1. Concussion Education

2. Tragedy opens the door for education, increased awareness, and law In North Carolina… –Gfeller-Waller Law passed in June 2011 Three components –Mandatory education for public middle & high school student-athletes & parents –Return to play decisions made by qualified medical personnel –Emergency action plan in place

3. Objectives What is a concussion? –How does a concussion occur? –What are the signs & symptoms? –How should a concussion be treated? –What if my child isn’t getting better? –Is there any way to prevent these injuries?

4. Definition of Concussion “A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” –Sports Related Concussion in Pediatric Athletes, Clinical Pediatrics Volume 47 Number 2 March 2008 106-113

5. 5 Features Used to Define Concussion 1.Trauma including a direct blow to the head, neck or face, or a blow to another part of the body which transmits an impulsive force to the head 2.Rapid onset of short-lived neurological impairment(s) which resolve over time 3.Acute clinical symptoms of concussion reflecting a functional injury rather than a structural abnormality

6. 4.A graded set of clinical syndromes, which may or may not involve loss of consciousness and which resolve in a sequential course. 5.Typically normal structural neuro-imaging in studies such as MRI or CT scan.

7. “Basic” Pathophysiology

8. Signs & Symptoms Some might be apparent right away, some may take longer to develop Four categories of symptoms to keep in mind –PHYSICAL –COGNITIVE –EMOTIONAL –SLEEP RELATED

9. PHYSICAL Headache –Pressure?? Nausea Vomiting Balance difficulties Dizziness –Specifically with position changes Fatigue Sensitivity to light Sensitivity to noise Feeling out of it or not acting like self Hearing problems/ringing in ears Vision changes/disturbances

10. COGNITIVE Feeling mentally foggy Feeling slowed down or slower than usual Difficulty concentrating Difficulty remembering Confusion

11. EMOTIONAL Sadness More emotional than usual Irritability Nervousness What is unusual for your child/player? Compare their behavior to what his/her NORMAL is.

12. SLEEP-RELATED Excessive daytime drowsiness Sleeping more than usual Sleeping less than usual Trouble falling asleep

13. RED FLAGS for Emergent Referral Loss of consciousness Any suspected cervical spine injury Repeated vomiting Disorientation Slurred speech Can’t recognize people or places Headache that gets progressively, severely worse Increased lethargy Facial swelling, significant bruising of the face/head Fluid from ears and/or nose

14. Emergency Action Plan Know your organization’s requirements Have a plan Educate those involved in the plan Practice the plan annually

15. Treatment When in doubt, sit them out –Removal from activity once suspected concussion is sustained IS THE STANDARD OF CARE –NFL, NCAA, NCHSAA, NC state law

16. See a doctor! Cognitive Rest –Stay home from school? –Limit homework –NO TV, computer usage, video games, texting Physical Rest –No return to activity until no symptoms at rest and with cognitive exertion

17. When is it safe to return to play? Completely symptom free at rest & with cognitive exertion Completely symptom free with physical exertion –GRADUAL! –Walk, jog, light weightlifting or push-ups/sit- ups, sport-specific non-contact agilities, contact practice, return to competition

18. Second Impact Syndrome Occurs when a second impact is sustained prior to the complete resolution of all symptoms of concussion –Loss of autoregulation of cerebral vasculature; rapid, irreversible massive swelling leading to lethal increased intracranial pressure Always catastrophic, very often fatal Occurs in teenagers –No documented cases in anyone over the age of 18

19. Post-Concussion Syndrome Three weeks post-injury with little/no resolution of symptoms –Persistent headaches –Inability to concentrate –Any of those symptoms listed earlier that don’t resolve or are exacerbated with any type of cognitive or physical exertion

20. What if my child isn’t getting better? Medication? Vestibular therapy? Formal neuropsychological testing? Gradual, very closely monitored physical exertion? Counseling/psych intervention? –Prolonged symptoms can greatly affect quality of life

21. Are my players at risk? Previous history of concussion –Once an individual has sustained a concussion, he/she is FOUR TIMES as likely to sustain another injury –It will take less of a blow each time and symptoms will take longer to resolve Diagnosis of ADD/ADHD History of headaches or migraines treated by a physician

22. Prevention Education Awareness Recognition Appropriate management Rules changes? No research supports mouthguards, specific helmets, headbands can prevent this injury from occurring