a lot of rest after a concussion and you may need to sleep more than usual. You should not play video games, read a lot, or do other things to make your brain work hard. If you rest, you will be able to return to normal activities quicker! If you try to go back playing a sport too soon, your concussion could take longer to get better.

65. Most Important Take Away Improved awareness and increase in concussion recognition!Improved awareness and increase in concussion recognition!

66. Questions?

67. Reminders The Rules Compliance Program (RCP) is required for coaches of grades 7-12. See UIL web page.The Rules Compliance Program (RCP) is required for coaches of grades 7-12. See UIL web page. CPR Refresher GISD web site. Go to my web page.CPR Refresher GISD web site. Go to my web page. Email me once you have gone over the refresher.Email me once you have gone over the refresher.