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Concussion in the Adolescent Athlete

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  • 1. Concussion in the Adolescent Athlete Jordan D. Metzl, MD, FAAP Co-Founder, The Sports Medicine Institute for Young Athletes Sports Medicine Service, Hospital for Special Surgery www.DrJordanMetzl.com [email_address]
  • 2.
    • HSS educational activities are carried out in a manner that serves the educational component of our Mission.
    • As faculty we are committed to providing transparency in any/all external relationships prior to giving an academic presentation.
    • Jordan D. Metzl, MD
    • Hospital for Special Surgery
    • I Do Not have a financial relationship with any commercial interest.
  • 3. Case History #1
    • 14 year old soccer player comes into the office
    • “ Hit in the Head” during game
    • 2 days after injury
    • Headache
  • 4. Concussion
    • A complex pathophysiological process affecting the brain brought on by biomechanical forces (Prague, 2004)
    • 300,000 yearly head injuries due to sports in US (reported)
    • Spectrum of injury
  • 5. Newton’s Laws
    • Impact 1/64 to 1/125 of a second
    • Linear
    • Rotational
    • Newton’s law:
      • F = m x a
      • F = m x v/t
  • 6. Classification of Concussion
    • Role of health provider
      • On site
      • In office
    • 23 grading scales
    • Return to activity guidelines
    • Future?
  • 7. Important Questions When Evaluating a Concussion
    • Post concussive symptoms
    • Previous history of concussion
    • Age of athlete
    • Level of athlete
    • Risk vs reward
  • 8. Post-concussive Symptoms
    • Headache
    • Irritability
    • Sleeplessness
    • Dizziness
    • Anxiety
  • 9. Back to Activity?
    • Neuropsychological Testing
      • IMPACT , CogSport
      • Orientation
      • Concentration
        • months backward
      • Memory (3 item recall)
        • 1 minute
        • 5 minutes
    • Second Impact Syndrome (SIS)
  • 10. Neurocognitive Testing
    • 1980’s- UVA- use of neuropsych testing for predictor to return to activity (Barth)
    • NFL, NHL, 1990’s, baseline neuropsych testing
    • Computerized neuropsych testing, 2003
    • ImPACT, Cogstate, others
    • Speed, efficacy, cost
  • 11. IMPACT Test Results
    • Word Memory
    • Design Memory
    • Symbol Matching
    • Total Score – Compared to baseline
  • 12. Rational for Neuropsych Testing: Adolescents
    • Purpose: To assess the clinical relevance of headache after concussive episode
    • Design: 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches.
    • Similar grades of concussion were compared to each other.
  • 13. Rational for Neuropsych Testing: Adolescents
    • Results: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time during neurocognitive composite scores.
    • These athletes were more likely to demonstrate amnesia
    • Conclusion: Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate.
    • Collins et al, AJSM, 2003
  • 14. Effect of Growth and Maturation
    • High school aged children (14-18) may have prolonged cognitive recovery when compared with young adults (18-25 years), although symptom recovery is equivalent
      • Field 2003
    • No information available for younger children
  • 15. Mouthguards?
  • 16. Take Home Points: Concussion
    • “Concussive Predisposition”
    • Identifying at risk athletes
    • Right sport for right athlete?
    • IMPACT testing?