1. Concussions

2. 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

4. 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

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

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

7. 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

8. 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.

9. 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.

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

11. 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

12. Signs and Symptoms: Mood
More emotional
Irritability
Fatigue
Anxiety
Sadness

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

14. 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

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

16. 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

17. 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 hours to look for signs of deteriorating function

18. 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

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

20. 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.

21. 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.

22. 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

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

24. 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

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

26. 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

27. 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

28. 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

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

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

31. Axon: Demonstration Test

32. 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