1. Chris Hummel, MS, ATC Clinical Assistant Professor/Athletic Trainer Ithaca College Department of Exercise and Sport Sciences

2. What is a Concussion? Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces (Zurich Consensus Statement, 2008) In English = Brain trauma that messes up your normal brain function. MTBI: Mild Traumatic Brain Injury Sports Concussion

3. The Facts- What we know… Concussions can Occur in Any Sport Concussions can be Life Threatening 300,000 to 4 million Concussions/Year Almost 9% of all injuries to High School athletes are concussions 80-90% resolve in 7-10 days, slower in High school athletes Professional < College < Youth 1/5650 NFL/Youth Concussions

4. More Concussion Facts-What we are now finding out… Injury appears to be metabolic not structural which is why CT scan is almost always normal Headache probably caused by increased glucose demand following injury Magnitude of force not predictor of outcome/severity of injury High School Facts Rate higher in girls 65% games/35% practices Highest rates in football and soccer NYS Survey (Rosenbaum, A, 2007): 26 % claim to have had concussion and not reported it!

5. Recognition of Concussion If you think the athlete has sustained a concussion, they probably have! Not always a one time event. Could be a result of cumulative small traumas, not just one big one. Having an Athletic Trainer at games and practices is key to recognition and proper early management Only 42% of High schools nationally have any ATC access (NATA, 2010) I think he has a concussion!

6. Signs/Symptoms of Concussion Headache (40%-90%) Dizziness (40-50%) Memory Loss Anterograde, Retrograde Loss of Consciousness (less than 10%) Poor predictor of severity Decreased Reaction Time Vision Problems Light Sensitive, Blurriness

7. Assessment of Concussion On the Field- SCAT (ICSCAT) S/S, Memory, Balance, Cognition Neuropsychological Testing- ImPACT Memory, Reaction Time, Cognition Coordination/Balance testing Other Memory Tests

8. Management of Concussion Treat each athlete individually, on a case by case basis Athlete will not return on day of injury Complete mental and physical rest Mental=School, texting, video games, TV, I-Pod Referral to trained medical professional ATC, MD What’s different about the HS athlete? Takes longer to recover (7-30 days) Compared to College, NFL (7-10 days)

9. NFHS Suggested Guidelines (2009) No return same day Should receive clearance from trained medical professional RTP should follow step-wise protocol with provisions for delayed RTP based on return of any S/S. New Rule for 2010-2011 An official must remove anyone from competition that shows the s/s of having had a concussion Athlete cannot return unless cleared by appropriate medical professional

10. RTP Decision Making Return to Play should not be considered until athlete is: Completely S/S free for at least 24 hours! NP Testing at/above baseline test score Normal SCAT test In one recent study high school football, 15.8% of athletes sustaining a concussion that resulted in LOC returned to play in < 1 day!

11. Progressive RTP Progressive system of return Level 1- Rest Level 2- Light Exercise Level 3- Sport Specific Exercise Level 4- Non-Contact Drills Level 5- Full Contact Level 6- Game Each level should take approximately 24 hours If s/s resume, drop back to previous level once asymptomatic Some concussions will be progressed much slower, MD controlled

12. Education Emphasis What do you know/think you know about concussions? What do your coaches, and parents know? Who is in charge of recognizing, and managing an athlete’s concussion? Recommend having annual meetings/seminars given by ATC/MD to coaches, parents and athletes on concussion management

13. Where to get the best info on Concussions? NATA.org CDC.gov Heads Up: Concussion in High School Sports Toolkit Consensus Statement 3 rd Int’l Conference on Concussion in Sport- Zurich 2008 Clin J Sport Med 19(3), p.185-200

14. Questions: Feel free to contact me at chummel@ithaca.educhummel@ithaca.edu THANK YOU!