Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
315
On Slideshare
315
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
2
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Developing a
    Concussion
    Management
    Program
    Bill Borowski MBA;ATC;LAT;LPTA
    411 N Washington Suite 4000
    Dallas TX 75246
    billbor@baylorhealth.edu
  • 2. CONCUSSION
    Concussion (cerbrumcommotum) “shaking of the brain”
    Acute metabolic dysfunction due to post-traumatic hyperglycolysis and decreased cerebral blood flow.
    MTBI –Mild Traumatic Brain Injury
    Confusion and amnesia are the hallmarks of concussion (recovery)
  • 3. IMPORTANT DOCUMENTS
    1. “Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004 (Prague Statement)
    2. National Athletic Trainers’ Association Position Statement of Sport-Related Concussion (NATA Statement)
    3. http://www.nocsae.org/about/history.html
    4. CDC’s Toolkit (free) www.cdc.gov/ConcussionInYouthSports
  • 4. ASESSMENT AND EVALUATION
  • 5. CLINICAL HISTORY
    Concussion assessment about history of previous head injuries
  • 6. RECOGNITION OF A CONCUSSION
    Cognitive Impairment (altered or decreased cognitive function)
  • 7. SIDELINE ASSESSMENT
    Orientation, anterograde and retrograde amnesia, concentration, memory
    Maddocks’ Questions
  • 8. SIDELINE ASSESSMENT
    Standardized Assessment of Concussion (SAC) (Quantitative)
    Also assesses strength, coordination, sensation, and the presence of amnesia
    r. Michael McCea and colleagues (1998)
    AAN/1991 Colorado Guidelines
  • 9. SIDELINE ASSESSMENT OF CONCUSSION (SAC)
  • 10. SIDELINE ASSESSMENT
    **See Handout
    McGill Sport medicine Clinic-Montreal, Quebec Canada
  • 11. BALANCE/VESTIBULAR
    *A postural stability study revealed that concussed athletes showed significant decrements
    in measures of composite balance and the vestibular ratio from a sensory organization test
    *McCrea et al. [21] found balance scores to be significantly lower in concussed subjects
    when compared with controls as well.
  • 12. MANAGEMENT AND REFERAL
  • 13. RECOMMENDATIONS
    Dr. Lee is a pediatrician with Pediatric Healthcare Associates in Southport, Connecticut specializing in adolescent and sports medicine. He is a charter member of AMSSM and Medical Director of the Student Health Center at Fairfield University
  • 14. LATER SIGNS OF CONCUSSION:
    Post-Concussion Syndrome
    • Decreased Processing Speed
    • 15. Short-Term Memory Impairment
    • 16. Concentration Deficit
    • 17. Irritability/Depression
    • 18. Fatigue/Sleep Disturbance
    • 19. General Feeling of “Fogginess”
    • 20. Academic Difficulties
  • Neuroimaging Techniques
    STRUCTURAL:
    CT Scans, MRI
    Good for ruling out brain bleeds or emergency situations (e.g.-scull fractures etc). Usually normal with most concussions
    FUNCTIONAL: (Metabolic)
    Position Emission Tomography (PET) –glucose utilization Single Proton Emission Computed Tomography (SPECT) – Blood flow to brain
    Measures brain activity (fMRI)-oxygen utilization
    Functional testing not used widely due to expense, lack of availability, and research status of some tests.
    ***Functional Testing : Will likely be the way of the future for concussion assessment
  • 21. Neuropsychological Testing
    Neurocognitive Tests –Indirect measures of brain functioning via paper and pencil, Q&A or computer-based tests.
    SPORT CONCUSSION:
  • 22. Return to Play
  • 23. Clinical Presentations and Concerns
  • 24. SCHOOL CONSIDERATIONS
  • 25. DOCUMENTATION
  • 26. IMPACT TESTING
    ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing)
    Developed in the early 1990's (Drs. Mark Lovell and Joseph Maroon)
    20-minute test that is a standard tool used in comprehensive clinical management of concussions for athletes of all ages.
    Allows management concussions on an individualized basis (baseline testing and/or post-injury neurocognitive testing)
    Objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion.
    ImPACT can be administered by an athletic trainer, school nurse, athletic director, team coach, team doctor, or anyone trained to administer baseline testing.
  • 27. 22
    Module 1 (Word Discrimination)
     Evaluates attentional processes/verbal recognition memory
     Utilizes a word discrimination paradigm.
     Twelve target words are presented for 750 milliseconds (twice to facilitate learning of the list)
     The subject is then tested for recall via the presentation of the 24-word list that is: comprised of 12 target words and 12 non-target words
     Words chosen from the same semantic category as the target word.
     EX: the word “ice” is a target word, while the word “snow” represents the non-target word.
     The subject responds by mouse-clicking the “yes” or “no” buttons
     Individual scores are provided both for correct “yes” and “no” responses -In addition, a total percent correct score is provided.
     There are five different forms of the word list.
    Delay Condition: Following the
    administration of all other test
    modules (approximately
    20 minutes), the subject is
    again tested for recall via the
    same method described above.
    The same scores that are
    described above are provided
    for the delay condition.
  • 28. 23
    Module 2 (Design Memory)
    • Evaluates attentional processes and visual recognition memory
    • 29. Utilizes a design discrimination paradigm.
    • 30. Twelve target designs are presented for 750 milliseconds (twice to facilitate learning)
    • 31. The subject is then tested for recall via the presentation of the 24-designs
    comprised of 12 target
    designs and 12 non-target
    designs
    • EX: target designs that
    have been rotated in space
    • The subject responds by
    mouse-clicking the “yes” or
    “no” buttons
    • Individual scores are
    provided both for correct
    “yes” and “no” responses
    • In addition, a total
    percent correct score is
    provided
    • There are five different forms of this task
  • 24
    Module 3 (X’s and O’s)
    • Measures visual working memory, visual processing speed, and visual memory paradigm
    • 32. Encorporates a distractor task.
    • 33. The subject can practice the distractor task prior to presentation of the memory task
    • 34. The distractor is a choice reaction time test: the subject is asked to click the left mouse button if a blue square is presented and the right mouse button if a red circle is presented.
    • 35. Once the subject has completed this task, the memory task is presented.
    • 36. Memory task: a random assortment of X’s and O’s is displayed for 1.5 seconds
    • 37. For each trial: three of the X’s or O’s are illuminated in YELLOW (the subject has to remember the location of the illuminated objects).
    • 38. Immediately after the presentation
    of the 3 X’s or O’s, the distractor task
    re-appears on the screen.
    • Following the distractor task, the
    memory screen (X’s and O’s)
    re-appears and the subject is asked
    to click on the previously illuminated
    X’s and O’s.
     Scores are provided for correct
    identification of the X’s and O’s
    (memory), reaction time for the
    distractor task, and number of
    errors on the distractor task.
    • For each administration of ImPACT, the subject completes 4 trials.
  • 25
    Module 4 (Symbol Matching)
    • Evaluates visual processing speed, learning and memory
    • 39. Initially, the subject is presented with a screen that displays 9 common symbols (triangle, square, arrow, etc).
    • 40. Directly under each symbol is a number button from 1 to 9
    • 41. .Below this grid, a symbol is presented.
    The subject is required to click the matching
    number as quickly as possible and to
    remember the symbol/number pairings
    Correct performance is reinforced
    through the illumination of a correctly
    clicked number in GREEN. Incorrect
    performance illuminates the
    number button in RED.
    Following the completion
    of 27 trials, the symbols disappear
    from the top grid.
    The symbols again appear below the
    grid and the subject is asked to recall
    the correct symbol/number pairing by
    clicking the appropriate number button.
    • This module provides an average reaction time score and a score for the
    memory condition.
  • 42. 26
    Module 5 (Color Match)
     Represents a choice reaction time task and measures impulse control/response inhibition
    • First, the subject is required to respond by clicking a red, blue or green button as they are presented on the screen. This procedure is completed to assure that subsequent trials would not be affected by color blindness
    • 43. Next, a word is displayed on the screen in the same colored ink as the word (e.g. RED), or in a different colored ink (GREEN orBLUE)
    • 44. The subject is
    instructed to click
    in the box as
    quickly as
    possible only
    if the word is
    presented in the
    matching ink.
    In addition to
    providing a
    reaction time
    score, this task
    also provides
    an error score.
  • 45. QUESTIONS?
    Bill Borowski
    Baylor SportsCare
    411 N Washington Ste 4000
    Dallas TX 75246
    214-820-7333
    billbor@baylorhealth.edu
    Tortilla man