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Concussions In Football

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  • 1. Concussions in Football
    Jeffrey Kachmann, MD
    James Keszei
  • 2. Topics Covered
    What is a Concussion;
    Symptoms/Signs of a Concussion;
    Research on Long Term Effects of Concussions;
    Second Impact Syndrome (video);
    How to Deal with Concussions, When in Doubt, Sit it Out (video);
    Athlete Responsibilities.
    Return To Play Guidelines
    Discussion/Questions/Comments (VIDEO)
  • 3. What is a Concussion?
    A concussion is caused when there is a jarring or shaking that causes a a rapid onset of brief disruption of brain function. Research has indicated that concussions of youth brains can occur at much higher rate as compared to fully developed adult brains. It is VERY important to realize that it DOES NOT require a blow to the head to cause a concussion! Any acceleration/deceleration or twisting/rotational injury to the body can transmit to the brain. It is a GLOBAL brain injury. Concussions cause real injury to brain tissue.
    Youth brains react differently, more unpredictably when concussed, which
    is one of the main reasons why it is so important to recognize signs of concussions and
    have the athlete sit out until symptom free, while at rest and during exertion. Rotational forces result in more brain injury than blunt trauma.
  • 4. Initial Evaluation
    The suspected head injured athlete exam should always begin with basic life support-ONFIELD-particularly with a loss of consciousness-LOC, neurologic symptoms, or spinal pain
    Airway-check the airway and note obstructions
    Breathing- breathing rate and pattern, skin/nailbedcolor
    Circulation-pulse rate and rhythm, nailbedcolor
    Spine-palpate the entire spine for tenderness or irregularities
    LOC/Concussion evaluation
  • 5. Symptoms of a Concussion
    The Center for Disease Control (CDC) has provided the following signs and symptoms of a concussion:
    OBSERVATIONS OF COACHES, PARENTS, ATHLETIC TRAINERS
    Appears dazed and stunned;
    Is confused about assignment or position;
    Forgets instructions;
    Is unsure of game, score or opponent;
    Moves clumsily;
    Answers questions slowly;
    Loses consciousness (even briefly);
    Shows behavior or personality changes;
    Can’t recall events prior to hit or fall;
    Can’t recall events after a hit or fall.
    “WHEN IN DOUBT, SIT ‘EM OUT”
  • 6. SYMPTOMS REPORTED BY ATHLETE
    Headache or “pressure” in head
    Nausea and/or vomiting
    Balance problems or dizziness
    Double or blurred vision
    Sensitivity to light
    Sensitivity to noise or ringing in ears
    Feeling sluggish, hazy, foggy or groggy
    Concentration or memory problems
    Confusion
    Does not “feel right”
    Neck Pain
    More irritable or emotional
    “WHEN IN DOUBT, SIT ‘EM OUT!”
  • 7. WHAT SHOULD I DO??Any athlete suspected of having a concussion must be removed from play and evaluated by a trained professional knowledgeable about concussions:Trainer/TherapistNurse/NP/PADocHave someone reliable frequently observe and assess the child for at least 24-72 hours or until all signs and symptoms resolveMake sure you have a SCAT card available
  • 8. THE SCAT CARD
    Name: ___________________________ Date __________
    Sport/Team: _______________________ Mouth guard? YN
    1) SIGNS
    Was there loss of consciousness or unresponsiveness? Y N
    Was there seizure or convulsive activity? Y N
    Was there a balance problem / unsteadiness? Y N
    2) MEMORY
    Modified Maddocks questions (check correct)
    At what venue are we? __; Which half is it? __; Who scored last?__
    What team did we play last? __; Did we win last game? __?
    3) SYMPTOM SCORE
    Total number of positive symptoms (from reverse side of the card) = ______
  • 9. SCAT CARD, COT’D
    4) COGNITIVE ASSESSMENT
    5 word recall Immediate Delayed
    (Examples) (after concentration tasks)
    Word 1 _____________ cat ___ ___
    Word 2_____________ pen ___ ___
    Word 3 _____________ shoe ___ ___
    Word 4 _____________ book ___ ___
    Word 5 _____________ car ___ ___
    Months in reverse order:
    Jun-May-Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sep-Aug-Jul (circle incorrect)
    or
    Digits backwards (check correct)
    5-2-8 3-9-1 ______
    6-2-9-4 4-3-7-1 ______
    8-3-2-7-9 1-4-9-3-6 ______
    7-3-9-1-4-2 5-1-8-4-6-8 ______
    Ask delayed 5-word recall now
  • 10. SCAT CARD, COT’D
    5) NEUROLOGIC SCREENING
    Pass Fail
    Speech ___ ___
    Eye Motion and Pupils ___ ___
    Pronator Drift ___ ___
    Gait Assessment ___ ___
    Any neurologic screening abnormality necessitates formal neurological evaluation by a trained professional
  • 11. Concussion Treatment
    First recognize the concussion by onfield, sideline, or ER eval
    Close observation 24-72 hours minimum—check pupil size , consciousness, movements, ability to think and function
    Follow RTP-Return To Play- guidelines strictly
    Rest--Non stimulating environment for a week or until all symptoms cease-NO TV, IPOD, Video Games, Reading, Computers, Loud Noise, Bright Lights
    Tylenol as needed
    No alcohol or illicit drugs
    Frequent evaluations by trainer, medical professional
    One percent require emergent surgeries
    Take to the hospital if ever in doubt!
  • 12. Send your player to the Hospital if:
    Headaches worsen
    Too drowsy to wake up
    Can’t Recognize people or places or very confused
    Repetitive vomiting—more than once!
    Seizures
    Extremity or facial numbness, tingling, pain or weakness
    Slurred speech
    Unsteady walk
    Dilated Pupils or unequal gaze
    Irregular, slow, or very fast pulse or breathing
    Any obvious injuries
    LOC (loss of consciousness) more than 5 minutes
  • 13. Head Injuries can cause structural injury in and around the brain
    NEVER forget that a seemingly simple hit resulting in a concussion can cause a:
    skull fracture
    epi or subdural hematoma (blood clot on the outside or inside of the lining around the brain)
    post traumatic subarachnoid hemorrhage (salt n pepper bleeding on the brain surface)
    intracerebral hemorrhage (bleeding inside the brain-petecchial or larger clot)
    brain contusion (bruise)
    axonal shearing injury (nerve fiber or coating injury)
    Brainstem injury
    Malignant out of control brain swelling resulting in death or disability
    Spinal injury (VIDEO)
  • 14. SECOND IMPACT SYNDROME
    One of the worst scenarios involving concussions occurs when a youth athlete is concussed during an event, returns to play, and receives a second concussion on top of the existing concussion. In this scenario, and athlete can suffer a traumatic brain injury that can debilitate the youth athlete for the rest of their life, or even result in their death. Particularly in children, a concussion can result in loss of autoregulation of brain blood flow with a rush of blood into the brain blood vessels causing very rapid brain swelling and herniation through the skull and instant death or severe debilty. I have personally witnessed this and it is very scary!
    WHEN IN DOUBT, SIT ‘EM OUT!
  • 15. Brain Vulnerability After a Concussion
    The brain is VERY vulnerable to further injury after a concussion for minutes to days
    Large numbers of neurons (nerve cells) can die as a result of even small changes in intracranial (inside the head) pressure, blood flow, and anoxia (lack of oxygen—always remember the ABC’s of resuscitation!!!) after a concussion
    REMEMBER, CONCUSSIONS ARE VERY GROSSLY UNDERDIAGNOSED—UP TO 88% ARE UNRECOGNIZED!!!
  • 16. REPEATS
    Athletes involved in a concussion are far more vulnerable to further concussions
    (VIDEO)
  • 17. Research on Long Term Effects of Concussions
    New research regarding the long term effects of repeated concussions can cause some athletes to suffer the progressive neurodegenerative brain disease Chronic Traumatic Encephalopathy (CTE), which eventually leads to dementia.
    An estimated 10% to 20% of all athletes participating in contact sports suffer a concussion each season. Most athletes recover completely and can return to play following an appropriate period of recovery. Realize that cumulative concussions injure the brain permanently and cause long term effects now and later in life.
  • 18. CTE
    Healthy >
    CTE >
  • 19. Long Term effects from Concussions
    Memory loss
    Cognitive disorders (problems thinking through things)
    Dementia
    Depression
    Anxiety
    PTSD-Post Traumatic Stress Disorder
    Substance abuse
    Poor Physical Performance
    Lack of energy or enthusiasm
    Irritabilty
    Headaches
    Dizziness
    Insomnia
    Tremors/Parkinsonism—Muhammad Ali
  • 20. OUCH!
  • 21. How to Deal With a Suspected Concussion
    The most important thing to remember when dealing with an athlete with a
    suspected concussion is to air on the side of caution. It is not worth the potential
    long term health problems, or traumatic brain injury, to rush an athlete back into
    a game or practice situation, prior to being symptom free at rest and during exertion.
    *****WHEN IN DOUBT, SIT THEM OUT*****
    Review your league’s concussion policy to ensure the safety of the players is the
    number one priority.
    Return to play policy. Many leagues, to include Youth, Middle School, and High
    School programs do NOT have a return to play policy, which could result in
    catastrophic injury coupled with legal action.
  • 22. Athlete Responsibilities
    As Coaches you must let athletes know they will not be looked down upon
    or treated unfairly if they report a concussion. Athletes must feel confident
    they can report symptoms of a concussion without Coaches punishing them
    for not “Toughing it Out”. Most Athletes are very competitive, however, they are
    responsible for reporting symptoms and need to understand the potential
    long term negative effects of not reporting concussions.
  • 23. www.sportslegacy.org
    Minimum Recommended Guidelines
    As a natural evolution of the 10 Point Plan, in September 2010, SLI announced the release of 7 Steps for Brain Safety: Minimum Recommended Guidelines for Youth Sports, a list of practical, simple, and free solutions to minimize brain trauma.
    On the following pages, you will find a link to recommended programs, as well as links to supplemental programs. Programs should adopt at least the recommended program.
    If you received a paper version of the 7 Steps, visit www.sportslegacy.org to locate the links.
    SLI’s 7 Steps for Brain Safety
    1. Preseason Education for Coaches
    2. Preseason Education for Athletes
    3. Preseason Education for Parents
    4. Coaches Use CDC’s Heads Up Clipboard Sticker
    5. Adopt CDC’s Concussion Action Plan for Removal
    and Return-to-Play
    6. Prevention through Neck Strengthening
    7. Prevention through Overall Brain Trauma Reduction
  • 24. Concussion Return To Play Guidelines
    SYMPTOMS GRADE 1ST 2ND3RD
    ***RTP time begins after completely asymptomatic
    <15 MIN/NO PTA* 1 RTP OK 20 min RTP in 2 wk End season/OK next yr
    PTA<30MIN/NO LOC**1 RTP 1 week RTP 3-4wks End season/OK next yr
    PTA>30MIN<24HR/LOC<5MIN
    2 RTP 1 week RTP 1 mo or End season/OK next yr
    end season
    *PTA=post trauma amnesia **LOC=loss of consciousness ***RTP=return to play
  • 25. Concussion RTP Guidelines, Cont’d
    SYMPTOMS GRADE 1ST 2ND3Rd
    PTA>24HR/LOC>5MIN3 RTP 4-6MO END SEASON
    OR END SEASON
    **STRONGLY CONSIDER TRANSPORT TO HOSPITAL ER FOR EVAL W GRADE 3 CONCUSSIONS**
  • 26. Graduated Return to Play
    **Athlete MUST be asymptomatic at REST and after EXERTION
    No activity for ONE WEEK after injury and asymptomatic
    Cleared to return by trainer/medical professional
    Component scores of ImPact test normal
    Gradual daily increase in activity as follows unless symptoms recur—if they recur wait 24 hrs and start progressions from day one again:
    Light aerobic exercise—walk/slow jog/stationary bike, etc—no resistance training
    Sport specific activity—throwing/kicking a ball, etc
    Non contact training drills with resistance training
    Full contact training drills
    Return to sport without restriction
  • 27. REMEMBER
    Always use certified headgear in practice and game play
    Make extra sure it fits and is secure
    Check air bladders and padding each and every time of use
    Use properly fitting mouthpieces at all times
    Use IMPACT or equivalent testing
    Use a SPECT card or equivalent sideline test
    WHEN IN DOUBT SIT ‘EM OUT!
  • 28. DiscussionQuestionsComments

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