sports concussion education seminar · vscc – scope of care • middle and high school athletes...
TRANSCRIPT
![Page 1: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/1.jpg)
SPORTS CONCUSSION
EDUCATION SEMINAR
For Parents, Coaches, and School Administrators
Presented by the
Vanderbilt Sports Concussion Center Vanderbilt University Medical Center
Nashville, TN
![Page 2: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/2.jpg)
What is the Vanderbilt Sports Concussion Center?
• Collaborative effort among VUMC sports medicine providers to standardize diagnosis, treatment, and management of concussed athletes using state of the art, evidence-based care while advancing the current standard of care throughout the community through public and provider education and the discovery of new knowledge.
![Page 3: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/3.jpg)
VSCC – Scope of Care • Middle and high school athletes
– All Nashville metro and Williamson county high schools and several
private schools
• “Club” sports teams – lacrosse, soccer, hockey
• College teams – Vanderbilt University, Belmont University
• Professional teams – Nashville Predators (NHL), Nashville Sounds (AAA baseball)
• US Olympic Equestrian team and elite riders (USEF)
• Many individual athletes of all levels
![Page 4: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/4.jpg)
VSCC - Providers • Primary care sports medicine
• Neurosurgery
• Neuropsychology
• Certified athletic trainers
• Affiliated consultants – neuroradiology, neurology, pediatrics, ENT, rehab services, psychiatry, counseling, physical and occupational therapists
• Only comprehensive sports concussion center in the region
![Page 5: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/5.jpg)
VSCC – Locations
• Campus - Vanderbilt Sports Medicine (VOI), Children’s Hospital, Neurosurgery (VAV)
• One Hundred Oaks
• Cool Springs – Orthopedics and Neurosurgery
• Vanderbilt Bone and Joint Clinic, Franklin
• Brentwood Primary Care
• Outreach clinics – Murray, KY; Mt. Juliet, TN
![Page 6: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/6.jpg)
VSCC - services • Team coverage
– Comprehensive concussion plan
– Coach/parent/athlete education
– Individual preseason baseline testing (history, cognitive, and balance)
– Injury assessment and evaluation
– Supervised return to play
– Access to all resources for complex or refractory cases
![Page 7: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/7.jpg)
VSCC - education • Many resources on our website:
– www.vanderbiltsportsconcussion.com
• “Quick facts” brochures
• In-services for ATCs and staff
• Annual CME updates
• Numerous outreach seminars and courses for physicians, trainers, and other providers
![Page 8: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/8.jpg)
Why are we here today? • Data shows that an overwhelming majority of youth
sports concussions occur in practices or games where no athletic trainer or physician is present
• We want to educate coaches, parents and school officials about basic concussion diagnosis and treatment so that these important injuries are recognized and more severe injuries are prevented
![Page 9: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/9.jpg)
But we are NOT here to…
• Get rid of football (or any other sport)
• Frighten everyone that all sports are dangerous and cause long term brain damage
• Turn everyone into a concussion expert or brain surgeon in 2 hours
![Page 10: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/10.jpg)
Program objectives • Understand what is a concussion and what
are common signs and symptoms
• Discuss initial treatment and transport
• Outline how we return someone to play after injury
• Review baseline testing
• Describe current evidence about long term outcomes
• Update prevention strategies
![Page 11: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/11.jpg)
Unrestricted Educational Grant Robert Parish, CEO April 30, 2013: Nashville
![Page 12: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/12.jpg)
Concussion: Definition,
Demographics, Signs & Symptoms
Andrew Gregory, MD, FAAP, FACSM
Associate Professor Orthopedics & Pediatrics
Team Physician, Vanderbilt & Belmont Universities
![Page 13: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/13.jpg)
Is this a concussion?
• 11 yo was swinging on a tree limb, fell 5-6’ and hit the back of his head on the ground
• Loses consciousness for one min according to other kids
• Then has headaches and blurry vision
• Vomits twice
![Page 14: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/14.jpg)
Is this a concussion?
• Seen at the Emergency Room - “normal exam”, CT Scan negative
• Goes back to school with headaches needing Ibuprofen
• Headaches get worse with physical activity (including practicing with his travel baseball team)
![Page 15: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/15.jpg)
Self Reported Symptoms
• Headache – 3/6
• Trouble Sleeping – 3/6
• Drowsiness – 2/6
• Sensitivity to light – 2/6
• Feeling like “in a fog” – 1/6
• Difficulty concentrating – 1/6
• All others - 0/6
![Page 16: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/16.jpg)
Did this child have a concussion?
![Page 17: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/17.jpg)
What is a Concussion? • Lots of terms
– Ding, bell rung, shaking off the cobwebs, closed head injury, mild traumatic brain injury (mTBI)
• “A trauma induced alteration in mental status that may or may not involve loss of consciousness” —AAN 1997
• Headache plus… • Transient Neurological
Phenomenon
![Page 18: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/18.jpg)
Definition of Concussion
1. Caused either by a direct blow to the head, face, neck or elsewhere on the body with a resultant force transmitted to the brain.
2. Typically results in the rapid onset of short-lived changes in
neurological function that resolves spontaneously. 3. May result in structural brain changes, but the symptoms
largely reflect a functional disturbance rather than a structural injury.
4. Usually follows a progressive course of improvement 5. Imaging studies (brain CT/MRI) are usually normal.
![Page 19: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/19.jpg)
Signs and Symptoms of Concussion
Signs • Appears dazed or stunned • Confused about assignment • Forgets plays • Is unsure of game, score, or
opponent • Moves clumsily • Answers questions slowly • Loses consciousness • Shows behavior or personality
change • Forgets events prior to play
(retrograde) • Forgets events after hit
(posttraumatic)
Symptoms • Headache • Nausea • Balance problems or dizziness • Double vision • Sensitivity to light or noise • Feeling sluggish • Feeling “foggy” • Concentration or memory
problems • Change in sleep pattern (appears
later) • Feeling fatigued
![Page 20: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/20.jpg)
Common symptoms of concussion from a series of injured high school athletes
• Three most common symptoms:
1. Headaches (55%)
2. Dizziness (42%)
3. Blurred vision (16%)
• 46% experienced either cognitive or memory problems
• 9% had loss of consciousness (“knocked out”)
![Page 21: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/21.jpg)
Do you have to be “knocked out” to have a concussion?
•NO!!!!! • In fact, only a SMALL number of concussed athletes were
“knocked out”
• Many studies have now shown that amnesia (inability to remember) is a much more common sign of concussion and ALWAYS indicates that a brain injury has occurred
![Page 22: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/22.jpg)
What are the “Grades” of a concussion?
• In the past concussions were often classified into grade 1, 2, or 3 based on the severity and duration of symptoms at the time of injury
• Many research studies have showed that these grading scales were useless in predicting the severity of injury or how long to recover
• Grading scales are no longer used
![Page 23: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/23.jpg)
If you have a history of a previous concussion are you more likely to have a
longer duration of symptoms?
• Available research says “yes”
![Page 24: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/24.jpg)
Does having a concussion increase your chances for a future concussion?
• Some research says “yes”
• 92% of the in-season repeat concussions occurred within 7-10 days of first
![Page 25: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/25.jpg)
Epidemiology of Concussion
• 1.5-3.8 million reported cases of brain injury per year in the US
(CDC)
• 20% (300,000-760,000) are sports-related
• 53,000 deaths each year • 70-90,000 permanently disabled
• Highest sports incidence: ages 15-
24
• Cost estimated at > $60 billion annually
![Page 26: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/26.jpg)
HS RIO™ Injury Surveillance System
• Internet-based high school sports-related injury surveillance system
• Weekly data capture 2005 - 2010 academic years
• Representative sample of 100 US high schools – Geography (4 US census regions)
– Size (≤1,000 vs >1,000 students)
• 20 sports – Boys’ - football, soccer, basketball, wrestling, baseball, lacrosse, ice
hockey, swimming & diving, track & field, volleyball
– Girls’ - volleyball, soccer, basketball, softball, lacrosse, field hockey, gymnastics , swimming & diving, track & field, cheerleading
26
![Page 27: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/27.jpg)
Rates per 1,000 Athletic
Exposures
Sport
# of
Concussion
s
National
Estimate
s Practice Competition Overall
Football 1392 357,114 1.3 11.4 2.9
B Soccer 182 89,237 0.3 3.0 1.1
G Soccer 243 132,062 0.3 4.6 1.6
G Vball 54 17,326 0.2 0.6 0.3
B Bball 111 27,404 0.2 1.3 0.6
G Bball 184 47,439 0.4 2.7 1.1
Wrestling 152 33,979 0.6 1.9 1.0
Baseball 32 9,569 0.1 0.4 0.2
Softball 66 23,692 0.4 0.8 0.5
Concussion Rates, 2005- 2010
27
Includes concussions resulting in <1 day time loss (non time loss = 2% of all concussions)
![Page 28: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/28.jpg)
Concussion Severity 2005-2010
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Football
B Soccer
G Soccer
G Volleyball
B Basketball
G Basketball
Wrestling
Baseball
Softball
Sp
ort
1-2 days 3-6 days 7-9 days 10-21 days 22 Days +
Time lost (days)
28 Time lost means days missed from sport due to concussion
![Page 29: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/29.jpg)
Concussion Mechanisms 2005-2010
29 Includes only time loss concussions
![Page 30: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/30.jpg)
Activity Associated with Concussions,
Soccer 2005-2010
Activity Boys’ soccer Girls’ soccer
Heading ball 36% 30%
Goaltending 17% 13%
General play 10% 11%
Defending 9% 17%
Chasing loose ball 11% 15%
Ball
handling/dribbling 6% 5%
Receiving pass 6% 3%
30 Includes only time loss concussions
![Page 31: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/31.jpg)
Activity Associations Basketball 2005 - 2010
31
Activity Boys’ basketball Girls’ Basketball
Rebounding 30% 21%
Chasing loose ball 17% 17%
Defending 20% 27%
General play 14% 7%
Shooting 10% 6%
Ball
handling/dribbling 6% 10%
Receiving pass 1% 7%
Includes only time loss concussions
![Page 32: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/32.jpg)
Activity Associations Baseball/Softball 2005 -2010
Activity Baseball Softball
Batting 37% 8%
Running
bases 22% 4%
Fielding 15% 25%
Pitching 6% 5%
Catching 6% 33%
Sliding 12% 5%
32 * Includes only time loss concussions
![Page 33: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/33.jpg)
Football Concussions 2010
33
Concussions resulting from player-to-player contact
Type of contact: head to head (66%), head to other body site (26%), head to playing surface (8%)
Position of head during contact: head-up (38%), head-down (25%), no flexion (4%), unknown (33%)
Direction of impact: front (45%), side (22%), top (8%), back (5%), unknown (20%)
Did athlete see impact coming: yes (37%), no (27%), unknown (37%)
![Page 34: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/34.jpg)
Girls’ Soccer Concussions 2010
34
Concussions resulting from player-to-player contact
Type of contact: head to head (48%), head to other body site (45%), head to playing surface (7%)
Position of head during contact: head-up (21%), head-down (26%), no flexion (7%), unknown (46%)
Direction of impact: front (24%), side (43%), top (3%), back (14%), unknown (16%)
Did athlete see impact coming: yes (55%), no (25%), unknown (20%)
![Page 35: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/35.jpg)
Summary • Concussion is a temporary disruption of ANY function of the
brain caused by trauma • All coaches and parents should become familiar with common
signs and symptoms of concussion and be alert for them • No return to play if concussion is suspected • Grading scales are no longer used • ANY athlete in ANY sport at ANY age is at risk for concussion
![Page 36: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/36.jpg)
Sports Concussion: Immediate, short-and long-term effects on the brain
Gary Solomon, Ph.D., FACPN
Associate Professor of Neurological Surgery, Psychiatry,
and Orthopaedic Surgery & Rehabilitation
Co-Director, Vanderbilt Sports Concussion Center
Team Neuropsychologist, Nashville Predators
Consulting Neuropsychologist, Tennessee Titans
![Page 37: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/37.jpg)
• I receive royalties from book sales. • I receive consulting fees from the Nashville Predators and
Tennessee Titans.
• I am involved in beta testing a new version of ImPACT and receive free use of the test during the testing; I am a member of the ImPACT Professional Advisory Board and am reimbursed for travel expenses to Board meetings
• This presentation is not endorsed by any organization with which I
am affiliated.
Disclosures/Competing Interests
![Page 38: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/38.jpg)
Objectives:
1. Overview of the brain 2. What happens in the brain during a concussion--- immediate, short, and long-term effects 3. How long it takes for the brain to recover from a concussion 4. Potential long-term effects a. Post-Concussion Syndrome (PCS) b. Chronic Traumatic Encephalopathy (CTE)
![Page 39: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/39.jpg)
Average Adult Human Brain Weight = 1350 g (~3 lbs.) Width = 140 mm (5.6”) Length = 167 mm (6.68”) Height = 93 mm (3.72”) Brain = 2% of Total Body Weight Average Adolescent Brain is Smaller
![Page 40: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/40.jpg)
We can think of the brain as a computer
it is composed of hardware (structure)
and software (function)
![Page 41: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/41.jpg)
Hardware (Structure) = brain tissue Software (Function) = Electrical and chemical processes ongoing within the brain tissue that allows us to sense, think, feel, and act
![Page 42: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/42.jpg)
![Page 43: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/43.jpg)
Sports related concussions rarely cause a hardware problem (structural injury) When structural injuries do occur, they are usually due to tearing of a blood vessel (resulting in an epidural or subdural hematoma) or in some cases, tearing of nerve cells (traumatic axonal injury) However, these structural injuries are extremely rare in sports. This is why the structural CT or MRI scan is normal 99+% of the time after a sports concussion Sports concussion usually causes a disruption in brain function (software problem), which leads to the signs and symptoms described previously The disruption in brain function has been termed “the chemical cascade”
![Page 44: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/44.jpg)
The Chemical Cascade of Concussion Blood flow to the brain is reduced immediately after a concussion The brain operates on 2 kinds of fuel: glucose and oxygen The brain gets glucose and oxygen from the blood supply But because the brain is getting less blood flow after a concussion, the brain is not getting the typical amount of fuel (energy) The difference between the energy the brain is getting and what the brain needs to operate fully results in an energy crisis and the symptoms
![Page 45: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/45.jpg)
PET Scans in Head Injury (Glucose)
Marvin Bergsneider, M.D., and David Hovda, Ph.D. UCLA School of Medicine
![Page 46: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/46.jpg)
fMRI Scan (Oxygen)
Drs. Mark Lovell and Micky Collins University of Pittsburgh Medical Center
Drs. Victoria Morgan and Megan Strother, Vanderbilt
![Page 47: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/47.jpg)
The short term effects of concussion are age- and possibly gender dependent Younger athletes take longer to recover than older athletes, probably because the brain is not fully developed physically until about age 23 Many studies have indicated that females may take longer to recover than males, although a recent VSCC study did not support this Other factors affecting the duration and intensity of symptoms after a concussion can include concussion history and co-existing disorders such as ADHD, learning disabilities, sleep disorders, psychiatric illness, and migraine headaches
![Page 48: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/48.jpg)
To get back to the computer analogy, when we have a software problem, we usually shut down the computer and re-boot it. After a concussion the brain typically repairs (re-boots) itself. But how long does it take?
![Page 49: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/49.jpg)
First, there is no FDA-approved medication for concussion, although many drugs are used to treat the symptoms of concussion In general and on average, the short term effects of concussion resolve within: 7 days for professional athletes 7-10 days for collegiate athletes 7-14 days for high school athletes 7-21 days for younger athletes >90% of athletes with sport-related concussions recover within a month
![Page 50: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/50.jpg)
Second Impact Syndrome (SIS) However, if an athlete does not recover fully from an initial concussion and sustains another concussion before the first has cleared completely, then he may be at risk for Second Impact Syndrome (SIS) SIS is a very rare condition and typically occurs in teen aged males SIS has never been reported in females or in professional athletes SIS occurs when an athlete sustains an initial concussion that is unrecognized, not reported, or has not fully healed,
![Page 51: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/51.jpg)
SIS occurs when an athlete sustains an initial concussion that is unrecognized, not reported, or has not fully healed The brain remains in a vulnerable state from the initial concussion (energy crisis) The athlete then sustains a second concussion which causes additional chemical changes in the brain that lead to severe brain swelling The brain is encased in a hard skull and can only expand within certain limits SIS usually results in permanent disability or death
![Page 52: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/52.jpg)
![Page 53: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/53.jpg)
__________________________________________________________ Effective January 1, 2014
![Page 54: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/54.jpg)
Sports Concussion: Long Term Effects
Post-Concussion Syndrome (PCS) Chronic Traumatic Encephalopathy (CTE)
![Page 55: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/55.jpg)
Post-Concussion Syndrome (PCS)
The term was first used by an article by Strauss and Savitsky in 1934 Multiple definitions abound and vary somewhat, but all involve a constellation of symptoms after a blow to the head Symptoms common to most definitions include a persistence of the initial concussion symptoms, including headaches, dizziness, fatigue, irritability, forgetfulness, poor concentration, blurred vision, sensitivity to light and noise, frustration, sleep disturbance, difficulty thinking, nausea, depression, increased emotionality The diagnosis is made anywhere from 6 weeks to 3 months post-injury
![Page 56: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/56.jpg)
Most of the scientific research on PCS has been done on civilians, and more recently, on military personnel experiencing blast injuries Studies of PCS in athletes are now being conducted In general, less than 10% of athletes are diagnosed with PCS Most of these athletes recover within 6-12 months, although there is a small group that remains symptomatic longer PCS typically involves multiple factors and usually requires a multi-disciplinary treatment approach
![Page 57: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/57.jpg)
Chronic Traumatic Encephalopathy (CTE)
• Punch-Drunk Syndrome (Martland, 1928, JAMA)
• Dementia Pugilistica (Millspaugh, 1937, US Navy Medical Bulletin)
• Psychopathic deterioration of pugilists (Courville, 1962, Bulletin Los
Angeles Neurological Society)
• Chronic traumatic encephalopathy (Miller, 1966, Proceedings of The Royal Society of Medicine)
• Chronic traumatic brain injury
(Jordan et al., 1997, JAMA)
![Page 58: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/58.jpg)
CTE has receive a resurgence of interest due to several professional athletes (especially football players) being diagnosed with CTE after death The current definitions of CTE are somewhat different but common elements include the appearance of a tau protein in brain tissue, found on autopsy Mood, behavioral, and cognitive changes occur prior to death
![Page 59: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/59.jpg)
CTE is an evolving area of study and merits close scientific investigation with well designed, well controlled research CTE, like most neurodegenerative disorders, is a multi-faceted brain disease that involves a variety of genetic, athletic exposure, and lifestyle factors
![Page 60: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/60.jpg)
“…a cause and effect relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.”
![Page 61: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/61.jpg)
Thanks to all of you for being
here today, and special thanks to
Rawlings for their support
![Page 62: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/62.jpg)
Tim Lee, MHA, MS, ATC
Coordinator, VSCC
Concussion Baseline Testing
![Page 63: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/63.jpg)
What is baseline testing?
• Baseline testing is a series of standardized exams used to assess an athlete’s balance, brain function, and symptoms.
• Results of the baseline test can be used to compare to a follow-up exam if the athlete has a suspected concussion
![Page 64: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/64.jpg)
What is included in VSCC baseline testing? 875-8722
Clinical Visit
• Neurologic history
• Symptoms Checklist
• Modified Balance Error Scoring System (mBESS)
• ImPACT (Immediate Post Concussion Assessment and Cognitive Testing)Test
![Page 65: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/65.jpg)
What is included in VSCC baseline testing?
• On-Site/Mass Testing
• Symptoms Checklist
• ImPACT (Immediate Post Concussion Assessment and Cognitive Testing)Test
![Page 66: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/66.jpg)
VSCC Neurological History
![Page 67: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/67.jpg)
Symptoms Checklist
![Page 68: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/68.jpg)
Consent Form
![Page 69: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/69.jpg)
mBESS Testing
![Page 70: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/70.jpg)
ImPACT Test
• Module 1: Word Discrimination
• Module 2: Design Memory
• Module 3: X’s and O’s
• Module 4: Symbol Matching
• Module 5: Color Match
• Module 6: Three Letter Memory
_______________________________________________
These subtests yield scores in Verbal Memory, Visual Memory, Visual Motor (Processing) Speed, and Reaction Time
![Page 71: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/71.jpg)
When should an athlete be baseline tested?
• Pre-season, before contact
• Currently, ages 12 years old up.
![Page 72: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/72.jpg)
How often should an athlete be baseline tested?
• Every 2 years
• Unless an athlete has suffered a concussion, has a new diagnosis of ADD/ADHD, or learning disability
• mBESS and symptoms checklists should be
performed yearly.
![Page 73: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/73.jpg)
Who should administer the baseline test?
• A trained healthcare professional (MD, DO, ATC, PhD, PT)
• The testing environment should be quiet and free from distractions
• Computer-based testing should not be performed at home or anywhere without supervision
![Page 74: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/74.jpg)
Who should interpret the test results?
• A healthcare professional trained in concussion management
![Page 75: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/75.jpg)
What are we looking for in these tests after a concussion?
• We are expecting that the athlete’s test scores on all the measures will have returned to the baseline values.
• This would indicate that the athlete has most likely recovered from the concussion.
![Page 76: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/76.jpg)
Concussion Baseline Testing for All Now Available
[email protected] ---------------------------------------------------------------
-----------------
A concussion is an urgent medical problem and we strive to evaluate patients within 72 hours of injury.
Call us to make an appointment.
(615) 875-VSCC (8722)
![Page 77: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/77.jpg)
Sports Concussion: Sideline and Initial Management
Jim Fiechtl, MD
Assistant Professor: Depts. Of EM and Orthopedics
Vanderbilt Bone and Joint Clinic
Vanderbilt Bone & Joint
![Page 78: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/78.jpg)
Disclosures
• Unfortunately, I have no financial disclosures to make, but I am always willing to listen.
Vanderbilt Bone & Joint
![Page 79: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/79.jpg)
Objectives
• How to recognize?
• What we are doing on the sideline?
• What to do in the first 48 hours?
• What is this TSSAA form?
Vanderbilt Bone & Joint
![Page 80: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/80.jpg)
Who is concussed?
Vanderbilt Bone & Joint
http://i.cdn.turner.com/si/multimedia/photo_gallery/0910/cfb.impact.injuries/images/tim-tebow.3.jpg
![Page 81: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/81.jpg)
Who is concussed?
Vanderbilt Bone & Joint
http://www.cbssports.com/mcc/blogs/entry/24156338/29747154
![Page 82: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/82.jpg)
Who is concussed?
Vanderbilt Bone & Joint
http://theother87.files.wordpress.com/2011/05/youth-soccer.jpg
![Page 83: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/83.jpg)
Who does the evaluation?
• Anyone trained
– Means someone has been trained
– Coach
– Certified Athletic Trainer
– Physician
– Team Parent
Vanderbilt Bone & Joint
http://www.trophies2go.com/team-mom-trophy
![Page 84: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/84.jpg)
What are we looking for?
• Lying on the ground/slow to get up
– Are they unconscious?
• Unsteady or wobbly
• Grabbing their head
• Dazed, blank look
• Confused, running wrong plays
Vanderbilt Bone & Joint
Pocket Concussion Recognition Tool™
![Page 85: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/85.jpg)
Lying Motionless • If unconscious, assume
a cervical spine injury
– C-spine control
– Activate Emergency Action Plan
• Take your time – ensure safety
• Needs to go to Emergency Department
Vanderbilt Bone & Joint
http://mnhopper1s.files.wordpress.com/2011/10/spine.jpg?w=420&h=337
![Page 86: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/86.jpg)
Able to Move
• Take your time – ensure safety
• Move them to a ‘quiet’ area on the sideline
• Give the player a few minutes to catch breath
• Observe
Vanderbilt Bone & Joint
![Page 87: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/87.jpg)
Sideline Assessment • Maddocks’ Questions
– What city and stadium?
– Opponent?
– Month and day?
– Remember being injured, score of the game, the play, etc
• Memory and Cognition
– Months, 3 objects, numbers backwards
Vanderbilt Bone & Joint
![Page 88: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/88.jpg)
Sideline Assessment • Brief Neuro Exam
– Cranial nerves
– Strength
– Balance
– Cerebellar
Vanderbilt Bone & Joint
![Page 89: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/89.jpg)
When can they go back in?
They’re done for the day.
Vanderbilt Bone & Joint
![Page 90: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/90.jpg)
Who needs a trip to the ER? • Worsening headache or
symptoms
• Drowsy, hard to awaken
• Repeated vomiting
• Unusual behavior
• Seizures
• Weakness or numbness in arms or legs
• Slurred speech, unsteady walking
Vanderbilt Bone & Joint
http://ia.media-imdb.com/images/M/MV5BMjA0NjI0ODgzNF5BMl5BanBnXkFtZTcwMDAxNDUyMQ@@._V1_SY317_CR20,0,214,317_.jpg
Putukian. BJSM 2013;47:285-8.
![Page 91: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/91.jpg)
Once in the ER…
• To Scan or Not To Scan
– Why not scan everyone?
• Multiple prediction rules
Vanderbilt Bone & Joint
![Page 92: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/92.jpg)
What Does this all Mean? • Think about Headache Plus – the Sills Criteria
– Worsening
– Persistent Vomiting
– Altered (GCS < 15)
– Older (> 60)
– Prolonged amnesia (> 2 hours)
– Seizure
– Fracture
– Social Situation
– Anticoagulants
Vanderbilt Bone & Joint
![Page 93: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/93.jpg)
Now, what do we do – Initial Management
• Rest, Rest, Rest
– Brain Rest: limit screen time, noises
– Physical Rest: no exertion
• Medications
– Acetaminophen over Ibuprofen, certainly over Aspirin
• Let them sleep – Don’t awaken every 2 hours
• Symptoms can develop over 24-48 hours
Vanderbilt Bone & Joint
![Page 94: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/94.jpg)
Post-injury Follow-up
• Who needs follow-up?
– Everyone will need medical clearance
– ED can not clear you back to sport
• Timing?
– Emergent v. Clinic
• School assistance
• Additional medications and/or specialty referrals
Vanderbilt Bone & Joint
![Page 95: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/95.jpg)
Summary • Someone trained at every event
• Recognize and remove from the game
– No return to play on the same day
• Remember what leads to an ER trip
• Rest – brain and body
• Can evolve over 24-48 hours
• Needs medical clearance for return to play
– Provide additional resources, school help
Vanderbilt Bone & Joint
![Page 96: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/96.jpg)
Post Injury
Management and
Rehab
Or, What do I do now?
Allen Sills, MD, FACS Associate Professor of Neurosurgery,
Orthopedic Surgery and Rehabilitation Co-Director, Vanderbilt Sports Concussion Center
Team Neurosurgeon - Nashville Predators Consulting Neurosurgeon to:
Vanderbilt University Athletics
Belmont University Athletics
US Olympic Equestrian Team
Federation Equestrian Internationale (FEI)
Concussion in Sport Group
![Page 97: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/97.jpg)
Outline
• What is a comprehensive concussion
plan and who should have one?
• How do we safely return someone to play
after a concussion?
• What does “return to learn” mean?
• When should ImPACT testing be
repeated?
• What to do when symptoms continue for
more than a few days?
![Page 98: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/98.jpg)
Comprehensive
Concussion Plan
![Page 99: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/99.jpg)
Comprehensive Concussion Plan
• Defines goals, key personnel, groups to
be served
• Discusses prevention and equipment
• Details baseline evaluations
• Delineates immediate management
• Identifies “red flags” for urgent medical
evaluation or transfer to ER
• Determines follow up care
• Return to Play (RTP) protocol
![Page 100: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/100.jpg)
Concussion Plan
• Not a “rigid recipe” but rather a roadmap
to a common destination
– Allows for rest stops and sightseeing –
individual flexibility!
• But it is not OK to just “wing it”!
– Increases liability
– Decreases credibility
• No need to reinvent the wheel
![Page 101: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/101.jpg)
![Page 102: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/102.jpg)
![Page 103: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/103.jpg)
Return to Play
“When can my boy get back out
there where he belongs?”
![Page 104: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/104.jpg)
Return to Play - goals
• Return athlete to play as soon as possible
after brain injury has healed
• Emphasize actions and treatments that
enhance and promote recovery
• Avoid actions and treatments that hinder
recovery
• Return to play really begins as soon as
concussion is diagnosed
![Page 105: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/105.jpg)
Same Day Return to Play
• Once any athlete at any age has been
diagnosed with any concussion they are
done for that day
– No exceptions!
– No such thing as a ding!
– No grading scale
– Be aware that some injuries may evolve over
time and symptoms may be delayed
– Serial evaluations are helpful
![Page 106: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/106.jpg)
Acute treatment
• First 48 hrs
– Physical AND cognitive rest
– Avoid tasks which increase symptoms
• “overstimulation” of brain
• Simplify brain inputs
– “live like the Andy Griffith show”
– Some symptoms may evolve
• especially headache, concentration
![Page 107: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/107.jpg)
Acute treatment
• First 48 hrs
– Encourage sleep
• Don’t need the every hour wakeup!
• “excessive” sleep probably OK
– School OK depending on tolerance
• Low threshold for absence – generally avoid until no
symptoms for 24 hours
– Meds – Tylenol usually adequate
– Red flags – immediate referral for medical eval
• Previous talk
– ER physician CANNOT CLEAR FOR RETURN
TO PLAY!!!
![Page 108: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/108.jpg)
After 48 hours
• Reassess by practitioner trained in
concussion management
• NO role for ImPACT testing in this stage
– May increase symptoms
– Practice effect
– Does not change plan
• Once asymptomatic for 24 hrs can return
to class
– If symptoms in class may need to modify
schedule
![Page 109: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/109.jpg)
Return to play stages
![Page 110: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/110.jpg)
Return to Play progression
• After a concussion, we want to
GRADUALLY increase exertion in a
progressive manner to see if the athlete
has symtoms
– Athletes may have no symptoms at rest but
symptoms may emerge with exertion
– This means the brain has not fully healed from
the concussion
![Page 111: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/111.jpg)
Return to Play progression
• Steps should be spelled out in your
concussion plan
• Should be overseen by someone trained
in concussion management
– Athletic trainer
– Physical therapist
– Physician (MD/DO), nurse practitioner (NP) or
physician’s assistant (PA) experienced in
athletic medicine and concussion care
![Page 112: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/112.jpg)
Return to Play - stages
• Phase “0” – cognitive exertion
• Phase 1 – aerobic exertion
• Phase 2 – functional testing progression
• Phase 3 – sport specific exertion
• Phase 4 – limited drills and non-contact
practice
• Phase 5 – full participation without
restrictions
• For most athletes 24 hour minimum per
phase From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 113: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/113.jpg)
RTP Phase 0 – Cognitive Exertion
• No physical exertion until completion of
full school day and all academic work
with NO symptoms
• If no school – find other cognitive tasks
– Reading for comprehension
Courtesy of Tracy Campbell, ATC
![Page 114: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/114.jpg)
• The athlete must be able to
“Return to Learn” BEFORE they
can begin the “Return to Play”
pathway
![Page 115: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/115.jpg)
RTP Phase 1 – Aerobic Exertion
• Begin exertion to raise HR under
monitored conditions
• Example: Functional exertion test
– Bike 20 minutes @ 70 percent of predicted maximum heart
rate(PMHR)
– Rest for 15 minutes
– Monitor symptoms
– Incremental Treadmill Test 20 minutes
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 116: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/116.jpg)
RTP Phase 2 – Functional Testing
Progression
• More complex movements at higher pace, but
generally in a single plane
• Examples: – Scissor step/quick step
– Jogs
– lateral shuffle
– Backpedal
– Sit-ups
– Push-ups
– Sprints
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 117: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/117.jpg)
RTP Phase 3 – Sport Specific Exertion
• Initial
– Moderate aerobic exercises specific to sport
– Duration approximately 10- 15 minutes with 5 minutes
rest post session
• Intermediate
– Progressively difficult aerobic exercises specific to sport
– Duration approximately 10- 15 minutes with 5 minutes
rest post session
–
• Advanced
– Demanding aerobic exercises specific to sport
– Duration approximately 10- 15 minutes with 5 minutes
rest post session
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 118: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/118.jpg)
RTP Phase 3 – Sport Specific Exertion Example
• SPORTS SPECIFIC EXERCISES - BASKETBALL
• Initial
– 10 laps around floor—sprint straight away/slide baseline
– Sprints full court
– Backpedal
– lateral Shuffle
• Intermediate
– Defensive zigzag
– Square drill
– Shooting/post drills—timed
• Advanced
– Intervals 10 x 40 sec duration w/minute rest
• Each interval contains various movements
• Lateral shuffle
• Sprints
• Change of direction
• Jumping
• backpedal
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 119: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/119.jpg)
RTP Phase 4 – Return to Limited Drills and
Non-contact Practice
• Non-contact training drills dependent upon sport
• Athlete can practice with team but no contact
• Consult team physician for full clearance
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 120: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/120.jpg)
RTP Phase 5 – Return to Full Participation
without restrictions
• Full participation without restriction
• For collision sports will usually practice
full speed with contact before game action
(if available)
From the
Vanderbilt University Athletics
Mild Traumatic Brain Injury (mTBI)/Concussion Evaluation Guidelines (2012)
![Page 121: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/121.jpg)
RTP – How NOT to do it
• “We didn’t let him practice all week and
he feels good today (Thursday) so we’re
gonna let him play Friday night.”
• “He rested for 3 days then I put him on
the bike today for 15 minutes and he did
fine so I let him go to practice today”
• “She felt bad all weekend but today she
just has a slight headache and seemed ok
in warmups so I let her go.”
![Page 122: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/122.jpg)
RTP – “Pearls”
• If athlete has symptoms during one stage,
then should rest for 24 hours and go back
to previous stage
• Careful observation during and after final
stage / first game back
– EDUCATION of athlete!
• An extra few days in the RTP protocol
might save your athlete a month, a
season, or even a whole school year!
![Page 123: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/123.jpg)
When should ImPACT testing be
repeated?
• Purpose of repeat test is to make sure
that brain function has returned to
baseline
– Especially if athlete is not being truthful about
their symptoms!
• NO reason to repeat test if athlete is still
having symptoms
![Page 124: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/124.jpg)
When should ImPACT testing be
repeated?
• Can do test either prior to starting RTP
protocol or at any stage as long as athlete
is still without symptoms
• ImPACT test alone cannot “clear” an
athlete to return – it is a PART of an
overall assessment to be used by a
trained provider
![Page 125: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/125.jpg)
Prolonged Recovery
JAE S. LEE / THE TENNESSEAN
![Page 126: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/126.jpg)
Pathways to Recovery
• 2 general “pathways” to recovery have
been identified
– Standard (80 – 90%)
• all symptoms resolve in 7 to14 days
– Prolonged (10 – 20%)
• Symptoms for > 30 days
• This distinction appears over time and
initial treatment principles are same
![Page 127: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/127.jpg)
Prolonged recovery
• Definition: more than 30 days of
symptoms
• Symptoms may not be specific to
concussion
– Require other management strategies
– Advanced imaging
– Formal neuropsych testing
![Page 128: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/128.jpg)
Prolonged recovery
• All of these patients will benefit from
evaluation by a concussion specialist and
a multi-disciplinary approach
• Advanced interventions
– Treat sleep / mood problems
– Headache prophylaxis and treatment
– Vestibular assessment and rehab for balance
issues
– Cognitive evaluation and therapy for
persistent school problems
![Page 129: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/129.jpg)
Vanderbilt Sports Concussion
Center
• (615) 875 – VSCC (8722)
• www.vanderbiltsportsconcussion.com
• Specialists in: – Sports medicine, neurosurgery, neurology
– Sports neuropsychology
– Headache management
– Sleep medicine
– Balance and vestibular problems
– Speech and cognitive therapy
– Ear, nose and throat
– Advanced MRI and imaging
– Physical and occupational therapists
– Supervised return to play
![Page 130: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/130.jpg)
Prolonged recovery – what to avoid
• Avoid social and personal isolation for
prolonged periods of time
– No school
– No sport
– No social activities
– No life!
![Page 131: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/131.jpg)
Summary
• Everyone needs a concussion plan – You need a trained provider to evaluate athletes who
sustain a concussion and to supervise their return to
play
• No RTP same day – no exceptions
• Physical and cognitive rest in first 48 hrs
• No physical exertion until asymptomatic
with brain exertion
• Stepwise RTP – be systematic
• Athletes with prolonged recovery are
unique and need specialist assessment
![Page 132: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/132.jpg)
![Page 133: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/133.jpg)
Thanks!
![Page 134: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/134.jpg)
Vanderbilt Sports Medicine
Prevention of Concussion: What Works, What Doesn’t and What’s Next
April 30, 2013
Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation
Assistant Professor of Pediatrics Medical Director, Program for Injury Prevention in Youth Sports (PIPYS)
Vanderbilt University Medical Center Team Physician
Vanderbilt & Belmont Universities Nashville Sounds & Nashville Predators
VSCC & Rawlings
Concussion Education Program
![Page 135: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/135.jpg)
Vanderbilt Sports Medicine
Injury Prevention 101
![Page 136: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/136.jpg)
Vanderbilt Sports Medicine
Categories of Prevention
• Primary
– Preventing the injury from happening
• Secondary
– Reducing a possible injury’s severity
• Tertiary
– Working for the best outcome after an injury
![Page 137: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/137.jpg)
Vanderbilt Sports Medicine
Injury Prevention is a Team Sport
![Page 138: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/138.jpg)
Vanderbilt Sports Medicine
Emery CA et al. CJSM, 2006.
Safety cannot be delegated, it is a shared responsibility of…
• Parents
• Coaches
• Youth athletes
• Safety advocates
• Athletic trainers
• Schools
• Health professionals
![Page 139: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/139.jpg)
Vanderbilt Sports Medicine
Clinical Care Research
Approaches To Prevention
![Page 140: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/140.jpg)
Vanderbilt Sports Medicine
Strategies for Concussion Prevention
![Page 141: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/141.jpg)
Vanderbilt Sports Medicine
Concussion Prevention: Equipment
• Football Helmets
• Mouth Guards
• Head Gear
![Page 142: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/142.jpg)
Vanderbilt Sports Medicine
Football Helmet Ratings: STAR Evaluation System
• 5 Stars – Riddell 360 – Rawlings Quantum Plus – Riddell Revolution Speed
• 4 Stars – Schutt ION 4D – Schutt DNA Pro + – Rawlings Impulse – Xenith X1 – Ridell Revolution – Rawlings Quantum – Riddell Revolution IQ
• 3 Stars
– Schutt Air XP
– Xenith X2
• 2 Stars
– Schutt Air Advantage
• 1 Star
– Riddell VSR4
• 0 Stars
– Adams A2000 Pro Elite
Virginia Tech National Impact Database. May 2012.
Reduction in concussion risk
![Page 143: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/143.jpg)
Vanderbilt Sports Medicine
Mouth Guards
• Effects of mouth guards on dental injuries and concussion in college basketball.
– Labella et al. MSSE, 2002. (LOE 2)
• Findings:
– No difference in concussion rate
– Significantly lower rate of dental trauma
![Page 144: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/144.jpg)
Vanderbilt Sports Medicine
Head Gear in Soccer
• Withnall et al. BJSM, 2005. – Three equipment types tested – No attenuation of mechanical
forces due to heading ball – 33% reduction in acceleration
forces from direct head-to-head contact
– Further evidence needed for effect on injury or concussion prevention
![Page 145: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/145.jpg)
Vanderbilt Sports Medicine
Navarro RR. Curr Sports Med Reports, 2011.
![Page 146: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/146.jpg)
Vanderbilt Sports Medicine
Summary of Helmet Benefits in Sports McIntosh AS et al. BJSM, 2011.
![Page 147: SPORTS CONCUSSION EDUCATION SEMINAR · VSCC – Scope of Care • Middle and high school athletes – All Nashville metro and Williamson county high schools and several private schools](https://reader036.vdocuments.us/reader036/viewer/2022081617/6043f95290c85a0c8b4ef1cf/html5/thumbnails/147.jpg)
Vanderbilt Sports Medicine
Headgear Fitting
• Important across sports – A well maintained, properly fitted helmet required
to provide advertised level of protection to athlete • Serious head injury (not concussion)
– Frequently inspect equipment for wear and tear including cracks, defects and loss of proper fit
• Hands-on demonstration – Rawlings