definitions a concussion is defined as a “traumatically induced alteration in mental status.”...
TRANSCRIPT
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Definitions
A concussion is defined as a “traumatically induced alteration in mental status.”
Amnesia - loss of memory - times vary.
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The Head The head is not as
forgiving as an arm, leg etc.
The brain does not like changes in blood flow or pH levels.
The brain has a different blood flow than the rest of the body.
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Concussions
This is the most common “brain” injury in sport.
Ranges from a minor “ding” with short periods of symptoms, to a prolonged loss of consciousness with persistent cognitive effects.
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Concussions
Memory Loss Can be associated
with amnesia which may occur immediately or develop several minutes later.
There are two kinds of amnesia:
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Concussions
1. Retrograde Amnesia - loss of memory for events that occurred before injury (breakfast, score, team playing, etc).
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Concussions
2. Anterograde Amnesia - is defined as a loss of memory for events that occurred after the injury.
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Concussions - Problem??? With this possibility of
“delayed development of symptoms”…
This greatly increases the need for careful evaluation and observation before the athlete is allowed to play.
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Concussions
Causes of Concussions:
Direct blow to the head
Landing on your butt!!
Whiplash mechanism.
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ConcussionsContracoup Injury This is a type of
movement of the brain inside the skull…
When you get hit in the front of the head, the brain shifts (backwards) and pain will be felt at the back of the head (opposite side of injury).
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ConcussionsObserved Features ofConcussions: Headache Vacant stare Confusion Tinitis (ringing in ears) Nausea/vomitting Blurred vision Dizziness
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ConcussionsOther more serioussymptoms: Altered
Consciousness Memory deficits Lack of
coordination/balance Disorientation Emotions Pupil size***Eyes are
poor indicator of concussion on sport field
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Classification of Concussions:
GRADE 1
Transient confusion(inattention inability to maintain a coherent stream of thought and carry out goal directed movements.
No loss of consciousness
Concussion symptoms or mental status abnormalities resolve in less than 15 min.
GRADE 2
Transient confusionAmnesia possible
No loss of consciousness
Concussion symptoms or mental status abnormalities (including amnesia) upon examination last more than 15 min.
GRADE 3
Any loss of consciousness, it can be brief (seconds) or prolonged (minutes).
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Concussions
Grade 1 Concussion: Remove from contest Player should be re-
evaluated every 5 minutes for at least 15 minutes for signs of amnesia and other mental status changes.
Management Recommendations:
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Concussions
Grade 2 Concussion
With grade 2 injury, the athlete should be removed from play for the remainder of event (day).
Continue to assess any inter-crainial* pathology.
*inter-crainial - inside the head (brain).
Management Recommendations:
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ConcussionsGrade 2 cont.d A trained person
should evaluate the person next day.
A physician should perform a neurologic examination to clear the athlete after 1 full asymptomatic week.
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Concussion
Grade 3 Concussion As with any loss of
consciousness, the athlete should be transferred to an Emergency Department (hospital) for further observation by a doctor.
Management Recommendations:
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Concussions
Grade 3 cont.d A thorough
neurologic assessment is indicated. (CT scan, MRI)
Keep casualty in the hospital if any pathology is indicated
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Return to play Grade of Concussion Return to play only after
asymptomatic time.
Grade 1 15 minutes or less
Multiple grade 1 1 week
Grade 2 1 week
Multiple grade 2 2 weeks
Grade 3, brief LOC 1 week
Grade 3 prolonged LOC 2 weeks
Multiple grade 3 1 month or longer, based on decision of evaluating physician, usually season terminator
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Concussions
Sideline EvaluationThese are some of the tests that you can do with anathlete on the sidelines (grade 1) or later on (grade2,3):
Mental Status Testing Orientation – to time, place, injury Concentration – digits backward, numbers etc. Memory – details of contest, names of teams,
recall 3 of 3 words, objects at 5 min. intervals
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Concussion
Exertional Tests 40 m sprint 5 push ups 5 sit ups 5 burpies
Neurologic tests Strength Coordination Sensations Balance
Check associated symptoms – headaches, dizziness, blurred vision, nausea, concentration, photophobia (sunlight)
Sideline Evaluation cont.d
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Concussions
Second ImpactSyndrome This condition occurs when
the athlete returns to play to fast.
Another concussion is suffered before the symptoms of the first are resolved.
Loss of conciousness is not required.
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ConcussionsSIS The hit does not need
to be as hard or traumatic as the first.
After suffering a second hit, the player may seem fine, but within seconds or minutes SIS may occur.
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Concussions
SIS Previously
observed features, but after SIS we may be looking at an extremely debilitating or life a threatening head injury.
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Concussions
Apart from SIS, this is another syndrome we need to be aware of.
As each person is different, the brain will react different to a concussion differently
Post Concussion Syndrome
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Concussions
PCS The following may
occasionally persist after concussions:
Gait and Balance abnormality
Exertional headache: When they do any
physical activity they get a headache
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Concussions
PCS Emotional Lability
Altered emotions, crying/agitation
Sleep disturbances Neurotransmitters in
the brain are not functioning correctly
Cognitive impairment Reflexes, coordiation
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Concussions
PCS Athletes with
these symptoms are not ready to return to sport.
See next slide for return to play for these athletes:
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ConcussionsReturn to Play – Post Concussion Step 1 – no activity, complete rest, once
asymptomatic proceed to step 2 Step 2 – Light aerobic exercise (walking,
stationary biking) if asymptomatic proceed to step three, if not go back to 1
Step 3 – Sport specific training. Once asymptomatic proceed to step four, if not go back to 2
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ConcussionsReturn to play – Post
concussion Step 4 – Non-contact drills, once
asymptomatic proceed to step five, if not go back to 3
Step 5 – Full contact after medical clearance. Once asymptomatic proceed to step six, if not go back to 4
Step 6 – GAME PLAY!!!
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ConcussionsSome Sportsattempting to
decreaseConcussions.2. Football:
Equipment: Mandatory mouthguards Helmets safety checked
each season Padding on all goal posts.
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ConcussionsFootball Cont.Rule Changes
No spearing (tackling with head)
No face masking No late hits Free catch Rules to protect
quarterback and kicker
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Concussions2. Hockey
Equipment Mandatory helmets Mouthgaurds –
highly recommended
Breakaway goal posts
Padding around benches, glass
Absorbing boards
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ConcussionsHockey cont.d No hitting from
behind Rules to deter
fighting No high sticking Goalie protection Longer
suspensions
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Concussions3. Rugby Equipment: not
too much here!!! Mandatory mouth
guards Scrum caps are
recommended Padding around
goal posts No hard
equipment
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Concussions
Rugby cont.d Rules:
No high tackles No late hits No stomping Mark catches No blocking Wrap person when
tackling