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Concussions and Concussion Management

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1 Concussions and Concussion Management

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 Concussion Objective 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 dazed Player has vacant facial expression Confusion about assignment Athlete forgets plays Disorientation to game or score Inappropriate emotional reaction Player displays clumsiness Player is slow to answer questions Loss of consciousness Any change in typical behavior

4 Signs Of Concussion Subjective symptoms of concussion: The symptoms of concussion reported by athletes with a concussion, according to the AMA, include the following: Headache Nausea Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise Feeling slowed down Feeling "foggy" or "not sharp" Change in sleep pattern Concentration or memory problems Irritability Sadness Feeling 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 concussion Athletes that are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury Once 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 rare Described as having concussion symptoms lasting more than one month People 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 outcomes How 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 Learned Lesser blows can cause more symptoms, harder blows may cause fewer symptoms Younger 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 Learned A gene may exist that causes some individuals to be more susceptible to concussions What 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 techniques Proper fitting and maintenance of football and lacrosse helmets Often 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 #2 AN 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 #3 SCHOOL 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 #4 NEUROCOGNITIVE TESTING IS AN IMPORTANT COMPONENT FOR THE MANAGEMENT OF CONCUSSIONS The 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 5 NO 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 program Day 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 6 ALL 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 Protocol Vienna Concussion Conference: Return to Play Recommendations. Athletes should complete 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 game 3. Medical evaluation following injury a. Rule out more serious intracranial pathology b. Neuropsychological Testing considered “cornerstone” or proper post-injury assessment 4. Stepwise return to play a. No activity and rest until asymptomatic b. Light aerobic exercise c. Sport-specific training d. Non-contact drills e. Full-contact drills f. Game play

20 Coaches Responsibility
Get medical attention as needed if ATC not on site Inform parent ASAP of concussion Report all concussions to ATC Staff if ATC not on site ATC will follow-up with athlete and parent

21 Questions and Comments
Directed to me via Any info you give may help in justification for purchase of software to start neuropsychological testing

22 REFERENCES Summary and Agreement Statement on Concussion in Sport. Clinical Journal of Sports Medicine, Vol.12, No 1, 2002 Impact Concussion Management Software Return to Play Guidelines Dr. Mark Lovell


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