1. Concussion Recognition And Neurological Intervention United Management
CRANIUM
Concussion Recognition And Neurological Intervention United Management

2. What is a Concussion
Mayo defines a concussion as: “Traumatic brain injury that alters the way your brain functions”
CDC defines a concussion as: “Type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth”

3. Traumatic Brain Injuries (TBI)
75% of all TBI’s result from concussions or other forms of mild TBI’s
TBI’s can cause:
Epilepsy
Parkinson's
Alzheimer's
Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal
Chronic Traumatic Encephalopathy
Newly identified disease associated with repeated concussions
Release of a protein called TAU slowly kills brain cells
Once started it appears to progress without further incident
Only diagnosed after death

4. Concussion Prevalence
Estimated million occur each year
60-80% resolve in 7-10 days
Up to 33% of individuals will have post concussion syndrome
Up to 30% of individuals will demonstrate post concussion symptoms 6 months post injury
Kozlowski, K. F., Graham, J., Leddy, J. J., Devinney-Boymel, L., & Willer, B. S. (2013). Exercise intolerance in individuals with postconcussion syndrome. Journal of Athletic Training, 48(5), doi: /

5. Possibility of Becoming a Star
8 million student athletes compete at the high school level
480,000 athletes compete at the collegiate level
Less than 2% of college athletes play professional sports

6. Signs & Symptoms Confusion Amnesia Headache Loss of consciousness
Balance problems
Blurry Vision
Concentration/ memory problems
Sensitivity to light/noise
Nausea
Feeling foggy, tired
Feeling irritable
Slowed reaction time

7. Concussion Management Protocol
Athlete suspected of concussion is immediately removed from field of play
Athlete assessed by qualified health care provider
Referral to Physical Therapist or Athletic Trainer
Return to play progression completed
Athlete referred to health care provider for clearance to return to practice and then competition

8. Three Is Better Than One
Sport Concussion Assessment Tool-3rd Edition
Vestibular Ocular Motor Screening
Balke Treadmill Test

9. Sports Concussion Assessment Tool 3rd
Includes: Symptom evaluation, Cognitive & physical evaluation, Balance, Coordination, Recall, Memory
Balance Error Scoring System
Broadly Normal: Score 1-4
Below Average: Score ≥ 5
Self reported symptom score of 24.91/122 compared to 6.53/122

10. Vestibular Ocular Motor Screening (VOMS)
Quick 5-10 minute test
Provocation testing of the vestibular and ocular motor systems
Symptom changes are rated by patient
2014 American Journal of Sports Medicine
Scores ≥ 2 total symptoms after any VOMS item (96%) or a Near Point Convergence distance of ≥ 5 cm (84%) resulted in high rates of concussion identification.

11. Balke Treadmill Test Standardized treadmill protocol
Test terminated due to fatigue or production of concussion symptoms
2013 Journal of Athletic Training:
100% of patients with concussion stopped the test due to return of concussion symptoms.
Median exercise duration was 40% of the control group, 9 minutes or less compared to 18
Sensitivity 99% and Specificity 89%

12. Return to Play Protocol
Consists of 5 phases each adding a plane of movement and intensity
Athletes 12 years old or younger- 72 hours symptom free before progressions
Athletes 13 years old and older- 24 hours symptom free before progression

13. Return to Play Phases Phase #1- No Activity
Complete physical and cognitive rest
Symptom free x 24 hours progress to phase 2
Phase #2- Light Aerobic Exercise
20 min of cardiovascular exercise at less than 70% heart rate max
Phase #3- Sport Specific Exercise
45min of cardiovascular less than 80% heart rate max
Phase #4 Non-Contact Training Drills
60min of complex training less than 90% of heart rate max
Phase #5- Full Contact/Practice

14. Medical Clearance Between Stage 4 & 5:
Balke Treadmill Testing
Normal SCAT-3
Normal VOMS
Medical Clearance to Return to Full Contact Practice Only
Symptom Free x 24 hours
Clearance to Return to Competition

15. Medical Coverage MHSAA Insurance Benefit Suspected concussion
Grades 7-12
Receive prompt and professional attention for head injuries
Requires referral to Physical Therapy services from qualified health care professional