1. Concussions

2. What is a Concussion?
The injured person may remain conscious or lose consciousness briefly, and is disoriented for some minutes after the blow.
A concussion is a change in mental status caused by a blow to the head, neck or upper body.
It occurs when the head hits or is hit by an object, or when the brain is jarred against the skull, with sufficient force to cause temporary loss of function in the higher centers of the brain.
2007 The New York Times Company
“Concussions.” Richard Robinson. The Gale Encyclopedia of Medicine. Ed. Jacquelin L. Longe. 3rd ed. Detroit: Gale, vols.

3. How it Happens Impact Spin
When the head slams into a hard surface, the skull stops abruptly while the brain, floating in cerebral fluid, continues to move and is shaken and sometimes bruised when it finally hits the skull.
Spin
A blow to the head can cause the head to snap rapidly. When the head stops abruptly, the brain continues to rotate, potentially causing cell damage.
2007 The New York Times Company

4. The Crisis and the Healing
At the moment of injury, the brain goes through an initial period of crisis followed by an undetermined period of healing. The rate of recovery varies according to the severity of the injury.
Period of Another concussion during this period can
Vulnerability can lead to irreparable damage or death.
Days
150%
Moment of Injury
Normal Artery
Demand for Glucose
100%
Blood Flow
Mismatch
Metabolic Rate For Oxygen
2007 The New York Times Company
Source: David A. Hovda, Ph.D., U.C.L.A. Brain Injury Research Center.
50%
After the injury, the arteries constrict, causing reduced blood flow to the brain and lowering the rate that oxygen is metabolized. The demand for glucose also rises to provide cell energy for healing. But the high demand for glucose cannot be met by the constricted arteries. This mismatch creates a metabolic crisis.
As the cells slowly repair themselves, the demand for glucose eases and blood flow returns to normal as vessels become less constricted. But the brain remains in a state of metabolic depression, a quiet state akin to rest, for a long period before returning to normal. 0%

5. Symptoms Symptoms (right after the hit) include:
Headache
Disorientation as to time, date, or place
Confusion
Dizziness
Vacant stare or confused expression
Incoherent or incomprehensible speech
In coordination or weakness
Amnesia for the events immediately preceding the blow
Nausea or vomiting
Double vision ringing in the ears
Symptoms (the following days) include:
Headache
Poor attention and concentration
Memory difficulties
Anxiety
Depression
Sleep disturbances
Light and noise intolerance
These symptoms may last from several minutes to several hours. If symptoms are more severe or longer lasting, they indicate severe head injury.
“Post-Concussion syndrome” can occur if such symptoms continue.
“Concussions.” Richard Robinson. The Gale Encyclopedia of Medicine. Ed. Jacquelin L. Longe. 3rd ed. Detroit: Gale, vols.

6. Different Grades Grade 2 (moderate) Grade 1 Grade 3 (severe) (mild)
No loss of consciousness: Post-traumatic amnesia <30 min
First Concussion: May return to play if asymptomatic.
Second Concussion: May return in 2 weeks if asymptomatic at that time for 1 week.
Third Concussion: Terminate season; may return next year if asymptomatic.
Grade 2 (moderate)
Loss of consciousness <5 min or post-traumatic amnesia >24 hours
First Concussion: Return after asymptomatic for 1 week.
Second Concussion: Wait at lease 1 month; may return then if asymptomatic for 1 week; consider terminating season.
Grade 3 (severe)
Loss of Consciousness >5 min or post-traumatic amnesia >24 hours
First Concussion: Wait at lease 1 month; may return then if asymptomatic for 1 week
Second Concussion: Terminate season; may return next year is asymptomatic.
From Cantu RC: Guidelines for return to sports after cerebral concussion. Physician Sports Med 14(10):75, 1986

7. Prevention
The use of protective headgear can dramatically decrease the risk of concussion when engaging in contact sport where concussions are common.

8. Medical Treatment
Bed rest, fluids, and a mild pain reliever such as acetaminophen (Tylenol) may be prescribed.
Ice may be applied to bumps for pain relief and to decrease the swelling.
Saline solutions or iodine solutions may be used to treat any cuts.

9. Tests Physical examination, the doctor will:
Medical History: Allergies, Prior Neurological injuries ie. Concussions, Bleeding disorders
Physical examination, the doctor will:
Assess normal neurologic function such as reflexes and mental status.
Look for other associated injuries such as a neck injury that is common with head injury.
Inspect for bleeding from the ears or nose as well as any bruising around the eyes or behind the ears that is commonly seen with certain types of fractures to the base of the skull.
Test Form A
Test Form B

10. Concussion Facts
Approximately 300,000 people sustain mild to moderate sports- related brain injuries each year, most of them young men between 16 and 25.
Most concussions are caused by motor vehicle accidents and sports injuries.
Others are due to blows received while bicycling, horseback riding, skiing, and soccer.
The American Academy of Neurology is asking for a ban on boxing.
Contact sports, especially football, hockey, and boxing, are among those most likely to
lead to concussion.
Multiple blows to the head can cause “Punch Drunk” syndrome or dementia pugilistica.
Studies show that approximately one in five high school level football players, and one in twenty collegiate level football players, suffer concussions.
In motor vehicle accidents, concussions can occur without an actual blow to the head.
“Second impact syndrome” might occur when a person with a concussion, even a very mild one, suffers a second blow before fully recovering from the first. The brain swelling and increased pressure can result in something fatal.
“Concussions.” Richard Robinson. The Gale Encyclopedia of Medicine. Ed. Jacquelin L. Longe. 3rd ed. Detroit: Gale, vols.

11. Concussion Video Concussion Video #2 Concussion Hit

12. Assessment Techniques
Total Body Water
The process of measuring water balance by collecting input and output data has been modernized by estimating total body water (TBW), which entails measuring the dilution of trace amounts of an isotope usually deuterium oxide, ₂H₂O). The details and assumptions, and limitations behind isotope dilution have been discussed elsewhere, but the accuracy of this method closely approximates values measured by dessication; ie the slow heating of cadaver tissue until water is removed (Ritz, 1998). In brief a known volume and concentration of isotope is taken into the body and a new concentration of isotope is later determined in a sample of body fluid.

13. Assessment Techniques
Total Body Water
The process of measuring water balance by collecting input and output data has been modernized by estimating total body water (TBW), which entails measuring the dilution of trace amounts of an isotope usually deuterium oxide, ₂H₂O). The details and assumptions, and limitations behind isotope dilution have been discussed elsewhere, but the accuracy of this method closely approximates values measured by dessication; ie the slow heating of cadaver tissue until water is removed (Ritz, 1998). In brief a known volume and concentration of isotope is taken into the body and a new concentration of isotope is later determined in a sample of body fluid.

14. Items for your Presentation
Title
Reference
Author(s) with background information
Summary of topic covering areas related to sports medicine
Supportive research
Conclusions
Question for the class
Question for the teacher

15. Public Speaking Skills
Preparation
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