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Introduction to Concussions: Recognition and Management of Concussion in Sport David B. Gealt, D.O. Cooper Bone and Joint Institute Cooper University Hospital.

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Presentation on theme: "Introduction to Concussions: Recognition and Management of Concussion in Sport David B. Gealt, D.O. Cooper Bone and Joint Institute Cooper University Hospital."— Presentation transcript:

1 Introduction to Concussions: Recognition and Management of Concussion in Sport David B. Gealt, D.O. Cooper Bone and Joint Institute Cooper University Hospital Asst Professor UMDNJ-RWJ Asst Professor UMDNJ-SOM Palmyra-Riverton Soccer Club August 24, 2011

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3 Estimates: Concussions in New Jersey

4 Athletic Trainers Report: 5.1% of football players sustained a concussion during a season 0.7% sustained a second concussion during the same season BUT…… (Guskiewicz et al.2000)

5 47% had at least one concussion during the season. 35% had multiple concussions during the season. (Langburt et al.2001) Players Report Symptoms of Concussion

6 Athletes Want to… STAY IN THE GAME!!

7 Education is #1 –Healthcare Personnel –Certified Athletic Trainers –Coaches –Parents –Athletes Everyone needs to be on the same page to avoid the potential dangers of repetitive concussive head injury

8 Concussion Facts A direct blow to the head, face, and neck can cause a concussion An indirect blow elsewhere on the body can transmit an impulsive force to the head, causing a concussion Most concussions do NOT involve loss of consciousness

9 Concussion Facts Typically results in rapid onset of short- lived impairment of neuro function that spontaneously resolves Majority of concussions resolve within days

10 Physical Signs and Symptoms Headaches Dizzy or Lightheaded Blurry Vision Ringing in the Ears Loss of Balance Numbness or Tingling Sensations Loss of consciousness Nausea/Vomiting Fatigue,Exhaustion Difficulty Sleeping Sensitivity to Light and Sound Dilated Pupils Slurred Speech Glassy eyed/foggy

11 Cognitive and Emotional Signs & Symptoms Confusion Difficulty Focusing or Concentrating Disorientation of Time & Place Slower Rate to Processing Information Memory Loss* Irritability/mood changes Anxiety Easily Saddened or Upset Sadness,Depression

12 Consequences can Affect: Academics Social Relationships Behavior Emotions GOES BEYOND THE PLAYING FIELD!

13 Evaluation/Management Basic Life Support to assure ABCs Determine if LOC has occurred If LOC and/or ? Cervical spine injury MUST STABILIZE and BOARD and TRANSPORT. Do not remove helmet and shoulder pads. Ask teammates involved in play if LOC * Once ruled out can move to sidelines

14 Evaluation Sideline Assessment –SCAT 2 Reassess q 5-10 minutes Remove helmet Deterioration of Neuro fcnSEND TO ED ASAP! Follow up with complete eval in office Computer Neuropsychological Testing-ImPACT

15 Baseline Testing- A Cutting Edge Technology-ImPACT Immediate Post-Concussion Assessment and Cognitive Testing Provides comparison based on pre and post concussion scores Provides clinicians with a tool to help determine safe return to play Documents an athletes concussion history

16 2010 NJ State Law N.J.S.A 18A: was passed on 12/7/2010 by Gov ChristieN.J.S.A 18A: Development of interscholastic athletic head injury safety training program NJ Dept of Ed (NJDOE) –Model Policy and Guidance for Prevention and Treatment of Sports-Related Concussions and Head Injuries February 28, 2011

17 2010 NJ Law Immediate removal from sports competition or practice Unable to RTP: Medical Evaluation and written clearance by a physician or other licensed health care provider trained in the evaluation and management of concussion.

18 NJ State Law All coaches, school nurses, school/team physicians and ATCs must complete a Concussion Head Injury Training Program Head Injury Fact sheet signed by each student/guardian annually before activity Each school needs a written concussion policy implemented by year

19 How to manage concussions?

20 Management Acute Response (All newest literature data supports) -Any signs/symptoms of concussion = No RTP, Out of Activity -Not to be left alone: to ck for deterioration -Medical evaluated ASAP -RTP by stepwise process with trained supervision

21 Other Factors to Consider Age of the child…younger is not always better in fact may be worse (Field et al 2003) Symptoms that persist for longer than 3-6 weeks (PCS) Cumulative effects of multiple concussions

22 RTP too soonSerious Consequences Post Concussion Syndrome Second Impact Syndrome –Loss of cerebrovascular autoregulation causing brain swelling, herniation, death

23 Management No Cookbook Guidelines Individualized Treatment Multi-Discipline Approach –Physicians –ATC –School Nurse –Neurocognitive Testing –Neuropsychologists/Psychologist –Cognitive Therapist –Guidance Counselors –Teachers –Family Support

24 In simplest terms think of a concussion as a sprained brain –Physical Rest –Cognitive Rest– limit ADLs, exertion and scholastic activities while symptomatic (INCLUDING VIDEO GAMES, TEXTING, FACEBOOK, INTERNET, ETC.)

25 Management Consider school during recovery –Extensions/Breaks/Testing/Time in School –Gym and athletics

26 RTP Protocol Must by ASYMPTOMATIC w/ normal neuro/cognitive fcn I.No activity, asymptomatic for 24 hours II.Light aerobic exercise III.Sport specific training IV.Noncontact drills V.Full contact VI.Game play If become symptomatic, return to prior level and wait 24 hours

27 Proper management of concussion is the best form of prevention of serious injury Not worth the risk of playing with a concussion Only 1 Brain: Protect It! When in Doubt - Sit Them Out!

28 Heads Up Concussion Kits tool_kit.htm ol_Kit.htm First step in fixing this epidemic Its Free!

29 Thank You

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