1. Concussions Education: Dangers You Should Be Aware Of

2. The Problem 1.Concussions are an “invisible” injury. 2.Proper diagnosis depends on the athlete to report “ALL” symptoms. 3.Athletes are not sure what they are feeling when the have a concussion.

3. Concussions: What Can We Do?  Prevent Proper Equipment and Technique Decrease the number of Head to Head hits.  “Look” for Signs and Symptoms Parents, Coaches, Teammates, Teachers, and Athletic Trainers should share this responsibility. All members should communicate in a “TEAM” fashion.  Obtain Baseline Cognitive Test  Education  Gfeller-Waller Concussion Awareness Act

4. Gfeller-Waller Concussion Awareness Act Mandatory Concussion Education For All Coaches, Volunteers, School Nurses, Athletes, and Parents. ▫Should Include: 1.Written information detailing the recognition of the signs and symptoms of concussions. 2.A description of the physiology and the potential short term and long term effects of concussions. 3.The medical return to play protocol for post- concussion participation in interscholastic activities.

5. Gfeller-Waller Concussion Awareness Act All coaches, school nurses, athletic directors, first responders, volunteers, students who participate in interscholastic activities and their parents will receive a concussion and head injury information sheet on an annual basis. The sheet must be signed and returned prior to participation in any interscholastic activities, including tryouts, practices, or competitions.

6. Gfeller-Waller Concussion Awareness Act Each school shall develop and maintain venue specific emergency action plan. This plan must include: ▫Delineation of roles. ▫Method of communication. ▫Emergency equipment available. ▫Access to and plan for emergency transport.

7. Emergency Action Plan Must be: ▫In writing ▫Reviewed by a licensed athletic trainer in North Carolina. ▫Approved by the principal of the school. ▫Distributed to all appropriate personnel. ▫Posted conspicuously at all venues. ▫Reviewed and rehearsed annually by all licensed athletic trainers, first responders, coaches, school nurses, athletic directors and volunteers.

8. What is a Concussion? Brain injury associated with a temporary loss of brain function. ▫Avoid terms such as “Ding” or “Bell Ringer” Causes ▫A direct blow or force to the head.  Head to Head  Head to Ground  Head to Object ▫Impact occurs to another part of the body, but the energy is transferred to the head.

9. Signs and Symptoms Headaches “Pressure in Head” Nausea or Vomiting Balance Problems or Dizziness Loss of Consciousness Seizures or Convulsions Blurred, Double, or “fuzzy vision. Sensitivity to light or noise Confusion Concentration Difficulty Memory Difficulty Amnesia “Don’t Feel Right” Feeling foggy or groggy Neck Pain Fatigue or Low Energy Drowsiness Sadness Nervousness or anxiety Irritability More Emotional Than Usual Repeating Change in Sleep Patterns Feeling Sluggish or Slowed Down

10. Concussion Management Gfeller-Waller Concussion Awareness Act No Return the same day regardless of severity. Must be evaluated and receive written clearance by a: ▫Physician licensed under Article 1 of Chapter 90 of the General Statutes with training in concussion management. ▫Neuropsychologist licensed under article 18A of Chapter 90 of the General Statutes with training in concussion management. ▫Certified Athletic Trainer licensed under Article 34 of Chapter 90 of the general statutes. ▫Physician Assistant, consistent with the limitations of G.S. 90- 18.1 ▫Nurse Practitioner consistent with the limitations of G.S. 90- 18.2

11. Return To Play Must be symptom free without medication for 24 hours. ▫Day 1: Low level physical activity (light Jogging, Stationary Bike, Walking) ▫Day 2: Moderate Levels of Physical Activity (Weightlifting) ▫Day 3: Heavy non-contact physical activity (Sports Specific Drills) ▫Day 4: Non-contact sports specific practice. ▫Day 5: Full contact practice ▫Day 6: Unrestricted return to activity or return to competition. Satisfactory Neuro-cognitive Scores Compared To Baseline ▫No earlier than 48-72 hours post injury. May only move 1 step per day. Any symptoms require starting the RTP process over.

12. Why So Conservative? Second Impact Syndrome ▫Occurs when an athlete sustains a direct or indirect force to the head before recovering from the last concussion. ▫Young Males Dangers ▫Long Term Morbidity  100% of cases ▫DEATH  50% of the cases

13. Long Term Effects Decreased Decision Making Abilities ▫Professional Athletes Permanent Brain Dysfunction Depression Suicide ▫Professional Athletes Early Onset of Dementia??? Early Onset of Alzheimer's??? Pre-mature DEATH

14. Resources of Interest 1.http://www.nata.org/statements/#offhttp://www.nata.org/statements/#off 2.http://www.cdc.gov/ConcussionInYouthSports.comhttp://www.cdc.gov/ConcussionInYouthSports.com 3.http://impacttest.com/concussion/overviewhttp://impacttest.com/concussion/overview 4.http://tbicenter.unc.edu/MAG_Center/Home.htmlhttp://tbicenter.unc.edu/MAG_Center/Home.html