concussions in high school athletes
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Concussions in High School Athletes. By Dr. Leyen Vu Resident Physician, St. Peter Hospital Sept. 28, 2010. Definition: Concussion. Change in mental status caused by a traumatic episode with or without loss of consciousness. - PowerPoint PPT PresentationTRANSCRIPT
By Dr. Leyen VuResident Physician, St. Peter Hospital
Sept. 28, 2010
Concussions in High School Athletes
Change in mental status caused by a traumatic episode with or without loss of consciousness. May be caused by blow to the head or
anywhere else on the body with an impulsive force on head
Most commonly no loss of consciousness
Definition: Concussion
300,000 sports related concussions each yearMost common sports: football, ice hockey,
soccer, boxing, rugby. 10% of college and 20% of high school football
players suffer head injuries each seasonOnly 4-5% of players report symptoms.
63.4% football10.5% wrestling6.2% girls basketball
14% had repeat concussion during same season
How Often Do Concussions Occur in Sports?
Males more likely than females2-3 times more likely
Who Gets More Concussions?
The Science
The Science
Children have weaker neck and shoulder muscles compared to adultsMore of the impact is absorbed by the head
and less by the upper body. Most brain scans are still normal
The Science
Signs of a Concussion
ImmediateConfusionDouble vision, seeing starsNot feeling rightAmnesia
Can’t remember the play, quarter, scoreLater on
HeadachedizzinessChange in mood
Signs of a Concussion
Vacant StareSlower to answer questionsCan’t focusDisorientation (walking in wrong direction)Poor coordinationPoor memoryLOSS OF CONSCIOUSNESS
Signs of a Concussion
Suspected concussions need evaluationMay be unrecognized by non medical
personnelMore than 80% of people with a previous
concussion did not recognize it as suchJust asking time and date not adequate“When in doubt, sit them out”
Sideline Detection of Concussion
Test at beginning of season and immediately after injuryDecline in 1 point 76-94% accurate in detecting
concussion
Standard Assessment of Concussion (SAC)
Brief QuestionairreWhat is your name?What is the name of this place?Why are you here?What month are we in?What year are we in?In what town/suburb are you in?How old are you?What is your date of birth?What time of day is it? (morning, afternoon,
evening)Three pictures are presented for subsequent recall
Other Tools
1 wrong answer suggests concussion
Other Tools
Any athlete with suspected concussion MUST be removed from game/eventCannot return to play on same dayDoes not matter how mild concussion
symptoms are!!!
Management
When to go to Hospital Loss of consciousnessSuspected broken skull
Black eyes, bruising behind earsEar drainage2 or more episodes of vomitingSignificant neurologic impairment
Management
Bleeding in the brainSecond Impact Syndrome
Occurs when a second head injury occurs before 1st concussion can fully heal
Causes brain swellingCan be deadlyRare
Complications of Concussions
General Principles:A player should not return to play until
symptoms have resolved completely, both at rest and during activity
Younger athletes have longer recovery time and a more conservative approach should be taken
All suspected concussions should have medical evaluation by physician before returning to play
Management
Athlete should not be left alone after concussionNeed to monitor for worsening condition
Management
Stepwise return to play (Vienna, 2001) Day 1 - No activity and rest until
no symptoms (i.e. headache dizziness, etc.)
Day 2 – May start light aerobic exercise if no symptoms
Day 3 - Sport-specific trainingDay 4 - Noncontact drillsDay 5 - Full-contact drillsDay 6 - Game play
How To Return to Play
Day 1: complete brain rest (i.e. no reading, video games)
If you have symptoms at any level, you have to go back to the level where you have no symptoms .
How To Return to Play
Neuropsychological testMeasures:
Attention spanMemoryReaction TimeNon verbal problem solving
Considered a “cornerstone of concussion management”
Can be given by coach, trainer, anyone who is trained to administer test
IMPACT Testing
May be able to detect subtle signs of a concussion
Can follow the accumulative effects of multiple concussions over time
Need Baseline test prior to injury to compareStill being researchedCannot alone determine return to play.
IMPACT Testing
Alzheimers DiseaseParkinsonsDepressionPermanent memory problemsLong term brain damageVertigo
Long Term Consequences of Multiple Concussions
Long Term Consequences of Multiple Concussions
Chronic Brain InjuryDid not suffer any
“documented” concussionsin college or NFL
Chris Henry, Cincinnati Bengals
Passed May 14, 2009Requires all school districts to work with the WIAA to
develop guidelines to educate coaches, youth athletes, and parents of the nature and risk of concussion and head injury
Requires an informed consent must be signed by parents and youth athletes recognizing risk of concussions
Requires that a youth athlete who is suspected of sustaining a concussion or head injury be removed from play. “When in doubt, sit them out”
Requires a written clearance from licensed health care provider prior to returning to play.
http://www.king5.com/sports/high-school/Sports-Head-Injuries-83303332.html
Zackery Lystedt Law
Specialized helmets or mouthpieces- no clear benefit
May be more harmfulAthlete has false sense
of security and changes behavior of play.
Prevention
Concussions are much more common than previously believed
Players with concussions (even mild) should be removed from play
Stepwise approach to return to playMust be seen by a medical professional and
preferably get IMPACT testing prior to returnLong term mental effects of repeated
concussionsNew laws in place in Washington
Summary
THANK YOU!