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Agnesian HealthCare Know & Go Showcase: Concussions
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Agnesian HealthCare Know & Go Showcase: Concussions

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Agnesian HealthCare athletic trainers and physicians discuss the trending topic of concussions.

Agnesian HealthCare athletic trainers and physicians discuss the trending topic of concussions.

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  • 1. CONCUSSIONS: From Injury to Return to Play A Look at Concussions & How to Treat Them Tyler Schwarz, LAT Agnesian HealthCare Sports, Spine & Work Center Lisa Weber, MD Fond du Lac Regional Clinic Family Medicine Know & Go Friday. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  • 2. Objectives 1. What is a Concussion? What is actually happening in the brain? 2. How to Treat a Concussion 1. Zurich Conference 2012 2. Wisconsin state law 3. Agnesian HealthCare process 3. Neurocognitive Testing 1. What is neurocognitive testing? 2. Different programs (ImPACT, etc.) 3. Sample test 4. How to read an ImPACT test 5. How to use ImPACT in treatment plan
  • 3. What is a Concussion? “A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or blow to the body that causes the head and brain to move quickly back and forth.” - Center for Disease Control and Prevention
  • 4. What is a Concussion – contd. • A concussion typically results in the rapid onset of short-lived impairment that resolves over time • Can be caused from a minor hit or blow; does not have to involve a big hit • Is a multi-symptom injury that varies from person to person • Is actually a metabolic/chemical imbalance or dysfunction within the brain, not a bruise • Children take longer to heal because their brain is still developing
  • 5. Causes • Two Main Causes – Deceleration (linear) • Brain moves forward in skull • Frontal lobes strike inside of skull (contusion) • Rebound (contre-coup) injury to occipital lobe – Rotational • Brain rotates on axis causing stretching/tearing of axons • Stretching/tearing of blood vessels results in hematoma • Brain strikes skull causing contusion • Three ways these occur
  • 6. Direct blow to the head
  • 7. Impact from head hitting the ground or other surface
  • 8. Whiplash effect; head snapping or changing direction quickly
  • 9. What’s Happening In the Brain? Normal Function
  • 10. What’s Happening In the Brain? During Injury
  • 11. What’s Happening In the Brain? During Injury
  • 12. What’s Happening In the Brain? Following Injury
  • 13. How To Treat a Concussion Zurich 2012 - 4th International Conference Consensus Statement on Concussion in Sport • Player should be evaluated by a physician or other licensed healthcare provider. If no healthcare provider available, player should be safely removed from practice or play, and an urgent referral should be arranged. • Assessment of a concussion should be made using the SCAT 3 or other sideline assessment tool.
  • 14. How To Treat a Concussion – contd. • A player diagnosed with a concussion should not return to play on the day of injury. • Key to concussion management is physical and mental rest until the acute symptoms resolve, and then a graded program of exertion prior to medical clearance and RTP. • Neuropsychological testing in concussion has been shown to be of clinical value and contributes significant information in concussion evaluation.
  • 15. How To Treat a Concussion… Wisconsin State Law • Signed on April 2, 2012 • Requires all youth athletic organizations to educate coaches, student athletes and parents on the risks of concussions, and prohibits participation in a youth activity until a parent or guardian has returned a signed information sheet indicating that they have reviewed the materials.
  • 16. How To Treat a Concussion… Wisconsin State Law • Law states, “An athletic coach or official involved in a youth athletic activity or healthcare provider, shall remove a person from the youth athletic activity if the coach, official or healthcare provider determines that the person exhibits signs, symptoms or behavior consistent with a concussion or head injury or is suspected of sustaining a concussion or head injury.”
  • 17. How To Treat a Concussion… Wisconsin State Law • The law also states, “A person who has been removed from a youth athletic activity may not participate in a youth athletic activity until he or she is evaluated by a healthcare provider, and receives a written clearance to participate in the activity from the healthcare provider.”
  • 18. How to Treat a Concussion… The Agnesian HealthCare Way • Athlete gets hit on the head during football game on Friday night • Athletic trainer performs SCAT 2 sideline exam and determines that athlete has a concussion • Athlete is removed from competition • During or after the game, the athlete and parents are informed of what to watch for and what to do
  • 19. How to Treat a Concussion… The Agnesian HealthCare Way • Athlete is scheduled for first available ImPACT post-injury test • Athlete shows up at Sports, Spine & Work Center and takes ImPACT test • After test athlete meets with healthcare provider
  • 20. How to Treat a Concussion… The Agnesian HealthCare Way • Provider performs physical exam – Checks balance, coordination, cranial nerves, etc. – Gets information on how injury occurred, type of student they are and number of concussions, etc. • Provider goes over ImPACT test and physical exam with athlete and parent
  • 21. How to Treat a Concussion… The Agnesian HealthCare Way • One of two things happens: – Athlete passes ImPACT test and physical exam and is cleared to start return-to-activity process (includes exertion test) – Athlete does not pass ImPACT test and/or physical exam • Provider places restrictions on athlete – i.e., no school, half days of school, no test taking, reduced homework, no PE, no computer use, no texting or video games, no driving
  • 22. How to Treat a Concussion… The Agnesian HealthCare Way • Athlete is turned back over to athletic trainer for monitoring • When athlete is symptom free: – Performs exertion test • Exercise test that stresses the brain to help determine if it is ready to take physical activity – Includes aerobic exercise, sprinting, cutting, jumping, balance test and lifting – If athlete passes, he/she will retake ImPACT test and see healthcare provider
  • 23. How to Treat a Concussion… The Agnesian HealthCare Way • If athlete passes second ImPACT post-injury test, they are cleared to start return-to-activity process • If athlete does not pass second ImPACT post-injury test: – Provider may modify restrictions – Provider may decided to prescribe medication or physical therapy • Athlete then follows same process as before until he/she passes ImPACT test and physical exam
  • 24. How to Treat a Concussion… The Agnesian HealthCare Way • Non-athletes follow same process: – Referred by another provider or emergency department – Still get restrictions, but are not monitored by athletic trainer – Usually scheduled to come back and see provider in one to two weeks
  • 25. Neurocognitive Testing • What is It? – A battery of tests that test the cognitive function of different parts of the brain – Computer based – Used to help determine if brain function is impaired after a TBI – Typically involves both a baseline test and a post- injury test is compared to it – Can be used without a baseline test • Without a baseline, compare test to national norms
  • 26. Available Programs • Cogsport • Headminders (CRI) • ANAM • CNS Vital Signs • ImPACT
  • 27. What is ImPACT? • Innovative program for evaluating and treating head injuries • Is the first, most-widely used and most scientifically validated computerized concussion evaluation system • Obtains objective data that measures how the brain is functioning and does not rely solely on how the athlete is feeling • 30 minute, game-like, on-line neurological exam
  • 28. What is ImPACT? – contd. • Measures six different functions of the brain: – Attention span, working memory, sustained & selective attention time, response variability, non-verbal problem solving and reaction time • Has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages, but is not the only tool used in concussion management
  • 29. What is ImPACT? – contd. • Used by: – All NFL, NHL, MLB and MLS teams – US Army and Navy – More than 1,000 colleges and universities, including University of Wisconsin – More than 3,000 high schools – Even WWE and Cirque de Soleil
  • 30. Why Are We Using ImPACT? • Agnesian HealthCare wants to provide the best care possible to make sure that our athletes can compete safely • ImPACT helps achieve that with head injuries (pre-season physical of the brain) • Provides visual/objective data to show how and at what level the brain is functioning • Does not rely on subjective observations or athletes self-reports to diagnose and track a concussion
  • 31. Sample Test www.impacttestonline.com/impacttestdemo
  • 32. Questions?