2 Definition of Concussion A traumatic injury to the brain as a result of a violent blow, shaking, or spinning. A brain concussion can cause immediate and usually temporary impairment of brain function such as of thinking, vision, equilibrium and consciousness.
3 Signs of ConcussionObjective signs of concussion: The signs of concussion observed by medical staff in athletes with a concussion, according to The American Medical Association (AMA), include the following:Player appears dazedPlayer has vacant facial expressionConfusion about assignmentAthlete forgets playsDisorientation to game or scoreInappropriate emotional reactionPlayer displays clumsinessPlayer is slow to answer questionsLoss of consciousnessAny change in typical behavior
4 Signs Of ConcussionSubjective symptoms of concussion: The symptoms of concussion reported by athletes with a concussion, according to the AMA, include the following:HeadacheNauseaBalance problems or dizzinessDouble or fuzzy visionSensitivity to light or noiseFeeling slowed downFeeling "foggy" or "not sharp"Change in sleep patternConcentration or memory problemsIrritabilitySadnessFeeling more emotional
5 Stats on Concussions 300,000 estimated in a year. It is not known how many suffer cognitive and neurobehavioral problems related to recurrent concussions.30 to 40 deaths per year from ”Second Impact Syndrome”
6 Second Impact Syndrome Suffering a second blow to the head while recovering from an initial concussionAthletes that are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injuryOnce a person has had a concussion, he or she is as much as four times more likely to sustain a second one
7 Post Concussive Syndrome Syndrome is rareDescribed as having concussion symptoms lasting more than one monthPeople with PCS have sleep disturbances, concentration and memory issues, depression and other psychiatric problems
8 Some of What We Have Learned About Concussions In recent years there were as many as 20 grading scales for concussions. Many of these scales used LOC as a predictor of recovery outcomesHow long the concussion symptoms last has turned out to be far more important than the initial symptoms of concussions in predicting outcomes
9 What We Have LearnedLesser blows can cause more symptoms, harder blows may cause fewer symptomsYounger athletes (in high school or in lower grades) have been shown to exhibit longer recovery times when compared to college and professional athletes.Concussions seem to have more symptoms and last longer in females
10 What We Have LearnedA gene may exist that causes some individuals to be more susceptible to concussionsWhat we now know is that each concussion should be treated individually depending on the symptoms and the neurocognitive test results. This may be the reason why standardized management guidelines were unsuccessful.
11 Prevention of Primary Concussion Proper tackling and blocking techniquesProper fitting and maintenance of football and lacrosse helmetsOften after the first 2 weeks of helmet usage, it should be checked for proper fit
12 Recommendations to Improve Concussion Management and Speed Recovery NO ADOLESCENT WITH A CONCUSSION SHOULD CONTINUE TO PLAY OR RETURN TO A GAME AFTER SUSTAINING A CONCUSSION.WHY? ATHLETES GETTING MULTIPLE BLOWS TO THE HEAD MAY TAKE LONGER TO RECOVER AND RISK POST CONCUSSIVE SYNDROME
13 RECOMMENDATION #2AN INDIVIDUAL SUSTAINING A CONCUSSION SHOULD CEASE DOING ANY ACTIVITY THAT CAUSES THE SYMPTOMS OF A CONCUSSION TO INCREASE (e.g. headaches, dizziness, nausea, etc.).Continuing activities, or exercise that increases symptoms, can delay the recovery from the concussion.
14 RECOMMENDATION #3SCHOOL ATTENDANCE AND ACTIVITIES MAY NEED TO BE MODIFIED.While some individuals may be able to attend school without increasing their symptoms, the majority will probably need some modifications depending on the nature of the symptoms. Trial and error may be needed to discover what they can and cannot do.
15 RECOMMENDATION #4NEUROCOGNITIVE TESTING IS AN IMPORTANT COMPONENT FOR THE MANAGEMENT OF CONCUSSIONSThe use of neurocognitive testing is one piece of the puzzle in assessing recovery from concussions and determining the timing of return to play. It should only be used as a tool, and should not be the only deciding factor in returning a concussed athlete to play. It provides objective data and prevents athletes who hide their symptoms from returning to play before they are fully recovered.
16 Recommendation 5NO ATHLETES SHOULD RETURN TO CONTACT COMPETITIVE SPORTS UNTIL THEY ARE SYMPTOM FREE, BOTH AT REST AND WITH EXERCISE AND HAVE NORMAL NEURO-COGNITIVE TESTING.
17 When they have no headaches or other concussion symptoms athletes can begin the concussion graduated return-to-play exercise programDay 1: Walking for minutes at a rate of 2-1/2 miles per hour Day 2: Jogging for minutes Day 3: Running for minutes Day 4: Performing sports specific practice drills Day 5: Return to contact sports if RECOMMENDATION #5 is met
18 Recommendation 6ALL SPORTS AND HEALTH EDUCATION PROGRAMS SHOULD TEACH STUDENTS THE SPECIFIC SIGNS AND SYMPTOMS OF CONCUSSIONS. INSTRUCTORS MUST EMPHASIZE THE SERIOUS CONSEQUENCES OF IGNORING CONCUSSION SYMPTOMS AND THE CONSEQUENCES THAT WILL OCCUR IF CONCUSSIONS ARE NOT PROPERLY TREATED.
19 HHS RTP ProtocolVienna Concussion Conference: Return to Play Recommendations. Athletes shouldcomplete the following step-wise process prior to return to play following concussion.1. Removal from contest following and signs/symptoms of concussion.2. No return to play in current game3. Medical evaluation following injurya. Rule out more serious intracranial pathologyb. Neuropsychological Testing considered “cornerstone” or proper post-injury assessment4. Stepwise return to playa. No activity and rest until asymptomaticb. Light aerobic exercisec. Sport-specific trainingd. Non-contact drillse. Full-contact drillsf. Game play
20 Coaches Responsibility Get medical attention as needed if ATC not on siteInform parent ASAP of concussionReport all concussions to ATC Staff if ATC not on siteATC will follow-up with athlete and parent
21 Questions and Comments Directed to me viaAny info you give may help in justification for purchase of software to start neuropsychological testing
22 REFERENCESSummary and Agreement Statement on Concussion in Sport. Clinical Journal of Sports Medicine, Vol.12, No 1, 2002Impact Concussion Management Software Return to Play Guidelines Dr. Mark Lovell