Sport-Related Concussion Information

Northwestern College Sports Medicine

Northwestern College Sports Medicine Team Dr John Odom MD

952-545-2225

Dave Hieb M.Ed. ATC/R 651-631-5345 651-675-7908

Sara Mortensen M.S. ATC/R; PES 651-628-3448 651-283-6011

Northwestern College Health Service 651-631-5246

What is a concussion?

A concussion is an injury to the brain that affects the brain’s ability to function properly. According to the Concussion in Sport

Group, these injuries are defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”

How many people get concussions? The Center for Disease Control and Prevention estimated

that approximately 1.6 to 3.8 million sport-related concussions occur annually in the United States. 18.2% of them were a sport-related concussion.3 In high

school athletics 8.9% of all injuries suffered were concussion. Of all the high school sports, the most concussions are

seen in football, and soccer. In football specifically, 67.6% of the concussion suffered

were caused by tackling or being tackled. Of the different positions, linebackers and running backs

suffered more concussions than compared to the other positions.

In soccer, the most common cause of a sport-related concussion in both boys and girls is heading the ball.

Signs Observed by Coaches

: Confusion Loss of

Consciousness Dizziness Easily Distracted Vomiting Easily Distracted Drowsiness

Poor Concentration Personality Change Memory Problems Irritability Poor Balance or

Coordination Nervousness

Symptoms Reported By Athletes Headaches Vomiting Neck Pain Nausea Dizziness Vision Problems Sensitivity to

Noise/Light Poor Balance or

Coordination

Feeling "in a fog“ "Seeing Stars“ Drowsiness Ringing in Ears Feeling "dinged“ Nervousness Poor Concentration Memory Problems

Signs Observed by Parents

Severity of Headache

Level of Consciousness

Dizziness Easily Distracted Vomiting Drowsiness Poor Concentration Personality Change

Memory Problems Irritability Nervousness Poor Balance or

Coordination Nausea Sensitivity to

Noise/Light Hyposmia (reduced

ability to smell)

Red Flag" for Immediate Referral to Emergency Room

"Brain Function Deteriorating Loss of Consciousness Decreasing Level of Consciousness Difficulty Breathing Mental Status Changes Pupils are Unequal Seizures

What do I do if my athlete has a concussion? If you suspect a concussion, it is recommended that the

athlete be immediately removed from competition or practice.

No athlete should be allowed to return to activity while still experiencing symptoms.

The athlete should be referred to a medical professional with a background in sport-related concussion treatment.

If the athlete is exhibiting signs or symptoms that warrant immediate medical attention, 911 should be activated and an emergency action protocol initiated.

If the athlete has any “Red Flag” Signs and Symptoms you should transport them immediately to an emergency room.

When should I refer the athlete? Worsening of

symptoms (i.e. headaches)

Vomiting Decrease in level of

consciousness Seizures Brain function

deteriorating Difficulty breathing

Mental Status Changes

Pupil are unequal Slurred speech Weakness or

numbness in arms/legs

Unusual behavioral changes

Cognitive and Physical Evaluation 1. Symptom Score 2. Physical Score Sign 3. Glasgow Coma Scale 4. Sideline Assessment – Maddocks Score 5. Cognitive Assessment 6. Balance Examination 7. Coordination Exam 8. Cognitive Assessment

Cognitive and Physical Evaluation 1. Symptom Score

Score of 22 different symptoms associated with a brain injury.

Each question is based on a 0 (no symptom) – 6 (severe symptom)

2. Physical Signs Score Two yes/no

questions Was there a loss

of consciousness? Was there a

balance problem or unsteadiness?

Cognitive and Physical Evaluation

3. Glasgow Coma Scale Best Eye Response (E)

No eye opening (1) Eye opening to response

to pain (2) Eye opening to speech (3) Eyes opening

spontaneously (4) Best Verbal Response (V)

No verbal response (1) Incomprehensible sounds

(2) Inappropriate words (3)

Confused (4) Oriented (5)

Best Motor Response (M) No motor response (1) Extension to pain (2) Abnormal flexion to pain (3) Flexion / withdrawal to pain

(4) Localizes to pain (5) Obeys commands (6)

G.C.S. = E+V+M = of 15

Cognitive and Physical Evaluation

Maddocks Score 1. At what venue are we at

today? (0 or 1) 2. What half is it now? (0 or

1) 3. Who scored last in this

game/match (0 or 1) 4. What team did we play

last week/game (0 or 1) 5. Did your team win the

last game? (0 or 1) Maddocks Score of 5

Cognitive Assessment Orientation Exam (5

questions) Immediate Memory

(3 trials of 5 words) Concentration

Exam (5 trials)

Cognitive and Physical Evaluation

Balance Examination Double Leg

Stance Single Leg Stance Tandem stance

Coordination Exam Upper Limb

Coordination

Cognitive Exam Delayed Recall

Exam

Overall Scoring of the Sports Concussion Assessment Tool {SCAT2}

Symptom Score

of 22 Physical Signs Score

of 2 Glasgow Coma Scale

of 15 Balance Exam Score

of 30 Coordination Score

of 1

Subtotal of 70

Orientation Score

of 5 Immediate Memory Score

of 5 Concentration Score

of 15 Delayed Recall Score

of 5

SAC Subtotal of 30

SCAT2 Total of 100

Maddocks Score of 5

Concussion Return to Play Guidelines

It is very important to NEVER return to play (physical education class, sports, practice, or game) while still experiencing symptoms of a concussion.

The same sentiment can be spoken for cognitive activities (school work, video games, text messaging, etc).

Gradual Return to Physical Activity While most athletes can return to play (physical

activity) in about 7-10 days, some may take longer for their symptoms to subside and may have a more prolonged absence from sports.

Once all symptoms subside and the scores on any additional objective clinical tests improve, the athlete may begin a return-to-play progression, supervised by a healthcare professional.

This progression often takes place over a period of 4-6 days and allows the athlete to gradually return to physical activity, and eventually sport.

Typically, each phase should occur in a 24 hour period, allowing for the athlete to rest and the observation of the onset of any delayed post-activity signs and symptoms.

If any post-concussive symptoms do occur along the stepwise progression, the athlete is required to drop back to the previous asymptomatic stage and allowed to return to the return to play protocol after a rest period of 24 hours.

Gradual Return to Physical Activity Protocol

Stage Functional Exercise

Objective

1. No Activity Complete physical

and cognitive rest Recovery

2. Light aerobic exercise

Walking, swimming or stationary cycling keeping intensity <70% maximum predicted heart rate. No

resistance training

Increase heart rate

3. Sport-specific

exercise Skating drills in ice

hockey, running drills in soccer. No head impact

activities

Add Movement

Gradual Return to Physical Activity

Stage Functional Exercise

Objective

4. Non-contact training drills

Progression to more complex training drills, e.g.

passing drills in football and ice hockey. May start

progressive resistance

training

Exercise, coordination, and

cognitive load

5. Full contact practice

Following medical clearance, participate in

normal training activities

Restore confidence and assess

functional skills by coaching staff

6. Normal game play

Gradual Return to Cognitive Activity Equally as important as physical rest, for

complete recovery, is cognitive rest. Athletes sustaining a concussion who are

reporting numerous symptoms such as headache, dizziness, fatigue, and inability to concentrate should be encouraged to limit scholastic activities and other cognitive stressors.

Daily activities such as reading, watching television, text-messaging and playing video games should also be avoided to allow a period of cognitive rest.

References Aubry M, Cantu RC, Dvorak J, Graf-Baumann T, Johnston KM, Kelly J, Lovell

MR, McCrory P, Meeuwisse W, Schamasch P. Summary and Agreement Statement of the 1st International Symposium on Concussion in Sport, Vienna 2001. Clinical Journal of Sports Medicine. 2002;12:6-11.

Langolis J, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: A brief overview. J Head Trauma Rehabil 2006;21:375-378.

Kelly KD, Lissel HL, Rowe BH, Vincenten JA, Voaklander DC. Sport and recreation-related head injuries treated in the emergency department. Clinical Journal of Sports Medicine. 2001;11:77-81.

Gessell LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among united states high school and collegiate athletes. J Athl Train. 2007;42:495-503.

Patel DR, Pratt HD, Greydanus DE. Pediatric neurodevelopment and sports participation: when are children ready to play sports? Pediatric Clinics of North America. 2002;49:505-531.

Patel DR, Pratt HD, Greydanus DE. Pediatric neurodevelopment and sports participation: when are children ready to play sports? Pediatric Clinics of North America. 2002;49:505-531.

Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod TC. National Athletic Trainers' Association Pronouncement Committee: Position Statement on Sport-Related Concussion. J Athl Train. 2004;39:280-297.