ANTIGONISH CONCUSSION CLINIC

March 30, 2012David CudmoreTara Sutherland Angela Wylie

THE BEGINNING

September 1996 Dr David Cudmore MD Tara Sutherland CAT(C) Varsity Athletes Sports Injuries and Concussions

In January ----2009 – we added Dr Maureen Allen MD – Outpatients St Martha’s

Hospital Community Athletes and General Population and

Concussions

WHY ??

A 15 year old hockey player, a 40 year old construction worker and a 35 year old woman all received a hit to the head and report to the Emergency Room.

all leave with diagnosis of a concussion SO what is next for them , who and or

where is the follow up .. Their family Doctor ? Time issues , specialty issues other concerns , return to play supervision.

CONCUSSIONS ARE A HOT TOPIC!

Sport organizations, schools and employers are now realizing that this injury has a significant short and or long term impact on people.

There is a demand for medical assessment and active management of these patients.

Other Practitioner

s

Patient to ACC

Athletic Therapists

SCAT

Physician & AT

Decision Making

Referral

Referral

WHAT AND HOW WE WORK St Martha's ER DOC ‘sConcussion

form

Next Appointment

AFTER THE APPOINTMENT

The patient is usually sent home with specific instructions and a follow up appointment is booked for one or two week’s time. A handout is given if they have not yet received one .

The physician will often write medical notes for modified work and or school.

The ACC sees a patient regularly and continues until complete recovery whenever possible.

RETURN TO PLAY

When the individual becomes asymptomatic and is ready to return to a sport or activity the athletic therapists will have them perform a bike test at the Athletic Therapy Clinic at STFXU.

If the patient completes this bike test satisfactorily then we will have them return to activity according to the return to play guidelines set forth by McCrory et al., 2009.

Follow up visits are done with the physician and the athletic therapist until an athlete returns to play, especially if they participate in contact sports.

Similarly, non athletes are flowed until they resume normal activities, i.e. work, school etc

OTHER TESTING

Diagnostic – xrays – CAT scans MRIs

Often head and or neck xrays are done at the outpatients on the patients orginal visit. If not and problems persist we will send them for xrays .

We do limited MRI or CT scans since imaging is usually normal as reported by McCrory et al., 2009

SPECIALISTS

We do not refer many patients to medical specialists such as neurologists or neurosurgeons as we feel we are capable of handling most concussion cases . However if the patient is not improving and or have complicating issues such as persistent cognitive defects we refer to the specialist.

One of the most difficult parts of sending to a specialists is that they are over two hours away by car and the travelling can cause worsening of symptoms.

PHARMACOLOGICAL THERAPY

For prolonged sleep disturbances we have used amitriptyline. It helps restore a normal sleeping pattern and is useful for chronic pain.

Or other sleeping aids such as >>>>

OTHER

In addition for neck or other musculoskeletal problems we will refer to a Physiotherapist , Massage Therapy or Cranial Sacral Therapy as needed

OR We will occasionally send

patients to see a psychologist for treatment of depression or anxiety

STATS

ANTIGONISH CONCUSSION CLINIC

  AGE  Total Sports MVA FALLS Other

MALES < 16 years 15 8 5 0 2

  17-80 yrs  40 0 6 2 6

FEMALES < 16 years 7 3 0 4 0

  17-80 yrs  33 6 4 0 7

             

Jan 2010 to Dec 2011

total 95 patients

Aveage # visits 3.25 /patient

total visits 214 

OUR GOAL

to enable our patients to return to a normal healthy active life

We consider our approach to be holistic and novel

We often call ourselves concussion coaches

Family doctors are kept informed of their patient’s progress through consultation letters sent by the physician

THE ANTIGONISH SET UP Multidiscipline collaboration practice with

athletic therapists and physicians It is sustainable in a medical fee for service

environment, requiring no new funding Athletic therapists have the expertise in the

area and can provided most of the care that the patient requires, with a small amount of medical supervision by the physician

Using this model we are able to efficiently and expertly look after a large number of patients every week

TESTIMONIAL

“The lingering aspect of this concussion is definitely the most difficult part. I sustained three concussions in a one year period, most recently 2½ months ago, and I am still not feeling 100%. I didn’t get hit by a rampaging hockey player at the speed of a train. You wouldn’t think that volleyball was a high-risk sport. All of my concussions were accidental, but they still add up nonetheless. The worst part is, I don’t know when it’s going to get better, and frankly, I’m scared of what another concussion might mean.” (Varsity University athlete)

“As an athlete having a concussion is hard to explain to your coaches and teammates. There's no visible evidence that you're hurt - like there is with an ankle or knee. I felt that my coaching staff didn't take my head injury seriously and pushed me to return to play earlier that I should. Without the care of our athletic therapists and doctors I probably would have returned to play too early and done further damage.” (Varsity University athlete)

QUESTIONS?

FORMS

Concussion Assessment Tool ( Antigonish) revised 2012

Name:         Reporter Self  

Date of Injury     Age   Parent  

Activity/sport         Other  

Local Phone No. _____________    

Signs: did you experience any of the following at the time of injury

Loss of consciousness YES NO

Seizures YES NO

Balance /Unsteadiness YES NO

Concussion History Headache History

Previous number     Prior treatment for Headaches

1 2 3 4 other   YES   NO

Longest symptom duration   History of Migraines  

days weeks months years Personal   Family

Symptom Check List

Please circle the number which describes your symptom best at this time

None Mild Moderate Severe

Headache 0 1 2 3 4 5 6

Pressure in Head 0 1 2 3 4 5 6

Neck Pain 0 1 2 3 4 5 6

Nausea or vomiting 0 1 2 3 4 5 6

Dizziness 0 1 2 3 4 5 6

Blurred vision 0 1 2 3 4 5 6

Balance Problems 0 1 2 3 4 5 6

Sensitivity to light 0 1 2 3 4 5 6

Sensitivity to noise 0 1 2 3 4 5 6

Feeling slowed down 0 1 2 3 4 5 6

Feeling like in a fog 0 1 2 3 4 5 6

Don't feel right 0 1 2 3 4 5 6

Difficulty concentrating 0 1 2 3 4 5 6

Difficulty remembering 0 1 2 3 4 5 6

Fatigue or low energy 0 1 2 3 4 5 6

Confusion 0 1 2 3 4 5 6

Drowsiness 0 1 2 3 4 5 6

Trouble falling asleep 0 1 2 3 4 5 6

More emotional than usual 0 1 2 3 4 5 6

Irritability 0 1 2 3 4 5 6

Sadness 0 1 2 3 4 5 6

Nervous or anixious 0 1 2 3 4 5 6

SYMPTOM SCORE   TOTAL

132 max

TO BE COMPLETED BY PHYSICIAN

Cognitive Assessment

Word Recall Immediate Delayed

Word 1   Cat    

word 2   Pen    

word 3   Shoe    

word 4   Book    

word 5   Car    

Months in Reverse

Jan -Feb - Mar -April - May - June - July - Aug - Sept - Oct - Nov - Dec

Neurological Screening Pass Fail

Speech    

PEARL    

Pronator Drift    

Gait assessment    

Antigonish Concussion Clinc Symptom Check List

Name:      

Date of Injury      

      None Mild Moderate Severe

Headache     0 1 2 3 4 5 6

Pressure in Head   0 1 2 3 4 5 6

Neck Pain     0 1 2 3 4 5 6

Nausea or vomiting   0 1 2 3 4 5 6

Dizziness     0 1 2 3 4 5 6

Blurred vision     0 1 2 3 4 5 6

Balance Problems   0 1 2 3 4 5 6

Sensitivity to light   0 1 2 3 4 5 6

Sensitivity to noise   0 1 2 3 4 5 6

Feeling slowed down   0 1 2 3 4 5 6

Feeling like in a fog   0 1 2 3 4 5 6

Don't feel right   0 1 2 3 4 5 6

Difficulty concentrating   0 1 2 3 4 5 6

Difficulty remembering   0 1 2 3 4 5 6

Fatigue or low energy   0 1 2 3 4 5 6

Confusion     0 1 2 3 4 5 6

Drowsiness     0 1 2 3 4 5 6

Trouble falling asleep   0 1 2 3 4 5 6

More emotional than usual   0 1 2 3 4 5 6

Irritability     0 1 2 3 4 5 6

Sadness     0 1 2 3 4 5 6

Nervous or anixious   0 1 2 3 4 5 6

SYMPTOM SCORE            

            132

Please list any significant changes in how you are feeling?

Positive

Negative

Antigonish Concussion Clinic

First time visit

Name:       Medications :    

Date of Injury       Allergies:    

Activity/sport      

Family Doctor      

Concussion History

Previous number   Prior treatment for Headaches

1 2 3 other YES   NO

      History of Migraines  

date of concussions # of weeks to full recovery Personal   Family

First    

Second     History of neck problems

Third     YES   NO

Symptom Check List

Please circle the number which describes your symptom best at this time

      None Mild Moderate Severe  

Headache     0 1 2 3 4 5 6  

Pressure in Head     0 1 2 3 4 5 6  

Neck Pain     0 1 2 3 4 5 6  

Nausea or vomiting     0 1 2 3 4 5 6  

Dizziness     0 1 2 3 4 5 6  

Blurred vision     0 1 2 3 4 5 6  

Balance Problems     0 1 2 3 4 5 6  

Sensitivity to light     0 1 2 3 4 5 6  

Sensitivity to noise     0 1 2 3 4 5 6  

Feeling slowed down     0 1 2 3 4 5 6  

Feeling like in a fog     0 1 2 3 4 5 6  

Don't feel right     0 1 2 3 4 5 6  

Difficulty concentrating     0 1 2 3 4 5 6  

Difficulty remembering     0 1 2 3 4 5 6  

Fatigue or low energy     0 1 2 3 4 5 6  

Confusion     0 1 2 3 4 5 6  

Drowsiness     0 1 2 3 4 5 6  

Trouble falling asleep     0 1 2 3 4 5 6  

More emotional than usual     0 1 2 3 4 5 6  

Irritability     0 1 2 3 4 5 6  

Sadness     0 1 2 3 4 5 6  

Nervous or anixious     0 1 2 3 4 5 6  

SYMPTOM SCORE             TOTAL

            132 max

               

Please include any other pertinent information re your concussion .