concussion is a brain injury and is defined as a complex pathophysiological process affecting the...

MANAGEMENT OF SPORT-RELATED CONCUSSIONS

What is a concussion?

Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.

Simply put, a concussion is tissue damage to your brain caused by an outside force. Blow to the head, or other part of the body, resulting in a whip-lash type injury.

Severity of Sports Concussions

Facts

Head injury is the most frequent direct cause of death in sports

About 350,000 concussion per year in football

95% are mild, 5% are the others 8 Deaths per year

Acute Subdural Hematoma or Second Impact Syndrome

Facts

A concussion is a brain injury and all are serious.

Most concussions occur without loss of consciousness.

Recognition and proper response to concussions when they first occur can help prevent further injury or even death.

71.0% of all sports- and recreation-related TBI emergency department visits were among males.

Symptoms Headache Nausea Vomiting Drowsiness Numbness or tingling Dizziness Balance Problems Sleeping more than

usual Difficulty

concentrating Difficulty

remembering

Sensitivity to light Sensitivity to noise Feeling slowed

down Feeling as if “in fog” Trouble falling

asleep More emotional

than usual Irritability Sadness Nervousness

Signs of a Concussion

Cognitive: Unawareness of period,

opposition, game score, Poor concentration Confusion Post Traumatic Amnesia

Retrograde Antegrade

LOC Repetitive questioning Repetitive questioning Repetitive questioning

Physical: Poor coordination Unstable gait Seizure Vomiting Slurred speech Inappropriate

behavior or emotions Vacant stare Slow to respond

What is it really?

Altered cellular metabolism causes decreased blood flow to the brain at a time the brain needs it most

The resulting “mismatch” increases the vulnerability of the brain to further injury.

Why are we concerned?

Traumatic brain injury is a common and potentially life-threatening injury

Possible long-term symptoms and disability

Important interventions prior to injury

*Student athletes not reporting symptoms to ATC’s or team physicians puts them at higher risk for long term or permanent disability and possibly death.

What can I do to prevent a concussion?

Use proper playing techniques.

Wear proper protective equipment and make sure equipment fits correctly.

Follow the rules and practice of good sportsmanship.

What should I do if I think I have a concussion?

Don’t Hide It. - Tell a coach or athletic training if you or a teammate has

symptoms! Report Symptoms.

– The sooner you get checked out, the sooner you may be able to return to play

Get checked out. – A concussion can affect your ability to perform everyday

activities, your reaction time, balance, sleep, and classroom performance .

Take time to recover. – You are more likely to have a repeat concussion when

your brain is still healing!• These concussions can lead to permanent brain

damage or death - SECOND IMPACT SYNDROME

What to expect if you have a concussion:

You will not be allowed to return to play or attend class the day of your injury.

Your athletic trainer (AT) will ensure that you are sent home with instructions for you and your roommate(s)/parents in case signs and symptoms worsen.

Your AT will closely monitor your progression based on daily follow-ups.

Your parents will be contacted so long as consent is given.

What to expect if you have a concussion:

You will be withheld from all physical activity until otherwise instructed.

If needed, further classroom accommodations will be made. This will be done in combination with academic services and the DRC.

Once all signs and symptoms have resolved you will be tested before beginning return-to-play progression.

Baseline Testing

All student athletes participating in high risk sports identified by the NCAA will do an initial Impact test prior to their first year.

A repeat test will be performed following their second year, prior to the start of the third. And.. If initial baseline is considered unacceptable Following the recovery of a concussion

Return to Play

Student athletes will be monitored daily. Once subjective symptoms have cleared and student athlete reports to be symptom free they will be evaluated by ATC or physician.

Student athletes will be evaluated using the SCAT3 test. This will need to be considered with in normal limits by ATC or physician before progressing.

A post-injury IMPACT test will be performed and compared to baseline*. Scores will need to have returned to the level of, or better than baseline scores. *Student athletes participating in high risk sports

identified by the NCAA will undergo a baseline IMPACT test prior to the start of their initial season, and following the completion of their second season.

All of the above must be considered with in normal limits prior to progress with the 6 day return progression.

Return to Play

All steps require 24 hours in between. You will be evaluated by a team physician

between steps 4 and 5. Student athletes have the right to seek

evaluation and treatment by a personal physician at their own cost.

PSU physicians and ATC’s have final say in clearance process, and the most conservative treatment plan will be followed.

6-Day/Step Progression

Few More Facts

Some injuries are worse than others Some athletes are more vulnerable Not everyone heals on the same timeline Pre-injury risk factors combine with injury

(modifiers) # previous concussions, headache, ADHD, LD, mood

Other possible factors that influence recovery Magnitude of force that is received Location that force is received Defensive position/ prep of individual receiving force Size, speed factors

Recovery

40% of concussion resolve in about a weeks time.

70% of concussion resolve in about two weeks time.

Following two weeks, the recovery time slows down, and may last weeks, to months, to years. Student athletes need to be aware of the risk for prolonged recovery, and post-concussive symptoms.

Recovery is typically slower after suffering past concussions.

Recovery

0

10

20

30

40

50

60

70

80

90

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 38 40+

All Athletes No Previous Concussions or More Previous Concussions 1

WEEK 1

WEEK 2

WEEK 3

WEEK 4

WEEK 5

Keys To Recovery

Resting the brain & getting good sleep No or limited screen time (computers cell

phones) No alcohol No additional forces to head / brain Managing / facilitating physiological recovery

Avoid activities that produce symptoms Not over-exerting body or brain

Ways to over-exert Physical Emotional Cognitive! (concentration, learning, memory)

Further Keys To Recovery

Following tens days of prolonged symptoms, or in case of severe concussion, rest may not be enough

Student athletes may be entered into a multidisciplinary concussion management program

Evaluation and recommendation for this treatment will be determined by treating physician

REMEMBER

Concussions are different for each athlete but ALL are a serious injury that should not be ignored.

Don’t hide it, report it, take time to recover At anytime, don’t be afraid to ask ATC’s or

team physician questions regarding concussions

Remember Max: http://www.oregonlive.com/opinion/index.ssf/

2009/06/maxs_law_one_tragedy_that_need.html