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Concussion in the Adolescent Athlete


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Concussion in the Adolescent Athlete

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