1. Concussions

2. What is a concussion?
Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. (Zurich Concussion Statement)
A concussion is a 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 quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells. (CDC- HeadsUp)
A concussion is a disturbance in brain function caused by a direct or indirect force to the head. It can result in a variety of symptoms and often does not involve loss of consciousness. (sports Concusions Library)

4. An athlete that has suffered a concussion may feel…
Headache Feeling like “in a fog” “Pressure in head” Don’t feel right Neck pain Difficulty concentrating Nausea/vomiting Difficulty remembering Dizziness Fatigue/low energy Blurred vision Confusion Balance Problems Drowsiness Sensitivity to light Trouble falling asleep Sensitivity to noise more emotional Feeling slowed down Irritability Sadness Nervous/Anxiety

5. Somebody on the sideline may observe…
Difficulty remembering plays
Athlete going into the wrong huddle
Difficulty balancing
LOC
Confusion
Change in personality
*Anytime this is observed, remove the athlete from play and evaluate them.

6. If a concussion is suspected…
Perform a thorough evaluation that:
Rates symptoms
Evaluates level of consciousness (Glasgow coma scale)
Evaluates awareness of time and space (Maddocks score)
Measures Cognitive Function
Balance (BESS test)
Coordination
Medical History
Any sign or symptom for the above, rules in a possible concussion.

7. Neurocognitive Testing
This includes Impact Testing.
Impact is taken as a baseline tool
Once a concussion is suspected, athletes then retake test to show when cognitive function has returned to baseline.
DOES NOT TEST FOR CONCUSSIONS
DOES NOT CLEAR AN ATHLETE TO RTP.

8. If there is a concussion protocols must be followed for RTP.
NFL
Independent Neurological Consultant evaluates players on the sideline during a game
Team physician gives clearance for athlete to RTP and INC confirms
INC in booth. Has the ability to stop the play so I player can be further evaluated

9. Must be asymptomatic and must be back to baseline
NFL
Must be asymptomatic and must be back to baseline
Day 1- rest
Step 2- light aerobic activity (stationary bike, dynamic stretching, etc)
Step 3- Aerobic activity and strength training
Step 4- non-contact football drills (this includes contact with players and dummies)
Step 5- full football activity
Clearance
Athletes are asked about S&S before and after every practice. If S&S are present, the athlete goes back to the previous step.
Neuro testing

10. If there is a concussion protocols must be followed for RTP.
NFL
Independent Neurological Consultant evaluates players on the sideline during a game
Team physician gives clearance for athlete to RTP and INC confirms
INC in booth. Has the ability to stop the play so I player can be further evaluated

11. Must be asymptomatic and must be back to baseline
NFL
Must be asymptomatic and must be back to baseline
Day 1- rest
Step 2- light aerobic activity (stationary bike, dynamic stretching, etc)
Step 3- Aerobic activity and strength training
Step 4- non-contact football drills (this includes contact with players and dummies)
Step 5- full football activity
Clearance
Athletes are asked about S&S before and after every practice. If S&S are present, the athlete goes back to the previous step.
Neuro testing