Concussions

You only get one brain. Concussion symptoms may appear mild, but this injury can lead to significant, life-long impairment affecting a person’s ability to function: Physically Cognitively Psychologically Appropriate diagnosis, management, referral, and education can help young athletes recover and avoid these consequences

What is a Concussion? Major health concern: 3.8 million sport related traumatic brain injuries in U.S. each year No universally accepted definition A brain injury caused by a bump or blow to the head that causes the brain to move within the skull A functional injury not a structural injury A concussion will likely not show up on an x-ray, CAT scan or MRI. Major health concern- 3.8 million sport-related TBI every year

Wave of energy passes through brain tissue and causes neurons to dysfunction

What does a concussion look like? Not always going to be this obvious- can be caused by an indirect.

Why are kids more at risk? Child’s brain is still developing: more vulnerable Less developed cervical and shoulder musculature Less likely to use proper technique Can’t absorb the forces of collisions

Diagnosing a Concussion Concussions are like snowflakes- no two are exactly alike Stay away from “grading” concussions mild, moderate, and severe. Use a graded symptom scale to treat each concussion individually.

Signs and Symptoms (S/S) May appear immediately or hours after the injury “Evolving” injury: may feel different at 5 minutes post injury or 30 minutes post injury Some s/s overlap with other conditions These symptoms may not all present right away- may show up hours or days later.

Signs and Symptoms: Somatic Headache Dizziness Balance problems Nausea/vomiting Visual problems: double vision, light sensitive Noise Sensitive

Signs and Symptoms: Cognitive Confusion Difficulty remembering (amnesia) Difficulty concentrating Disorientation Feels foggy or slowed down Loses consciousness (Less than 10%) Vacant stare Inability to focus Delayed verbal response Slurred speech Excessive drowsiness

Signs and Symptoms: Mood More emotional Irritability Fatigue Anxiety Sadness

Signs and Symptoms: Sleep Trouble falling asleep Sleeping more than usual Sleeping less than usual

Red Flags – Go to ER or Call 911 These could mean a more serious brain bleed is occurring– EMERGENCY!! Loss of consciousness greater than 30 seconds Headache that worsens significantly Repeated vomiting Slurred speech Increased confusion Unusual behavior Seizures Weakness/numbness in arms or legs Significant cervical pain with tenderness

Diagnosing a Concussion: On Field Exam Assess ABCs: airway, breathing, circulation Mental Status Neurological Deficit Cervical Spine Status

Diagnosing a Concussion: Sideline Evaluation More detailed physical exam and history Assess for symptoms (checklist) Evaluate orientation, memory, concentration, and balance SCAT2: Sport Concussion Assessment Tool

Diagnosing a Concussion: Removal from Play A player with just 1 sign or symptom must be removed from play No same day return to play! Don’t be pressured! Coaches Parents Teammates Monitor the athlete for 1-2 hours following injury and 24-48 hours to look for signs of deteriorating function

Treatment Complete physical rest No exercise, practice, or lifting weights Complete mental/brain rest- or limit as much as possible No TV, computers, video games, phones, texting No studying, reading, or doing homework Stay home from school

Return to Play (RTP) Requirements No Signs or Symptoms Must have been cleared by physician Must have completed a gradual exercise progression

Gradual Return to Play Progression 20 minutes stationary bike; light weight lifting 20 minutes jogging; moderate weight lifting 30 minutes running; Agility; Regular weight lifting Non-contact practice drills Controlled contact practice Gradual Return to Play Progression Talk about how you progress through these days- if no symptoms return next day can progress. If symptoms return- stop activity and stay at same level the next day.

Why Concussed Players Must Sit Out Second Impact Syndrome Can occur in people under the age of 23 Can happen with a minor blow or hit when the player is still recovering from a previous concussion Rapid swelling of the brain Almost always fatal Take a look... You can push through an ankle or a wrist but this is the athlete’s brain.

Gfeller-Waller Concussion Awareness Act Signed into law June 16, 2011 Major areas of focus: Education Emergency action Post concussion protocol implementation Clearance/return to play following concussion In August 2008 Matthew Gfeller (age 15) from Winston-Salem and Jaquan Waller (age 16) from Greenville died days apart after head injuries suffered during high school football games

North Carolina leads the way for concussion research. Using helmet sensors to learn more about concussions.

Types of Tests Symptom Score Balance Error Scoring System (BESS) Sport Concussion Assessment Tool (SCAT2) Neurocognitive Testing Immediate PostConcussion Assessment and Cognitive Testing (ImPACT) Concussion Vital Signs (CVS) Axon

Symptom Score Player rates how they feel for multiple symptoms Use a 0-6 scale: 0 = none; 6 = severe

Balance Error Scoring System (BESS) A player’s balance is tested in 6 positions Each position is tested for 20 seconds AT counts the # of errors or times the player moves out of position

BESS Testing Procedure Test all 3 positions on a hard/firm surface Test all 3 positions on a foam surface Athlete holds each position for 20 seconds Barefoot or socks – no shoes, no ankle tape Hands on iliac crest (hips) Eyes closed – time starts when athlete closes eyes

BESS Scoring – count each time any of the following happen. Lifting hands off of iliac crest (hips) Stepping/stumbling/falling Moving non-weight bearing hip more than 30 degrees of flexion or Abduction Opening eyes Lifting foot or heel **If more than 1 error happens at a time, only score it as 1 point **If out of position for 5 or more seconds stop test: score = 10 **Positive = 25% above baseline or above 12 if no baseline

Neurocognitive Testing Computer based test Not an intelligence test Measures Memory Reaction time Processing speed Symptoms ImPACT, CVS, CNSVS are examples

Concussion Vital Signs (CVS): Demonstration Test www.concussionvitalsigns.com Athlete Test “athletetest” for username and password

Axon: Demonstration Test http://www.axonsports.com/demotest/

Big Hits Broken Dreams Watch this documentary and answer the questions provided. This will be handed in for a grade at the end of class. Big Hits Broken Dreams