concussions in sports - juan ronderos m.d
TRANSCRIPT
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Concussions in SportsDr. Juan Ronderos, M.D.
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Financial
DisclosureConsultant for Orthofix Spine receive consulting fees and royaltiesInvestigator Zimmer Spine receive consulting fees
Investigator Globus Medical Receive consulting feesInvestigator Integra Medical receive consulting fees
Owner NMS medical solutions receive profitsOwn JNJ and Medtronic stock on open market
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This is
what aconcussion
looks like...
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Long term effects
Dementia Pugilistica
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I object to violence because when it
appears to do good, the good is only
temporary; the evil it does is
permanent.
Mahatma Gandhi
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Concussion
Recently described as the Silent
Epidemic
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Concussion
A stunning, damaging, or shattering
effect from a hard blow; especially: a
jarring injury of the brain resulting in
disturbance of cerebral function
Synonyms: bump, collision, impact,
crash, jar, jolt, slam, smash, strike,
wallop Merriam-Webster
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Silent
Making no mention: unspoken (condition)
Merriam-Webster
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Prevalence
Until very recently Concussion orMild
Traumatic Brain Injury (MTBI) has been
a silent epidemic
Synonyms or MTBI have helped to
disguise the overall incidence and
effect on our society
Lack of definitive testing has helped
disguise the impact as well
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Prevalence - Synonyms
Name
Shaken Baby
Syndrome
Concussion
Sports Concussion
Dementia
Pugilistica Alzheimer's disease
Senile Dementia
Age Group
Infants to age 4
Ages 5 and above
Limited to sports
Limited to Boxing?
Early Dementia Elderly
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Epidemic
Affecting or tending to affect a
disproportionately large number of
individuals within a population,
community, or region
Merriam-Webster
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Prevalence
38 million children and adolescents
participate in organized sports
170 million adults participate in
physical activity not related to work
1.1 million persons are treated and
released from ED following treatment
for TBI
235,000 are hospitalizedSource: MMWR, July 27, 2007
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Sports TBI 2001-05
5.1% of all SR ED visits were for TBI
70.5% male
Highest rate age 10
14
2nd highest age 15 19
Most common activities Bicycling
Football
Playground
Basketball
Riding ATVs
Source: MMWR, July 27, 2007
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Diagnosis
Symptoms reported by injured
Based on Observation
Observed Signs
Initial Physicians role is to rule out more
serious injury (Hematomas and Contusions)
Secondary Physicians role is to monitor and
control back to activity decisions Future Functional MRI and/or PET
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Diagnosis
Observed
Vacant stare/befuddled expression
Delayed verbal/motor responses
Easy distractibility
Difficulty focusing attention
Inability to perform normalfunctions
Disorientation
Walking in wrong direction
Unaware of date, time, place
Slurred/incoherent speech
Incomprehensible statements
LOC (Rare
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Common Findings
Vacant stare/befuddledexpression
Delayed verbal/motor
responses
Easy distractibility
Difficulty focusing attention
Inability to perform normal
functions
Disorientation
Walking in wrong direction
Unaware of date, time, place
Slurred/incoherent speech
Incomprehensible
statements
Lack of coordination
Inability to tandem walk
Exaggerated emotionality
Inappropriate crying
Distraught appearance Memory deficits
Cannot name 3 out of 3
objects after 5 minutes
Repeatedly asking same
question which has beenanswered already
Any period of LOC
Paralytic coma
Unresponsive to stimuli
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Diagnosis
CT and MRI are usually negative
Metabolic rather than structural
disruption Accurate diagnosis aimed at
preventing cumulative effects of
concussion
Preventing SIS (second impact
syndrome)
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Initial Treatment
Removal from current game oractivity
No return to play that day until
evaluation Preventing SIS (second impact
syndrome)
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SCAT-2
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SECOND IMPACT SYNDROME
Occurs in athletes with prior concussion following relativelyminor second impact
- Second impact has been shown to occur up to 14 days post-injury- Athlete returns to competition before resolution of symptoms
Catastrophic increase in intracranial pressure- Vasomotor paralysis, edema, massive swelling, herniation, death
Most often occurs in athletes
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Treatment
Widely used in
athletes
Baseline
normative data
Used as a
adjuvant to
clinical
observation and
reporting
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ImPACT: A TOOL FOR EVALUATING CONCUSSION
(Immediate Post-Concussion Assessment and Cognitive Testing)
Computerized test developed by clinical researchers at the University of
Pittsburgh Medical Center (UPMC)
Developed to allow for a more objective assessment of concussion and
recoveryAccounts for individual differences in cognitive ability and symptom
reporting through the use of baseline testingProvides a common metric which allows for effective collaborationbetween athletic trainers, coaches, physicians, and neuropsychologists
in concussion managementUtilized throughout professional and amateur sports across the countryand internationally
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Treatment
Throughout all phases look for signs of
deterioration
Look for signs of post concussion
syndrome
Neurocognitive testing
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Consensus statement on concussion in sport: the 4th International
Conference on Concussion in Sport held in Zurich, November 2012Graduated return to play protocolRehabilitation stage Functional exercise at each stage of rehabilitation
Objective of each stage
1. No activitySymptom limited physical and cognitive restRecovery
2. Light aerobic exerciseWalking, swimming or stationary cycling keeping intensity
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Study 1
How Long Does It Take The AthleteTo Recover from Concussion?
Lovell MR, Collins MW, Maroon et al. Medicine and Science
in Sports Exercise, 34:5;2002
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STUDY 2
Do Athletes Underreport Symptoms?
Lovell MR, Collins MW, Maroon et al. Medicine and Science inSports Exercise, 34:5;2002
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Long Term Effects
Mostly studied in athletes
Boxers and more recently football
injuries have brought issue to the
forefront
A few high profile cases
Recently Football players have become
high profile
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Famous boxers known to have
(or had) Dementia Pugilistica Muhammad Ali (1942 - )
Joe Louis (1914 1981)
Jack Dempsey (1895
1983) Floyd Patterson (1935 2006)
Sugar Ray Robinson (1921 1989)
Jerry Quarry (1943
1999) Mike Quarry (1951 2006)
Leon Spinks (1953 - )
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NFL prominent TBI
Jim McMahonbattling early
dementia, wishes
he'd playedbaseball
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NFL prominent TBI Junior Seaus family sues NFL claiming star linebackers suicide a result of
brain disease caused by violent hits
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NFL
(Reuters) - The National Football League and General Electric
Co are teaming up to improve the diagnosis and treatment of
brain injuries amid growing concerns about sports-related
concussions in youth and professional sports.
On Monday they announced a $60 million effort with leading neurologists to speed up researchinto brain injuries and the development of new technologies to help protect the brain from traumaticinjury to benefit athletes, the military and the broader public.
The initiative includes a $40 million research program into imaging technologies to improve
diagnoses and an additional $20 million pool of funds open to researchers andbusinesses trying to improve the prevention, identification and management of brain injuries.Mon Mar 11, 2013
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http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001 -
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Awareness
Recent push by professional athletes
to treat and prevent injury
Manufacturers have responded by
having better testing of equipment and
certification of equipment
Trainers and all personnel are more
aware of the signs, symptoms, andtreatment of MTBI
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Awareness
Main stream media has reported issuesand problems
Health care providers are obtaining
certification to provide better care Governmental agencies are requiring
safety initiatives at the manufacturing,
public, and private sectors Foundations are promoting awareness
Education is becoming ubiquitous
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National Geographic
February 2011
New BrainScience onFootballConcussions
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New York Times
October 10, 2010
Front page
As ConcussionsRise, Scant
Oversight for
Football Helmet
Safety
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Resources
CDC
NIH
Impact concussion testing Think First Foundation
The Watson Neuroscience Foundation
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www.watsonresearch.org
http://www.watsonresearch.org/http://www.watsonresearch.org/