Concussions and Concussion Management

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Concussions and Concussion Management

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Definition of Concussion

• A traumatic injury to the brain as a result of a
  violent blow, shaking, or spinning. A brain
  concussion can cause immediate and usually
  temporary impairment of brain function such as of
  thinking, vision, equilibrium and consciousness.

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Signs of Concussion

• Objective signs of concussion The signs of
  concussion observed by medical staff in athletes
  with a concussion, according to The American
  Medical Association (AMA), include the following
  
• Player appears dazed
• Player has vacant facial expression
• Confusion about assignment
• Athlete forgets plays
• Disorientation to game or score
• Inappropriate emotional reaction
• Player displays clumsiness
• Player is slow to answer questions
• Loss of consciousness
• Any change in typical behavior

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Signs Of Concussion

• Subjective symptoms of concussion The symptoms
  of concussion reported by athletes with a
  concussion, according to the AMA, include the
  following
• Headache
• Nausea
• Balance problems or dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling slowed down
• Feeling "foggy" or "not sharp"
• Change in sleep pattern
• Concentration or memory problems
• Irritability
• Sadness
• Feeling more emotional

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Stats on Concussions

• 300,000 estimated in a year.
• It is not known how many suffer cognitive and
  neurobehavioral problems related to recurrent
  concussions.
• 30 to 40 deaths per year from Second Impact
  Syndrome

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Second Impact Syndrome

• Suffering a second blow to the head while
  recovering from an initial concussion
• Athletes that are not fully recovered from an
  initial concussion are significantly vulnerable
  for recurrent, cumulative, and even catastrophic
  consequences of a second concussive injury
• Once a person has had a concussion, he or she is
  as much as four times more likely to sustain a
  second one

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Post Concussive Syndrome

• Syndrome is rare
• Described as having concussion symptoms lasting
  more than one month
• People with PCS have sleep disturbances,
  concentration and memory issues, depression and
  other psychiatric problems

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Some of What We Have Learned About Concussions

• In recent years there were as many as 20 grading
  scales for concussions. Many of these scales used
  LOC as a predictor of recovery outcomes
• How long the concussion symptoms last has turned
  out to be far more important than the initial
  symptoms of concussions in predicting outcomes

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What We Have Learned

• Lesser blows can cause more symptoms, harder
  blows may cause fewer symptoms
• Younger athletes (in high school or in lower
  grades) have been shown to exhibit longer
  recovery times when compared to college and
  professional athletes.
• Concussions seem to have more symptoms and last
  longer in females

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What We Have Learned

• A gene may exist that causes some individuals to
  be more susceptible to concussions
• What we now know is that each concussion should
  be treated individually depending on the symptoms
  and the neurocognitive test results. This may be
  the reason why standardized management guidelines
  were unsuccessful.

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Prevention of Primary Concussion

• Proper tackling and blocking techniques
• Proper fitting and maintenance of football and
  lacrosse helmets
• Often after the first 2 weeks of helmet usage, it
  should be checked for proper fit

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Recommendations to Improve Concussion Management
and Speed Recovery
RECOMMENDATION 1

• NO ADOLESCENT WITH A CONCUSSION SHOULD CONTINUE
  TO PLAY OR RETURN TO A GAME AFTER SUSTAINING A
  CONCUSSION.
• WHY? ATHLETES GETTING MULTIPLE BLOWS TO THE HEAD
  MAY TAKE LONGER TO RECOVER AND RISK POST
  CONCUSSIVE SYNDROME

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RECOMMENDATION 2

• AN INDIVIDUAL SUSTAINING A CONCUSSION SHOULD
  CEASE DOING ANY ACTIVITY THAT CAUSES THE SYMPTOMS
  OF A CONCUSSION TO INCREASE (e.g. headaches,
  dizziness, nausea, etc.).
• Continuing activities, or exercise that increases
  symptoms, can delay the recovery from the
  concussion.

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RECOMMENDATION 3

• SCHOOL ATTENDANCE AND ACTIVITIES MAY NEED TO BE
  MODIFIED.
• While some individuals may be able to attend
  school without increasing their symptoms, the
  majority will probably need some modifications
  depending on the nature of the symptoms. Trial
  and error may be needed to discover what they can
  and cannot do.

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• RECOMMENDATION 4

• NEUROCOGNITIVE TESTING IS AN IMPORTANT COMPONENT
  FOR THE MANAGEMENT OF CONCUSSIONS
• The use of neurocognitive testing is one piece of
  the puzzle in assessing recovery from concussions
  and determining the timing of return to play. It
  should only be used as a tool, and should not be
  the only deciding factor in returning a concussed
  athlete to play. It provides objective data and
  prevents athletes who hide their symptoms from
  returning to play before they are fully
  recovered.

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Recommendation 5

• NO ATHLETES SHOULD RETURN TO CONTACT COMPETITIVE
  SPORTS UNTIL THEY ARE SYMPTOM FREE, BOTH AT REST
  AND WITH EXERCISE AND HAVE NORMAL NEURO-COGNITIVE
  TESTING.

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When they have no headaches or other concussion
symptoms athletes can begin the concussion
graduated return-to-play exercise program Day 1
Walking for 20-30 minutes at a rate of 2-1/2
miles per hourDay 2 Jogging for 20-30
minutesDay 3 Running for 20-30 minutesDay 4
Performing sports specific practice drillsDay 5
Return to contact sports if RECOMMENDATION 5 is
met
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Recommendation 6

• ALL SPORTS AND HEALTH EDUCATION PROGRAMS SHOULD
  TEACH STUDENTS THE SPECIFIC SIGNS AND SYMPTOMS OF
  CONCUSSIONS. INSTRUCTORS MUST EMPHASIZE THE
  SERIOUS CONSEQUENCES OF IGNORING CONCUSSION
  SYMPTOMS AND THE CONSEQUENCES THAT WILL OCCUR IF
  CONCUSSIONS ARE NOT PROPERLY TREATED.

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HHS RTP Protocol

• Vienna Concussion Conference Return to Play
  Recommendations. Athletes should
• complete the following step-wise process prior to
  return to play following concussion.
• 1. Removal from contest following and
  signs/symptoms of concussion.
• 2. No return to play in current game
• 3. Medical evaluation following injury
• a. Rule out more serious intracranial pathology
• b. Neuropsychological Testing considered
  cornerstone or proper post-injury assessment
• 4. Stepwise return to play
• a. No activity and rest until asymptomatic
• b. Light aerobic exercise
• c. Sport-specific training
• d. Non-contact drills
• e. Full-contact drills
• f. Game play

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Coaches Responsibility

• Get medical attention as needed if ATC not on
  site
• Inform parent ASAP of concussion
• Report all concussions to ATC Staff if ATC not on
  site
• ATC will follow-up with athlete and parent

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Questions and Comments

• Directed to me via E-Mail
• Any info you give may help in justification for
  purchase of software to start neuropsychological
  testing

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REFERENCES

• Summary and Agreement Statement on Concussion in
  Sport. Clinical Journal of Sports Medicine,
  Vol.12, No 1, 2002
• Impact Concussion Management Software Return to
  Play Guidelines Dr. Mark Lovell