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Community Concussion Presentation

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Community Concussion Presentation

  1. 1. By Jon Basile, Courtney Churchill, Josh Leigh, & Cody Small The Ins and Outs of Sports Related Concussions in Middle/High School Athletes
  2. 2. Test Your Concussion Knowledge True or False: 1. A concussion generally isn’t considered severe unless the athlete loses consciousness or “blacks out.” 2. Properly fitting helmets and mouthguards prevent concussions in children. 3. Adolescent boys are more likely than adolescent girls to sustain a concussion. 4. A sideline assessment test, in which a coach or athletic trainer asks the injured athlete a series of questions immediately following injury, can help determine the severity of a concussion. 5. If a child no longer has any symptoms 24 hours after sustaining a mild concussion, it’s safe for him or her to return to play.
  3. 3. 6. The best way to diagnose a concussion is with a CT scan or MRI. 7. Most emergency room physicians are well trained in the management and treatment of sports concussions. 8. It’s possible for children to experience headaches and difficulty concentrating in class for weeks after a hard hit or a rough tackle. 9. The “three strikes and you're out” rule, suggests that children who have three concussions should no longer be allowed to participate in school-sponsored athletics. 10. There are cases where kids diagnosed with attention deficit hyperactivity disorder (ADHD) or other learning disabilities who could actually be suffering from undiagnosed post-concussion syndrome. Moser, 2012
  4. 4. Why is this important? "If she had been given the information from a younger age all the way along, I know that she would have made a different choice," Stringer’s mother, Kathleen. Rowan Stringer was just 17 when she died on May 12, 2013. She had been tackled hard during a rugby game four days before, hitting her head and neck on the ground. A friend of Rowan’s reported that she said she had a headache, was tired and had bags under eyes, yet never told her parents or an adult. She texted her friend, “nothing would stop me unless I’m dead” she decided to play despite the undiagnosed concussion symptoms Stringer died from Second Impact Syndrome, where a pre- existing injury followed by another head blow can cause death. http://www.cbc.ca/news/canada/ottawa/rowan-stringer-ignored-concussion- symptoms-days-before-death-1.3077245
  5. 5. Objectives After this presentation the audience should understand the following: ● What a concussion is ● What causes a concussion ● Symptoms of a concussion ● The risk of having multiple concussions ● Lasting side effects of a concussion ● Management to optimize healing ● Return to play protocol
  6. 6. Concussions in Youth Sports Young athletes brains are still developing and may be more susceptible to the effects of a concussion (Halstead & Walter, 2010). ● We must understand the Youth are not indestructible ● A concussion is a form of Mild Traumatic Brain injury (mTBI) ● Club sports are just as at risk as varsity leagues! Reported concussions account for nearly 8.9% of all high school injuries ● Girls have a higher chance of concussion than boys ○ Possibly due to weaker neck musculature and/or hormonal factors ● Highest risk exists in Girls Soccer, Basketball, Rugby, Lacrosse, and Ice Hockey ● Boys have increased risk in Football, Basketball, Soccer, Lacrosse, and Hockey ● It is important to remember a concussion can happen in any sport http://www.cbc.ca/news/health/soccer-concussions-more- likely-from-contact-with-foe-than-ball-study-finds-1.3149686 Middle school prevalence is hard to assess due to lack of identification and reporting at young ages
  7. 7. What is/causes of a Concussion? Concussion can be caused by a direct (Coup) or indirect (Contre-coup) blow to the head, face, neck or torso. Results in the rapid onset of short-lived impairment of neurologic function that can resolve spontaneously, however long term disturbance may persist. A concussion can still be present even without a Loss of Consciousness (LOC) ● LOC only happens less than 10% of the time! Concussion is not detectable on imaging such as MRI or CAT-scan. 3 Grades (Post-concussion symptoms may apply to all grades) 1. Confusion and Symptoms last less than 15 minutes 2. Symptoms last more than 15 minutes still no LOC 3. LOC for seconds or minutes, symptoms >15mins https://kin450-neurophysiology.wikispaces. com/file/view/Cerebral_concussion. jpg/189385993/Cerebral_concussion.jpg
  8. 8. Common Signs and Symptom of Concussion 1. Total Body Symptoms (Somatic) ● Headache, Dizziness, ● Balance problems ● Nausea/Vomiting ● Visual Disturbances ● Sensitivity to sound 2. Mind/Brain Symptoms (Cognitive) ● Confusion ● Forgetting what happened before and after ● Passing out ● Not knowing where you are ● Feeling “Foggy”, Glossy stare ● Inability to focus ● Delayed responses ● Slurred Speech ● Trouble Falling Asleep ● Sleeping more or less than usual http://www.bigteams.com/newssite/dt.common.streams.StreamServer1.jpg 3. Mood/Emotional Symptoms (Affective) ● Changing or excessive emotions ● Irritability ● Fatigue ● Anxiety ● Sadness Concussion Symptom Checklist CDC, (2015)
  9. 9. Second Impact Syndrome ● Athlete suffers a head injury, returns to play too soon, and suffers another head injury before the 1st has healed fully ● Research shows this is prevalent in 40.5% of cases ● Results in rapid, catastrophic increase of pressure in the brain ● How can this happen? ○ Student fails to report symptoms ○ 1st head injury often overlooked or not thought to be serious ○ Student does receive medical attention after 1st injury
  10. 10. Post-Concussion Syndrome ● Headaches ● Seizures (Epilepsy) ● Sleep disturbances (too much/too little) ● Mood changes (irritability) ● Light/Noise Sensitivity ● Cognitive Deficits ● Physical Paralysis/Motor deficits ● Diminished concentration ● Attention Deficit Hyperactivity Disorder ● Anxiety or Depression Disorders
  11. 11. What if my child hit his/her head and didn’t tell me? Children do not always realize the importance to tell someone they hit their head or purposely don’t tell anyone to continue to play. If your child tells you about an injury that happened earlier, watch for obvious and more subtle changes in your child’s thinking skills, physical functioning, and emotional or behavioral responses. For example, look for changes in the way he or she plays, or whether unsteady walking, etc.
  12. 12. Try Asking These Questions: 1) Did you bump your head recently? If so, how hard? 2) Did something hit your head? 3) Have you had any balance problems or have you felt like you might fall when you walk, run or stand? 4) Have bright lights bothered you more than usual (sunlight, TV, or lights)? 5) Have loud noises bothered you more than usual? 6) Have things looked blurry? 7) Did anyone else see it happen? (Speak to them) 8) Do you feel like “something is just not right”? http://www.cstsonline.org/assets/media/documents/ParentsGuide_Concussion.pdf
  13. 13. Managing Your Child’s Concussion At Home ● Reduce and monitor exacerbations of your child’s symptoms ● Ensure rest ○ Cognitive Rest ■ Avoid electronic devices ○ Physical Rest ■ Physical activity can prolong recovery ■ Sports and leisure related activities ● Promote independence ● Allow visits with friends with limits ● Parenting strategies ● Be aware of the signs and symptoms of you child’s concussion!
  14. 14. Managing Your Child’s Concussion at School ● Cognitive Rest is Key! ● School Accommodations: ○ Temporary leave of absence from school ○ Shortening of the athletes school day ○ Reduction of workloads in school ○ Allowance of more time for homework assignments ○ Avoid standardize tests as they are not true assessments of your child’s knowledge ○ Reintegration into school should occur with no production of symptoms ○ Don’t be afraid to communicate with your school’s teachers, nurses, and administrators! ○ Sometimes teachers can underestimate the symptoms of a concussion as they are more mental rather than physical
  15. 15. Concussion Assessments
  16. 16. Baseline Assessment On the Field Sport Concussion Assessment Tool (SCAT) ● On field assessment given by a Trained Athletic Trainer (ATC), Coach, or Medical provider to detect possible concussion signs and symptoms. ● Used in both high school and professional sport to assess possible symptoms concussions. ● Includes: ○ Glasgow Coma Scale ○ Neuro Assessment ○ Maddocks score ○ Symptom Checklist ○ Memory Tests ○ Neck Examination ○ Balance ○ Coordination ○ Delayed Recall
  17. 17. Return to Play: School Standards IMPACT(Immediate Post-Concussion Assessment and Cognitive testing) Baseline Assessment Individualized to each student ● Computerized tests that allows for storage of results for future testing ● Measurement taken at beginning of season, post test score taken after injury is compared to the normative value ● Test is designed to look at cognitive function: ○ Concentration ○ Information processing ○ Visual Memory ○ Reaction time
  18. 18. How Does Physical Therapy Relate? ● Referral occurs with symptoms lasting longer than 7-10 days ● Performs a full body assessment to determine your child’s level of impairment ● Prescribe exercises that focus on: ○ Increasing tolerance to activity and returning to play ○ Balance ○ Strength ○ Vestibular Function ● Provide a safe environment for you child to exercise ● Are able to determine when your child is ready to return to play ● Can advocate for your child’s health
  19. 19. Return to Play Protocol: Physical Therapy ● Step-wise approach that determines when your child is ready to return to sports related activities ● Return to play guidelines include 6 different steps and can be completed either by your school’s athletic trainers or a licensed physical therapists ● Your child must present with no symptoms for one full day before they are allowed to go onto the next step ● IF your child does becomes symptomatic they return to the last asymptomatic phase ● When in doubt, sit them out!
  20. 20. Return to Play Protocol Continued…. Rehab Stage Functional Exercise Objectives 1. No Activity for 2 Days Symptom limited physical and cognitive rest Recovery 2. Light Aerobic Exercise Walking, swimming, stationary cycling, intensity <70% max HR. No resistance training Increase 3. Sports Specific Exercise Skating drills in hockey, running in soccer. No head impact activities. (Borg 11- 14) Add movement
  21. 21. Return to Play Protocol Continued…. Rehab Stage Functional Exercise Objectives 4. Non-contact training Drills Progression to more complex training drills (passing drills in football and hockey) May begin progressive resistance training Exercise, coordination, cognitive load 5. Full Contact practice Following medical clearance, participate in normal training activities Restore confidence and assess functional skills by coaching staff 6. Return to Play Normal game play
  22. 22. Preventing Sports Related Concussions 1. Don’t Rush a. Recovery takes time. Ensure your child fully recovers before participating in activities that may lead to a second concussion. 2. Be a Good Role Model a. Communicate positive safety messages and model safety. Follow safety rules. Don’t lie about symptoms. 3. Appropriate Sports Management a. Proper fitting padding/uniforms/helmets/headgear, mouthguards, education, retirement from sports
  23. 23. Test Your Concussion Knowledge Post-test Review True or False: 1. A concussion generally isn’t considered severe unless the athlete loses consciousness or “blacks out.” 2. Properly fitting helmets and mouthguards prevent concussion in children. 3. Adolescent boys are more likely that adolescent girls to sustain a concussion. 4. A sideline assessment test, in which a coach or athletic trainer asks the injured athlete a series of questions immediately following injury, can help determine the severity of a concussion. 5. If a child no longer has any symptoms 24 hours after sustaining a mild concussion, it’s safe for him or her to return to play.
  24. 24. 6. The best way to diagnose a concussion is with a CT scan or MRI. 7. Most emergency room physicians are well trained in the management and treatment of sports concussions. 8. It’s possible for children to experience headaches and difficulty concentrating in class for weeks after a hard hit or a rough tackle. 9. The “three strikes and you're out” rule, suggests that children who have three concussions should no longer be allowed to participate in school-sponsored athletics. 10. There are cases where kids who are diagnosed with attention deficit hyperactivity disorder (ADHD) or other learning disabilities could actually be suffering from undiagnosed post-concussion syndrome. Moser, 2012
  25. 25. References Concussion Symptom Checklist. Center of Disease Control, (2015). Retrieved from: http://www.cdc.gov/concussion/pdf/TBI_schools_checklist_508-a. pdf. Defense and Veterans Brain Injury Center. (2014). A parent’s guide to returning your child to school after a concussion. Retrieved from http://www.cstsonline.org/assets/media/documents/ParentsGuide_Concussion.pdf Dompier, T., Kerr, Z., Marshall, S., Hainline, B., Snook, E., … & Simon, J. (2015). Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatrics, 169(7), 659-655. doi:10.1001/jamapediatrics.2015.0210 Giza, C., & Hovda, D. (2001). The neurometabolic cascade of concussion. Journal of Athletıc Traınıng, 36(3), 228-235. Halstead, M., & Walter, K. (2010). Clinical Report- Sport related concussion in children and adolescents. American Academy of Pediatrics, 126(3), 596-615. doi:10.1542/peds/2010-2005 Iverson, G., Silverberg, N., Mannix, R., Maxwell, B., Atkins, J., … Berkener, P. (2015). Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatrics, 10, E1-E9. doi:10.1001/jamapediatrics.2015.2374 Lloyd, J. (2009, May 5). High school athletes face serious concussion risks. USA Today, p. 7. Moser, R. S., & Pascrell, B. (2009). Ahead of the game: The parents’ guide to youth sports concussion. Dartmouth College Press. Tyler, J., & Nelson, M. (2000, May). Second impact syndrome: Sports confront consequences of concussions. USA Today, pp. 72-74.

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