 Concussion Awareness  Concussion Education o Role of Cognitive Testing  Concussion Management Recommendations 2

 International experts: ◦ “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces -- either a direct blow to the head, face or neck; or a blow elsewhere on the body with an ‘‘impulsive’’ force transmitted to the head.”  A concussion is a brain injury caused by traumatic force 3

  Linear Example: A quarterback falls to the ground and hits the back of his head. The falling motion propels the brain in a straight line downward.   Rotational Example: A hockey player is checked into the boards. His head strikes an opponent’s knee. The contact to the head can cause a rotational motion.

 One in 10 Athletes o Appr. 38 million boys & girls play organized sports  3.8 million reported sports- and recreation-related concussions  Many more go unrecognized & unreported  Most sports- and recreation-related concussions seen in emergency rooms (65%) occur among youth ages 5–18 o Even mild concussions may impair thinking and memory, and cause emotional or behavioral changes Source: Centers for Disease Control and Prevention

 Concussions can occur in any sport – contact with players, equipment, or facilities  Most common at the high school level: o Football o Boys & Girls Soccer o Lacrosse o Wrestling o Basketball  “Honorable Mentions” o Cheerleading, Baseball, Ice Hockey 6

 Cognitive - Amnesia, confusion, disorientation  Physical - Balance difficulty, vertigo, tinnitus, blurry vision, nausea  Emotional - Change in mood, anxiety, depression, agitation 7

May not develop until minutes, hours, or days after injury  Athlete Complaints o Headaches o Dazed feeling, not right, bell ringing, "out of it” o Blurry vision o Dizziness, unsteady  Athlete Injury Symptoms o Lethargy, mentally slow, perseveration  Harder to get them up in the morning o Loss of muscle tone, slow speech, aimless pacing o Detachment from game, anti-social, withdraw o Memory loss, cognitive dysfunction 8

 Cognitive = Thinking o Ability to problem solve o Working memory & attention to task o Independent from amnesia, orientation, number recall 9

 Historically - Pivotal event in the grading of concussion severity and return to play  Today - Recent literature reviews fail to support Loss of Consciousness as a predictor in either concussion severity or return-to-play timeframe o You do not need to lose consciousness to have a concussion 10

 Presence of amnesia or memory loss is an important clinical sign of concussion  May be delayed by 20 to 30 minutes following initial trauma  Amnesia may predict injury severity 11

 Heat Exhaustion and Heat Stroke  Dehydration  Medication  Weight lifters headache  Hypoglycemia   Migraine   First week of contact football   Soccer Heading   Altitude sickness 12

 Immediate removal from play o “When in doubt, sit them out”  Athletic Trainers, Parents, Coaches, Teachers & Medical Providers work together to support Athlete o And Athletes support & look out for each other  Parents seek appropriate medical care  Medical Providers make Return to Play decision o May recommend gradual increase in activity / play  Use Cognitive Testing – Set Baseline every year 13

 Gaining recognition as a valuable tool to assess cognitive impairment in the post concussive Athlete  Baseline & After Injury tests o Baseline - A benchmark used as a basis for comparison Recommendation: Beginning of the sports season, or every 12 months o After Injury - A test taken post or After Injury when other symptoms have resolved 14

 In the pre-season, or before the first contact practice of the sports season, establish a Baseline to measure brain speed and accuracy o Best effort o Share results with your Medical Provider  In the event of an injury, consult your Medical Provider o Take an After Injury test when other symptoms have disappeared o Medical Provider can compare results to help ensure cognition has returned to Baseline level 15

 Most mildly concussed Athletes: o Recover cognitive function in five to 10 days  More severe concussions: o May take one to three months to resolve cognitive function  Recovery of cognitive function does not parallel recovery from physical & emotional symptoms o Usually lags behind 16

 It’s best to evaluate Athletes in the post-concussive period for cognitive, physical, and emotional signs and symptoms o Cognitive testing aids the identification of persistent cognitive impairment o Clinical exam and attention to history important in evaluating physical and emotional dysfunction 17

 In a concussion, the Athlete’s brain is damaged o Healing time and rest required for recovery  Affects Thinking o May consider postponing academic activities that concern an Athlete’s future (final exams, college placement exams)  If Return To Play too soon o Exacerbate condition – longer recovery time Affects school (academics) & sports participation 18

 You do not need to lose consciousness to have a concussion  Memory loss is an important clinical sign of concussion  Most mildly concussed Athletes recover cognitive function in five to 10 days  More severe concussions may take one to three months to resolve cognitive function  Recovery of cognitive function does not parallel recovery from physical and emotional symptoms 19

 Manage Athlete’s cognitive health along with physical and emotional health o Complete annual Baseline Test. See  Be sure staff (Athletic Trainer, Coach, qualified Medical Provider) is knowledgeable about concussions and available on the sidelines to evaluate injuries  If Athlete suffers or is suspected of suffering from a concussion o Immediately remove from play o Consult with Medical Provider about recuperation, as well as return-to-classroom and return-to-play decisions Have Athlete complete an After Injury test to aid return-to- play decisions 20

Dr. James Moriarity Head Team Physician – University of Notre Dame Sports Medicine Consultant – Axon Sports  More than 10 years of experience in Athlete concussion testing and the clinical application of computerized cognitive testing -- tenure matched by very few in American sports. 21