2. Management of Concussions By: Michael Cox Technology and Assessment

3. What is a Concussion? Concussions are injuries that transiently impair the way your brain normally functions They can be caused by a direct blow to your head or by a force that causes your brain to shake within your skull Not all concussions include loss of consciousness Concussions are injuries that transiently impair the way your brain normally functions They can be caused by a direct blow to your head or by a force that causes your brain to shake within your skull Not all concussions include loss of consciousness

4. What to Do if There is a Suspected Concussion  If there is an athletic trainer at the location where the injury took place, call him/her for immediate evaluation  Contact your primary physician  If they are not available  Contact emergency services  If there is an athletic trainer at the location where the injury took place, call him/her for immediate evaluation  Contact your primary physician  If they are not available  Contact emergency services

5. Concussion Symptoms  Headache  Dizziness  Nausea  Ringing in the ears  Blurred vision  Dazed or confusion  Amnesia  Balance and coordination problems  Aniscoria (pupil size)  Headache  Dizziness  Nausea  Ringing in the ears  Blurred vision  Dazed or confusion  Amnesia  Balance and coordination problems  Aniscoria (pupil size)

6. Evaluating A Concussion  Determine their consciousness and what symptoms the athlete is experiencing  Signs and Symptoms Signs and Symptoms  Memory Testing  Determine what they remember before the injury (antrograde amnesia) and what they remember after the injury (retrograde amnesia)  SAC test  Balance Testing  Have athlete balance on both feet with their eyes closed  Then perform same test with one foot in front of the other and vies versa  Neurological Testing  Test dermatome (sensitivity to touch) and myotome (strength test) to specific nerve roots  Determine their consciousness and what symptoms the athlete is experiencing  Signs and Symptoms Signs and Symptoms  Memory Testing  Determine what they remember before the injury (antrograde amnesia) and what they remember after the injury (retrograde amnesia)  SAC test  Balance Testing  Have athlete balance on both feet with their eyes closed  Then perform same test with one foot in front of the other and vies versa  Neurological Testing  Test dermatome (sensitivity to touch) and myotome (strength test) to specific nerve roots

7. Cranial Nerve Testing  Olfactory- Sense of smell  Optic- vision, reading a text at close proximity and distant proximity  Oculomotor- PEARL, pupil dilation  Trochlear- Eye trackign up and down  Trigeminal- Facial sensations  Abducens- Lateral eye tracking  Facial- facial movements  Vestibulocochlear- Balance and hearing  Glossopharyngeal- Swallowing reflex  Vagus- Gauge reflex  Accessory- Shoulder shrug  Hypoglossal- Tongue lag  Olfactory- Sense of smell  Optic- vision, reading a text at close proximity and distant proximity  Oculomotor- PEARL, pupil dilation  Trochlear- Eye trackign up and down  Trigeminal- Facial sensations  Abducens- Lateral eye tracking  Facial- facial movements  Vestibulocochlear- Balance and hearing  Glossopharyngeal- Swallowing reflex  Vagus- Gauge reflex  Accessory- Shoulder shrug  Hypoglossal- Tongue lag

8. Determining the Severity of a Concussion Grade 1 No loss of consciousness Memory loss lasting < 30 minutes Symptoms lasting < 24 hours Grade 2 Loss of consciousness lasting < 1 minute Memory loss lasting 30 minutes to 24 hours, OR Symptoms lasting > 24 hours but < 7 days Grade 3 Loss of consciousness lasting > 1 minute OR Memory loss lasting > 24 hours OR Symptoms lasting > 7 days Grade 1 No loss of consciousness Memory loss lasting < 30 minutes Symptoms lasting < 24 hours Grade 2 Loss of consciousness lasting < 1 minute Memory loss lasting 30 minutes to 24 hours, OR Symptoms lasting > 24 hours but < 7 days Grade 3 Loss of consciousness lasting > 1 minute OR Memory loss lasting > 24 hours OR Symptoms lasting > 7 days

9. Post-concussion Symptoms  Photophobia (sensitivity to light)  Seeing stars  Difficulty concentrating  Irritability  Depression  Anxiety  Fatigue  Headache  Trouble sleeping  Photophobia (sensitivity to light)  Seeing stars  Difficulty concentrating  Irritability  Depression  Anxiety  Fatigue  Headache  Trouble sleeping

10. Rehabilitation  Once an athlete has been diagnosed with a concussion they are not aloud to start rehabilitation until they are symptom free  Once symptom free, a 7 day progressive rehab program can begin focusing on cardiovascular exertion, strengthening, and sport-specific activites  If at any time an athlete develops symptoms as a result of their rehab, they are to stop activity until symptoms are gone and start over  Once an athlete has been diagnosed with a concussion they are not aloud to start rehabilitation until they are symptom free  Once symptom free, a 7 day progressive rehab program can begin focusing on cardiovascular exertion, strengthening, and sport-specific activites  If at any time an athlete develops symptoms as a result of their rehab, they are to stop activity until symptoms are gone and start over

11. DAY 1  10 minute elliptical/bike session  Moderate intensity  Impact test- cognitive functioning  SAC test- memory  No participation during practice/game  Goal: Increase heart rate  10 minute elliptical/bike session  Moderate intensity  Impact test- cognitive functioning  SAC test- memory  No participation during practice/game  Goal: Increase heart rate

12.  20-25 minute elliptical/bike session  Higher intensity  No participation during practice/game  Goal: Increase heart rate  20-25 minute elliptical/bike session  Higher intensity  No participation during practice/game  Goal: Increase heart rate DAY 2

13.  20-25 minute elliptical/bike session  Begin full-body lifting  Leg extension/curls  Chest press  Bicep curls  Triceps pull-downs  Seated rows  No participation in practice/game  Goal: Get person moving  20-25 minute elliptical/bike session  Begin full-body lifting  Leg extension/curls  Chest press  Bicep curls  Triceps pull-downs  Seated rows  No participation in practice/game  Goal: Get person moving DAY 3

14.  Warm-up on elliptical/bike 10-15 minutes  Full-body workout  Sprinting  10-15 sprints ranging from short to long distances  No participation in practice/games  Goal: increase athletes heart rate close to max  Warm-up on elliptical/bike 10-15 minutes  Full-body workout  Sprinting  10-15 sprints ranging from short to long distances  No participation in practice/games  Goal: increase athletes heart rate close to max DAY 4

15.  Warm-up on elliptical/bike 10-15 minutes  Sport specific activities  i.e- shooting, throwing, hitting, kicking  Minimal participation in practice  No participation in game  Goal: get them back to sport-specific training  Warm-up on elliptical/bike 10-15 minutes  Sport specific activities  i.e- shooting, throwing, hitting, kicking  Minimal participation in practice  No participation in game  Goal: get them back to sport-specific training DAY 5

16.  Return to practice with no contact  Goal: Return to all sports activity restraining from contact  Return to practice with no contact  Goal: Return to all sports activity restraining from contact DAY 6

17.  Full return to participation including contact  Able to play in games  Goal: Contact drills being aware of any symptoms that may return  Full return to participation including contact  Able to play in games  Goal: Contact drills being aware of any symptoms that may return DAY 7

18. Returning from a Concussion to Soon  Returning from a concussion before someone is ready can not only lead to an increase in symptoms, but it can cause further damage  Secondary Impact Syndrome  This occurs when an athlete sustains a secondary head injury while still experiencing symptoms from the first concussion  The secondary injury can be very minor  It will cause rapid swelling and disruption of the brain possibly leading to respiratory failure and possibly death  Returning from a concussion before someone is ready can not only lead to an increase in symptoms, but it can cause further damage  Secondary Impact Syndrome  This occurs when an athlete sustains a secondary head injury while still experiencing symptoms from the first concussion  The secondary injury can be very minor  It will cause rapid swelling and disruption of the brain possibly leading to respiratory failure and possibly death

19. What to Avoid  Athletes who sustain a concussion should avoid certain behaviors until instructed otherwise. Such behaviors include:  Drinking coffee or other stimulants  Consuming alcohol  Consuming foods in excess that will upset the stomach  Weight lifting or exercise  Taking medications that contain ibuprofen such as advil or Aleve because they are blood thinners and can cause further problems  Athletes who sustain a concussion should avoid certain behaviors until instructed otherwise. Such behaviors include:  Drinking coffee or other stimulants  Consuming alcohol  Consuming foods in excess that will upset the stomach  Weight lifting or exercise  Taking medications that contain ibuprofen such as advil or Aleve because they are blood thinners and can cause further problems

20. Some Ways to Help Treat a Concussion There is no cure or specific medication for a concussion but there are some ways to help treat the symptoms: REST- the most important thing a person can do is rest the body and get a good nights sleep Taking tylenol (acetaminophen) for minor headaches Avoid strenuous activity Try not to watch TV or use the computer to much If doing homework or reading is bothersome, stop doing it There is no cure or specific medication for a concussion but there are some ways to help treat the symptoms: REST- the most important thing a person can do is rest the body and get a good nights sleep Taking tylenol (acetaminophen) for minor headaches Avoid strenuous activity Try not to watch TV or use the computer to much If doing homework or reading is bothersome, stop doing it

21. Summary  If an athlete sustains any type of headache or “not feeling right” after being hit in the head, it is very important to have a certified health professional evaluate the injury  Do not lie about symptoms  Most important thing to do is rest the body and refrain from strenuous activity  A doctor must clear the athlete before returning to activity  If an athlete sustains any type of headache or “not feeling right” after being hit in the head, it is very important to have a certified health professional evaluate the injury  Do not lie about symptoms  Most important thing to do is rest the body and refrain from strenuous activity  A doctor must clear the athlete before returning to activity