1. Concussion Management Kari Nelson MS, LAT

2. Concussion Definitions *A mild traumatic brain injury (MTBI) *Injury caused by direct or indirect force to head that disrupts function to the brain * Rapid onset of short lived impairment of neurologic function

3. What is happening? Brain rotates causing stretching or tearing of axons Shaking disrupts the brains normal chemical balance Tearing of blood vessels results in hematoma Brain striking skull causes contusion

4. Neuro. Anatomy… Normal function= neurotransmitters are released at synapse with a specific coded message With concussions, potassium ions leave the cell and calcium rushes in causing metabolic dysfunction and energy crisis. Nerve cells are vulnerable at this time and further stress can cause serious cell damage or cell deterioration. Takes several days for cells to balance out and return to normal function.

5. Symptoms  Vary greatly----no more grading scales  You do not need to lose consciousness to have a concussion!  Cognitive delay > physical symptoms Potential symptoms: headache, dizzy, nausea, confusion, feeling “slowed down”, fatigue, light sensitivity, etc.

6. What is wrong with this picture?

7. New WI State Law: As of April, 2012, WI became the 36 th state to enact a youth concussion law. Law States… ◦1. Parents of students under age 19 must sign a concussion-information form each season before their kids can participate on a sports team. ◦2. Any student-athlete suspected of having a concussion must be removed from play. ◦3. Student-athletes who get removed can not return to play until obtaining medical clearance.

8. What are we doing for return to play guidelines at GHS?? Physical testing & Cognitive testing

9. Below is the Return to Play Progression to be completed under the supervision of a medical professional. Step 1: Sign and Symptom free for at least 24 hours. Step 2: 15-30 minutes of light stationary biking, elliptical or treadmill jogging. Step 3: 45-60 minutes of strenuous activity such as sport specific drills with cones or ladders. Step 4: Non-Contact drills in uniform. Ok to try weight lifting if appropriate. Step 5: Full practice with contact. (Before individual starts the practice educate him/her on proper technique, mechanics, concussion signs and symptoms, and what to do if signs and symptoms come back.) Step 6: Full Game

10. ImPACT Testing (Immediate Post-Concussion Assessment & Cognitive Testing) Baselines (eventually all frosh and juniors) Testing 24-48 hrs. post injury Follow up testing as needed Reports can be printed off or emailed to MDs

14. For Additional information… Centers for Disease Control and Prevention (http://www.cdc.gov/concussion/sports/index.html)http://www.cdc.gov/concussion/sports/index.html WI Sports Concussion Collaborative (http://www.wisportsconcussion.org/)http://www.wisportsconcussion.org/ WI Interscholastic Athletic Association (http://wiaawi.org/index.php?id=430)http://wiaawi.org/index.php?id=430 National Federation of State High School Associations (http://www.nfhslearn.com/)http://www.nfhslearn.com/ Milwaukee Journal Sentinel – Dr. Walters Interview (http://www.jsonline.com/multimedia/video/?bctid=1 465030068001)http://www.jsonline.com/multimedia/video/?bctid=1 465030068001

15. Any Questions??