Coaches Understanding Sports-Related Concussion

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Coaches Understanding Sports-Related Concussion

• Safe Concussion Outcome, Recovery Education
  (SCORE) Program
• Childrens National Medical Center
• Washington, DC

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USA Hockey Foundation Project

• Goal of Project
• Maximize safety of youth hockey players,
  specifically as it relates to the prevention and
  management of concussion.

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USA Hockey Foundation Project

• Completed with support from USA Hockey Foundation
  (Heads Up Hockey)
• In collaboration with Gardens Ice House and
  Montgomery Youth Hockey Association
• Modeled after NHL Concussion Program
• Education, Baseline Testing, Post-Concussion
  Evaluation Gradual Return-To-Play

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1997

• NHL REQUIRES BASELINE
• TESTING FOR ALL ATHLETES
• Over 3800 athletes tested
• 800 concussion evaluations
• Player and league supported
• Post-Concussion Evaluation
• Gradual Return-To-Play

Eric Lindros
(8 reported concussions)
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Four-Part Concussion Education Management
Program

1. Education Increase knowledge of signs, symptoms,
   and risks associated with concussion
2. Baseline Establish pre-season baseline levels of
   concussion symptoms
3. Early ID of concussion Promote effective, early
   identification of concussions
4. Return to play Implement safe return-to-play
   (RTP) protocol

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Key Starting Points

• Concussions can occur in any sport
• Ice hockey is a safe sport
• Concussions are relatively infrequent
• Concussions vary with the level, skill
  intensity of the play.
• Individuals likely vary in their susceptibility
  to concussion.
• Proper management of a suspected concussion
  significantly reduces the chances of a bad
  outcome.

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Four-Part Concussion Education Management
Program

1. Education Increase knowledge of signs, symptoms,
   and risks associated with concussion
2. Baseline Establish pre-season baseline levels of
   concussion symptoms
3. Early ID of concussion Promote effective, early
   identification of concussions
4. Return to play Implement safe return-to-play
   (RTP) protocol

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What is a Concussion?

• A concussion is an injury to the brain that
• Is caused by a bump, blow or jolt to the head.
• Can change the way the brain normally works.
• Can range from mild to severe.
• Can occur during practices or games in any sport.

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What are the Symptoms of a Concussion?

• 3 symptom types
• Physical Headache, nausea, balance problems,
  double/fuzzy vision, sensitivity to light or
  noise, feel sluggish, dizziness
• Thinking Poor concentration, memory, trouble
  following conversation, fogginess, confusion
• Emotions irritable, more emotional, sadness

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Do you need to lose consciousness with a
concussion?

• NO!
• You may or may not have a loss of consciousness
• Only a small do (approx 10)!
• Can happen even if you havent been knocked out.
• Can be serious even if youve just been dinged
  or had your bell rung.

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Incidence

• Traumatic brain injury (TBI) is among the most
  common injuries in children
• Annually, more than one million children sustain
  a TBI 80-90 mild
• Concussion Mild TBI
• Estimated 300,000 sports-related concussions per
  year (likely an underestimate by 3-8x)

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How do you know if a player has had a Concussion?

• After a blow, something seems different.
• You might notice some symptoms right away
  (confusion, loss of balance, fogginess, memory).
• Player is not following the game or the plays.
• BUT - Other symptoms may take hours, days, or
  weeks (headache, irritability, poor
  concentration).
• Later on, difficulties with schoolwork,
• completing everyday tasks, irritability.

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What Parents/ Coaches/ Teammates See (Signs)

• Appears dazed, stunned, glassy
• Confused about tasks, game assignment
• Forgetful, repeating same questions
• Unsure of game, score, opponent
• Moves clumsily
• Answers questions slowly
• Shows behavior or personality changes
• Cant recall events before hit or after hit
• Loses consciousness

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Symptoms The Player May Report

• Headache
• Nausea
• Balance problems, dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish or slowed down
• Feeling foggy or groggy
• Concentration or memory problems
• Confusion

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What to do if your player has a Concussion

• Initial Assessment - Do NOT ignore a blow or jolt
  to the head. Observe the player for signs and
  symptoms.
• If a Concussion is suspected, implement the
  ACTION PLAN.
• When in doubt, sit them out.

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Basic Assessment

• Observe player for signs symptoms
• Check Concussion Card or clipboard
• Questions to Ask
• Score of game, Who playing, Last Play, Current
  Period
• What happened right before hit
• What happened right after hit
• Symptom list (card/ clipboard)
• Questions Not to Ask (not useful)
• Name of self or others
• Day, date, time, where they are (orientation)
• How many fingers

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ACTION PLAN

• Do NOT allow the player to play with symptoms.
• Remove the player from the game/ practice.
• Inform the parents.
• Encourage a medical checkup. Obtain a proper
  evaluation by sports concussion expert.
• Allow return to play only with permission from an
  appropriate health care professional.

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What if I Have Questions about a possible
Concussion?

• If Coach, Parent, or Player has any question
• Call the SCORE Information Hotline to discuss
  with a Concussion consultant
• SCORE Hotline [phone]
• SCORE Hotline Hours
• Mon-Fri 8am-9pm
• Sat-Sun 10am-9pm

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Treatment of a Concussion

• Give yourself time to recover. REST!
• Your brain needs to heal.
• If not healed, your brain is more likely to be
  injured again - and worse.
• Recovery can take several days or weeks.
• Manage physicial (e.g., running, weightlifting)
  and cognitive (e.g., schoolwork, homework)
  exertion

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What could happen if nothing is done?

• Player is more likely to be re-injured.
• Second/ third... injuries
• are more likely to be more severe
• could cause permanent brain damage
• can take longer to recover from.
• The player is put in greater danger.
• The player is not helping their team or
  teammates.
• Teammates must help their fellow teammates!

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After a Concussion, When Can the Player Return to
Play?

• No longer have symptoms
• No longer need medicine to control symptoms.
• Cognitive/ thinking skills back to normal.
• Cleared by medical professional.

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After a ConcussionGradual Return to Play Protocol

• After rest and gradual activity (exertion)
• Light aerobic exercise such as walking or
  stationary cycling.
• Sport specific training.
• Non-contact training drills.
• Full contact training.
• Game play.

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How Can Concussions be Prevented?

• Follow the sports safety rules (especially
  checking, rough play).
• Good sportsmanship.
• Use proper equipment.
• Right equipment for the sport and position.
• Use equipment properly.
• Properly fitted.
• Use it every time you play.
• Do not ignore a blow or jolt to the head.

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Key Ending Points

• Know what a concussion is and its symptoms.
• Dings and bell-ringers count!
• 3 types of symptoms physical, thinking,
  emotional
• Dont Ignore. Observe the players, tell parents.
• Encourage teammates to watch out for their
  friends.
• When in doubt, consult with SCORE.
• Give TIME to recover. REST!
• Follow the sports rules safely.
• Use the equipment properly.
• Play Hard! Play Safe! Play Smart!

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Its better to miss a game or two than the whole
season or a career!
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Four-Part Concussion Education and Management
Program

1. Education Increase knowledge of signs, symptoms,
   and risks associated with concussion
2. Baseline Establish pre-season baseline levels of
   concussion symptoms
3. Early ID of concussion Promote effective, early
   identification of concussions
4. Return to play Implement safe return-to-play
   (RTP) protocol

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Pre-Season Symptom Baseline

• Assess presence of any symptoms prior to any
  injury
• Allows for comparison following an injury
• Identify number and degree of symptoms
• After an injury, symptoms are monitored until
  return to pre-injury levels
• Assist in guiding a safe return to play

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Pre-Season Symptom Baseline

• With parental permission, complete baseline
  assessment by both parent and athlete
• Copies of baseline assessments collected by SCORE
  staff will be returned to parents for their
  records
• Letter to pediatrician indicating that baseline
  has been completed, should a concussion occur

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0 Not a problem 2 Moderate problem 4 Severe
problem
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Four-Part Concussion Education and Management
Program

1. Education Increase knowledge of signs, symptoms,
   and risks associated with concussion
2. Baseline Establish pre-season baseline levels of
   concussion symptoms
3. Early ID of concussion Promote effective, early
   identification of concussions
4. Return to play Implement safe return-to-play
   (RTP) protocol

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Concussion Identification and Return to Play

• Implement the ACTION PLAN
• Should an injury occur, SCORE staff can provide
  consultation and evaluation, in collaboration
  with athletes physician
• Return to Play Ideally, conducted by certified
  athletic trainer.

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Safe Concussion Outcome, Recovery, and Education
(SCORE) Program

• Staff includes neuropsychologists, sports
  medicine physician, and athletic trainer
• Symptom monitoring and concussion-specific
  neuropsychological testing
• Computerized testing (ImPACT) assessing
  attention, memory, and processing speed/ reaction
  time

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Safe Concussion Outcome, Recovery, and Education
(SCORE) Program

• Provide consultation to coaches and trainers
  regarding safe return to play
• Provide consultation to schools regarding
  academic issues

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SCORE Hotline

• If Coach, Parent, or Player has any question
• Call the SCORE Hotline to discuss with a
  Concussion consultant
• SCORE Hotline [phone]
• SCORE Hotline Hours
• Mon-Fri 8am-9pm
• Sat-Sun 10am-9pm