presented by: matt brennan, atc/at-l. “….just got their bell rung” 300,000 sports concussions...
TRANSCRIPT
“….just got their bell rung” 300,000 sports concussions per year 1.6 to 2.3 million sports concussions per
year (CDC 2006)
16 deaths in youth sports since August 2008, 6 head injury related
36 concussions in SHS athletics during the 2008-2009 school year
What is a concussion?
A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.
Caused by a blow or jolt to the head that disrupts the function of the brain.
In concussions acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. (Zurich Consensus Statement 2009)
What is a concussion?
Complex --- no “easy” concussion Pathophysiological--- not structural! Trauma Induced--- impact to the head Less than 10% of all concussions
involve a loss of consciousness.
Pathophysiology
In a concussion, certain chemical levels are altered at the cellular level
Blood supply to the brain decreases The brain’s demand for glucose increases
The result is a metabolic imbalance referred to as an “energy crisis”
The supply/demand mismatch can last days. (Giza,
Hovda J Athl Training 2001)
If your brain is a computer….
Then a concussion is a software issue, not a hardware problem
Imaging (X-ray, CT, MR, etc) shows structure not function
Imaging will be normal in most cases Normal Imaging ≠ Normal Function! Most concussions have Normal Imaging!
Concussions-Not Just a Football
Problem…. Concussion rate per 1000 athlete-exposures
Football 0.47Girls Soccer 0.36Boys Soccer 0.22Girls Basketball 0.21Boys Basketball 0.07
Most injuries occur in football players due to the large number of participants
Gessel LM et al. “Concussions Among United States High School and Collegiate Athletes” Journal of Athletic Training 2007; 42:495-503
60% Higher
300% Higher
Signs and Symptoms COGNITIVE SOMATIC AFFECTIVE SLEEP
ConfusionPost-Traumatic Amnesia (PTA)Retrograde Amnesia (RGA)Loss of Consciousness (LOC)DisorientationFeeling “in a fog”, “zoned out”Vacant StareInability to focusDelayed verbal and motor responsesSlurred/incoherent speechExcessive drowsiness
HeadacheFatigueDisequilibrium, dizzinessNausea/VomitingVisual disturbances (photophobia, blurry/double vision)Phonophobia
Emotional liabilityIrritability
Sleeping more than usualSleeping less than usualTrouble falling asleepDrowsiness
Recognizing a Concussion
Signs observed by coach, parent, teammates
Appears dazed or stunned Is confused about assignment Forgets plays Is unsure of game, opponent, or
score Moves clumsily Answers questions slowly Shows behavior or personality
changes Loss of consciousness Can’t recall events prior to the hit Can’t recall events after the hit
Symptoms reported by the athlete
Headache Nausea Balance problems or
dizziness Double or fuzzy vision Sensitivity to light or noise Feeling sluggish Feeling foggy Concentration and/or memory
problems Confusion
Zackery Lystedt Law, EHB 1824 Parents and athletes must sign an information sheet
about head injuries prior to beginning participation in athletics each year
Requires that any youth athlete suspected of having a concussion be removed from practice or play
Any athlete suspected of suffering a concussion is removed from play until they receive written medical clearance from a licensed health-care provider trained in the evaluation and management of concussions.
http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1824&year=2009
When a concussion is suspected Remove the athlete from practice or play
IMMEDIATELY! If there is a school approved licensed health
care provider trained in the management and evaluation of a concussion available they should provide care for the athlete
When a concussion is suspected If there is no school approved licensed health
care provider available it is the coaches job to continually evaluate and reassess the athlete
Never leave the athlete unsupervised by a member of the coaching staff
Inform the athletes parent/guardian of the suspected injury
If the athlete worsens, call 911 If the athlete is stable, release them to their
parent/guardian
When can an athlete return to play?
Youth athletes should not be returned to play on the same day as injuryThe younger the athlete the more conservative the treatment
REST is BEST! This is both physical and cognitive rest
Every athlete is different and there is no set timeline for their return to activity
Athletes will follow a gradual multi-stage return to play protocol once they are symptom free and all of their exams have returned to normal
Catastrophic Head Injuries in High School and College
Football Players National Center for Catastrophic Sports Injury
Research data from 1989-2002 94 cases 92 cases were in high school players 59% of athletes had a previous history of
concussion(s):71% of those injuries occurred in the same season as the
catastrophic injury 39% of the athletes at time of catastrophic injury were
playing with residual symptoms from a previous concussion
Boden et al. AJSM 2007; 35: 1075 - 1081
Risk of Early Return to Play Intracranial Bleeding----can lead to death Second Impact Syndrome---can cause
death Multiple Concussions Longer Recovery Period Post-Concussion Syndrome Permanent Brain Damage
Gradual Return to Play
The athlete should be completely symptom free to begin this process
There should be 24 hours between each stage
The athlete must be asymptomatic in each stage
If symptoms return at any time, they must stop and rest for a minimum of 24 hours and be symptom free before restarting return to play protocol back at stage 1
Gradual Return to Play Steps:
No activityLight aerobic activitySport-specific activityNon-contact training drillsFull contact practiceFull return to play
This process takes at least 1 week to return an athlete to play
SHS/MS Head Injury Protocol ImPACT baseline testing If a head injury occurs:
No same day return to playEvaluation will be done by AT/L and the athlete will
be evaluated by a physicianAthlete will re-test using ImPact 24-48 hours after
the injuryAthlete will begin the return to play protocol when
they are symptom free and have returned to baseline on all testing
SHS/MS Head Injury Protocol If a head injury occurs:
If the AT is not present do not leave the athlete unsupervised
If they are stable contact their parents and have them pick them up and take them for further evaluation
If they are not stable, call 911Contact the AT to notify of the injury so that it can
be followed up on the next day
Is This Practice/Game More Important Than:
The rest of the season?
The rest of the athlete’s career?
The rest of the athlete’s life?
Finally
Do not let an athlete suspected of having a concussion back into practice or games until
they have been evaluated and cleared in writing by a Licensed Health Care Provider
trained in the management and evaluation of concussions.
That is not only the LAW;
It Is the Right Thing To Do!
Resources
Heads up kit: www.cdc.gov/concussioninYouthSports/
www.biawa.org www.nata.org www.seattlechildrens.org www.wiaa.com