Play It Smart: What you need to know about sports concussions

Cynthia L. Boyer, Ph.D. Executive Director, Brain Injury Services September 26, 2012

@2012 All rights reserved

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Why the increased focus on sports-related concussions? Concussions are common in sports, and

their frequency appears to be increasing Although typically mild, sports

concussions have a high risk of recurrence and can have significant complications

Knowledge of the potential for long-term negative outcomes

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What is a Concussion? A concussion ( or mild traumatic brain injury) is a complex physiological process affecting the brain, induced by traumatic biochemical processes secondary to direct or indirect forces to the head.

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What is a Concussion? Disturbance of brain function is related to neurometabolic dysfunction rather than structural brain injury and is typically associated with normal structural imaging findings

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What is a Concussion? Concussion may or may not involve a loss of consciousness

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What is a Concussion? Results in a constellation of physical, cognitive, emotional, and sleep-related symptoms

Symptoms may last from several minutes to days, weeks, months, or longer in some cases

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Current Diagnosis of Concussion

Does not require LOC Does not require a direct blow to the head Does not require amnesia CT/MRI likely to be normal

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Sports and Concussions

In the United States there are over 3.8 million sports related concussions a year.

It is estimated that an athlete playing a contact sport has a 19% chance of suffering a concussion each year of play.

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Sports and Concussions

34% of college football players have suffered at least one concussion.

20% of college football players have suffered multiple concussions

Department of Neurosurgery, University of Pittsburgh

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Sports and Concussions

All sports and recreation-related concussion in U.S. 1.6-3.8 million/year

Concussion is COMMON in youth sports: 8.9% of high school athletes

Concussions appear to be increasing, especially among high school athletes

Meehan WP, et al. High School concussions in the 2008-2009 Academic Year: Mechanisms, Symptoms and Management. A J Sports Med.2010;38(12):2405-2409.

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Sports and Concussions

Commonly involve: Other players Falls on hard surfaces Equipment

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“Limited Contact” Sports Also Carry a Risk of Concussion Baseball Bicycling Cheerleading Fencing Flag Football Gymnastics Horseback Riding

Raquetball Ice Skating Skateboarding Snowboarding Softball Squash Volley ball

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Head Injuries Per Sport 2010 Cycling: 85,389 Football: 46,948 Baseball/softball: 38,394 Basketball: 34,692 Water sports: 28,716 Powered recreational

vehicles: 26,606 Soccer: 24,184

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Head Injuries Per Sport 2010 Skateboards/scooters:

23,114 Winter sports: 16,948 Horseback riding: 14,466

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Gender Differences

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Mechanism of Injury

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Mechanism of Injury

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Pathophysiology

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Metabolic Abnormalities Potassium, glutamate and glucose are

immediately released from affected brain cells Calcium enters these disturbed cells Neurotransmitter release occurs with loss of

autoregulation on the affected area Decreased cerebral blood flow

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Neurometabolic Changes and Concussion

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Injury Aftermath An energy crisis in the brain The brain is vulnerable to further damage

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Emergency Symptoms Changes in alertness and consciousness Seizures Muscle weakness on one or both sides Persistent confusion Remaining unconsciousness (coma) Repeated vomiting Unequal pupils Unusual eye movements Walking problems

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Concussion Symptoms Headache Nausea/Vomiting Balance Problems/

Dizziness Fatigue/Drowsiness Trouble sleeping Irritability/Sadness Nervousness/more

emotional

Feeling slowed down Foggy Difficulty with

memory/concentration Double vision Ringing in ears Sensitivity to light/noise

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Observed Signs of Concussion Appears dazed, stunned Confused about assignment/position Forgets an instruction Moves clumsily Answers questions slowly Loses consciousness (even briefly) Exhibits mood/ behavior/personality changes Can’t recall events before hit

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Cumulative Effects Increased severity of

symptoms with subsequent concussions

Unknown effects on the developing brain

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Second Impact Syndrome Experiencing a second

concussion before signs and symptoms of a first concussion have resolved may result in rapid and typically fatal brain swelling.

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Second Impact Syndrome Athletes should never to

return to sports while they're still experiencing symptoms of concussion.

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Post Concussion Syndrome 20-25% of patients who suffer a

concussion residual symptoms

Estimated < 5% of sports related concussions

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Post Concussion Syndrome Symptoms Headache Dizziness Sensitivity to light and sound Blurred vision Concentration, attention, and memory

problems

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Post Concussion Syndrome

Most people recover fully from post concussion syndrome within 3-6 months.

However, 7-15% of people will experience symptoms 1 year post injury.

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Long Term Effects of Concussions

Chronic Clinical Changes seen in NFL players - Increased risk of cognitive impairment - Increased risk of depression

Chronic Traumatic Encephalopathy (CTE) - Damaged Tau Protein as seen in AD - Diagnosed in a college football player

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Concussion Management

ANY Signs or Symptoms: NO RETURN TO ANY SPORTS ACTIVITY

Rest Gradual Return to Play

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Clinical Dilemma of Concussion

There is no proven treatment-the injury must run its course

The severity of the concussion is not fully known until it has resolved

Uncertainty about when it is safe to return to competition

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Concussion Management

REMOVE REFER REST RETURN Children’s Hospital, Boston, Sports Concussion Clinic

athlete from play to medical provider no sports, no texting, no tv only with medical clearance

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We Don’t Know……

How many concussions are too many? When the brain is really back to “normal”? If pharmocotherapy could help? Why are more injury prone?

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Prevention Teach safe techniques in

practice and play Encourage recognition

and reporting of concussion symptoms

Be aware that injuries are more common in younger athletes

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Prevention Use available assessment

tools Monitor developments

at advanced levels of play and legislative efforts

Head and spine injury prevention programs (Think First)

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Education

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Videos About Concussions Can Be Seen On

https://www.nanonline.org/NAN/_Research_Publications/Concussions_in_Sport.aspx

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Resources Mayo Clinic http://www.mayoclinic.com The Center for Sports Concussion at Idaho

State University www.knowconcussion.org Center for Disease Control www.cdc.gov Medicine Plus www.nlm.nih.gov Sports Concussion Center of NJ

http://www.sportsconcussionnj.com/?1f6c3100

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Resources

Concussion tear-off pad: a resource for coaches, physical education teachers, school nurses, community youth sports personnel, and emergency response professionals. It is a pad of 50 sheets which can be torn off and sent home with parents or students. http://www.sportsconcussion.com/pdf/resources/tear-off%20pad%202010.pdf

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Thank you!