Concussion Recognition And Neurological Intervention United Management CRANIUM Concussion Recognition And Neurological Intervention United Management

What is a Concussion Mayo defines a concussion as: “Traumatic brain injury that alters the way your brain functions” http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/CON-20019272 CDC defines a concussion as: “Type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth” http://www.cdc.gov/headsup/basics/concussion_whatis.html

Traumatic Brain Injuries (TBI) 75% of all TBI’s result from concussions or other forms of mild TBI’s TBI’s can cause: Epilepsy Parkinson's Alzheimer's Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal Chronic Traumatic Encephalopathy Newly identified disease associated with repeated concussions Release of a protein called TAU slowly kills brain cells Once started it appears to progress without further incident Only diagnosed after death http://www.cdc.gov/HeadsUp/ http://concussionfoundation.org/learning-center/what-is-cte

Concussion Prevalence Estimated 1.7-4.0 million occur each year 60-80% resolve in 7-10 days Up to 33% of individuals will have post concussion syndrome Up to 30% of individuals will demonstrate post concussion symptoms 6 months post injury Kozlowski, K. F., Graham, J., Leddy, J. J., Devinney-Boymel, L., & Willer, B. S. (2013). Exercise intolerance in individuals with postconcussion syndrome. Journal of Athletic Training, 48(5), 627-635. doi:10.4085/1062-6050-48.5.02

Possibility of Becoming a Star 8 million student athletes compete at the high school level 480,000 athletes compete at the collegiate level Less than 2% of college athletes play professional sports http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics http://work.chron.com/likelihood-someone-becoming-professional-sports-player-26110.html

Signs & Symptoms Confusion Amnesia Headache Loss of consciousness Balance problems Blurry Vision Concentration/ memory problems Sensitivity to light/noise Nausea Feeling foggy, tired Feeling irritable Slowed reaction time

Concussion Management Protocol Athlete suspected of concussion is immediately removed from field of play Athlete assessed by qualified health care provider Referral to Physical Therapist or Athletic Trainer Return to play progression completed Athlete referred to health care provider for clearance to return to practice and then competition

Three Is Better Than One Sport Concussion Assessment Tool-3rd Edition Vestibular Ocular Motor Screening Balke Treadmill Test

Sports Concussion Assessment Tool 3rd Includes: Symptom evaluation, Cognitive & physical evaluation, Balance, Coordination, Recall, Memory Balance Error Scoring System Broadly Normal: Score 1-4 Below Average: Score ≥ 5 Self reported symptom score of 24.91/122 compared to 6.53/122

Vestibular Ocular Motor Screening (VOMS) Quick 5-10 minute test Provocation testing of the vestibular and ocular motor systems Symptom changes are rated by patient 2014 American Journal of Sports Medicine Scores ≥ 2 total symptoms after any VOMS item (96%) or a Near Point Convergence distance of ≥ 5 cm (84%) resulted in high rates of concussion identification.

Balke Treadmill Test Standardized treadmill protocol Test terminated due to fatigue or production of concussion symptoms 2013 Journal of Athletic Training: 100% of patients with concussion stopped the test due to return of concussion symptoms. Median exercise duration was 40% of the control group, 9 minutes or less compared to 18 Sensitivity 99% and Specificity 89%

Return to Play Protocol Consists of 5 phases each adding a plane of movement and intensity Athletes 12 years old or younger- 72 hours symptom free before progressions Athletes 13 years old and older- 24 hours symptom free before progression http://www.cdc.gov/headsup/providers/return_to_activities.html

Return to Play Phases Phase #1- No Activity Complete physical and cognitive rest Symptom free x 24 hours progress to phase 2 Phase #2- Light Aerobic Exercise 20 min of cardiovascular exercise at less than 70% heart rate max Phase #3- Sport Specific Exercise 45min of cardiovascular less than 80% heart rate max Phase #4 Non-Contact Training Drills 60min of complex training less than 90% of heart rate max Phase #5- Full Contact/Practice

Medical Clearance Between Stage 4 & 5: Balke Treadmill Testing Normal SCAT-3 Normal VOMS Medical Clearance to Return to Full Contact Practice Only Symptom Free x 24 hours Clearance to Return to Competition

Medical Coverage MHSAA Insurance Benefit Suspected concussion Grades 7-12 Receive prompt and professional attention for head injuries Requires referral to Physical Therapy services from qualified health care professional