What is a Concussion? A concussion is a mild traumatic brain injury that interferes with normal function of the brain Evolving knowledge  “dings” and “bell ringers” are serious brain injuries  Do not have to have loss of conciousness Young athletes are at increased risk for serious problems

Coup and Contracoup

The Problems in the Medical Field There is much variation in the knowledge of health care providers managing concussed athletes  Physicians (MD/DO)  Physician assistants  Nurse practitioners  Chiropractors  Athletic trainers  School nurses New and emerging research and technologies will lead to a continuing evolution of care

Problems for Athletes- Post-Concussion Syndrome 85-90% of concussed young athletes will recover within 1 to 2 weeks The remainder may have symptoms lasting from weeks to months interfering with school and daily life Subtle deficits may persist a lifetime

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Extent of the Problem Professional athletes get a great deal of attention  1600 NFL players Much more common in high school than any other level- due to large number of participants  HS Sports Participants Football million Boys Soccer- 384,000 Girls Soccer- 345,000 Boys Hoops- 545,000 Girls Hoops- 444,000  NFHS

Extent of the Problem 19.3% of all FB injuries in 2009!!! Likely at least 100,000 concussions in HS athletes yearly based on CDC estimates

Not Just a Football Problem Injury rate per 100,000 player games in high school athletes Football47 Girls soccer36 Boys soccer22 Girls basketball21 Wrestling18 Boys basketball7 Softball7 Data from HS RIO  JAT, 2007

What has happened to make this such a big deal? Increasing awareness and incidence  Number of high profile athletes over the past 20 years Steve Young, Troy Aikman, Eric Lindros, etc  Bigger and faster kids, increased opportunities

What has happened to make this such a big deal? High profile cases  Second Impact Syndrome Death or devastating brain damage when having a second injury when not healed from the first  Long-term effects Possible long-term effects- dementia, depression

Chronic Traumatic Encephalopathy CTE- progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma  Tau protein Examples-  Normal brain  45 yo former NFL player  73 yo boxer

Chronic Traumatic Encephalopathy 18 yo HS athlete  2 documented concussions in football  Multi-sport athlete  Early CTE changes on autopsy Isolated case or harbinger of huge ramifications for contact sports?

NFL making changes Commissioner before Congressional Sub- committee in Oct NFL’s response since that time:  Resignation of concussion committee co-chairs  Hiring of “independent” neurologists to make RTP decision  No RTP same game in most cases

NCAA Follows NFL lead December 2009  NCAA now making changes in response to what NFL has done No return to play same day of concussion

Sea Change? November 2009  2 Super Bowl QBs report that they cannot play in upcoming games due to persistent headaches and/or not feeling that they had recovered from most recent concussion.  How important is that upcoming HS game this week??

What has the NFHS SMAC done? Rulebook  Language change Education!!  Suggested management Concussion Brochure  No RTP same day- Fall 2008 Dissemination of information Where does that information come from?

2010 – 2011 NFHS Rule Book Changes on Concussion Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional. (Please see NFHS Suggested Guidelines for Management of Concussion).  Approved by NFHS Sports Medicine Advisory Committee – October 2009  Approved by the NFHS Board of Directors – October 2009

Concussion Management- The Basics Coach Education  Awareness and Recognition  When in doubt, sit ‘em out!! Policies  No return to activity on the same day of a concussion  No return to activity if having symptoms of a concussion

Ontario Physical and Health Education Association- OPHEA 2011 Any athlete with a concussion shall not be permitted to return on that same day. No return until no longer experiencing post-concussive symptoms, and a medical release form signed by an physician

Washington- “Zach’s Law” Zach Lystedt- suffered devastating brain injury playing with concussion symptoms Similar to Oregon Law with additions:  Applies to youth sports  Parents and athlete read and sign information sheet which details signs, symptoms, and effects of a concussion Outstanding press state-wide and nationally FB player from Spokane died in September

Neuropsychologic Testing Computerized programs  Easily accessed  Can be done quickly with immediate results  Can obtain “baseline” data on all athletes  Can assess reaction times and processing speed

Prevention “Concussion prevention” has become the “holy grail” for sports equipment marketers  Soccer head gear  Girl’s Lacrosse head gear/helmets  Pole vaulting helmet New football helmets, soccer head pads, mouth guards- NO PROVEN PROTECTION FROM CONCUSSION!! Multiple flaws in a study looking at “Riddell Revolution” helmet  Neurosurgery, 2006

Conclusions Educate  Everyone dealing with young athletes must be aware of the signs, symptoms, and ramifications of concussions Mandate or Legislate?  Concussion management policies must be in place at every level  If you don’t do it, someone will do it for you

Sources Thad Stanford, MD, JD- Salem Bill Bowers- Executive Director, OADA Tom Welter- Executive Director, OSAA Mickey Collins, PhD- Pittsburgh Ron Savage, EdD- New Jersey Brian Rieger, PhD- New York Ann Glang, PhD- Eugene traumatic-brain-injury-powerpoint