Whether playing football, soccer or just riding a bicycle, everyone is vulnerable to concussions. This webinar will provide the latest medical information on how to identify, treat and prevent sports concussions – and the mild traumatic brain injuries they result in.

1. Play It Smart:
What you need to know
about sports concussions
Cynthia L. Boyer, Ph.D.
Executive Director, Brain Injury Services
September 26, 2012
@2012 All rights reserved

2. Our Mission
To ensure that every person is given opportunities for lifelong learning
and fulfillment.
We do this by altering perceptions, and by supporting those with
intellectual and developmental challenges and acquired brain injuries in
achieving their life goals as valued and respected members of our world.
Our Vision
By 2014 our distinct ability to deliver high quality individualized services in
modern living, learning and working environments will exceed stakeholder
expectations and secure Bancroft as the region’s elite provider of services to
people with intellectual and developmental disabilities and brain injuries.
Our Core Values
Responsible Empathetic Supportive Passionate Empowered Committed Trustworthy
RESPECT
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4. Why the increased focus on
sports-related concussions?
 Concussions are common in sports, and
their frequency appears to be increasing
 Although typically mild, sports
concussions have a high risk of recurrence
and can have significant complications
 Knowledge of the potential for long-term
negative outcomes
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5. What is a Concussion?
A concussion ( or mild
traumatic brain injury) is a
complex physiological
process affecting the
brain, induced by
traumatic biochemical
processes secondary to
direct or indirect forces to
the head.
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6. What is a Concussion?
Disturbance of brain
function is related to
neurometabolic
dysfunction rather than
structural brain injury and
is typically associated with
normal structural imaging
findings
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7. What is a Concussion?
Concussion may or may
not involve a loss of
consciousness
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8. What is a Concussion?
Results in a constellation
of physical, cognitive,
emotional, and sleep-
related symptoms
Symptoms may last from
several minutes to days,
weeks, months, or longer
in some cases
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9. Current Diagnosis of Concussion
 Does not require LOC
 Does not require a direct blow to the head
 Does not require amnesia
 CT/MRI likely to be normal
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10. Sports and Concussions
 In the United States there are
over 3.8 million sports related
concussions a year.
 It is estimated that an athlete
playing a contact sport has a
19% chance of suffering a
concussion each year of play.
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11. Sports and Concussions
 34% of college football
players have suffered at least
one concussion.
 20% of college football
players have suffered multiple
concussions
Department of Neurosurgery, University of Pittsburgh
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12. Sports and Concussions
 All sports and recreation-related concussion in
U.S. 1.6-3.8 million/year
 Concussion is COMMON in youth sports:
8.9% of high school athletes
 Concussions appear to be increasing,
especially among high school athletes
Meehan WP, et al. High School concussions in the 2008-2009 Academic Year: Mechanisms,
Symptoms and Management. A J Sports Med.2010;38(12):2405-2409.
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13. Sports and Concussions
Commonly involve:
 Other players
 Falls on hard surfaces
 Equipment
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14. “Limited Contact” Sports Also
Carry a Risk of Concussion
 Baseball  Raquetball
 Bicycling  Ice Skating
 Cheerleading  Skateboarding
 Fencing  Snowboarding
 Flag Football  Softball
 Gymnastics  Squash
 Horseback Riding  Volley ball
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15. Head Injuries Per Sport 2010
 Cycling: 85,389
 Football: 46,948
 Baseball/softball: 38,394
 Basketball: 34,692
 Water sports: 28,716
 Powered recreational
vehicles: 26,606
 Soccer: 24,184
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16. Head Injuries Per Sport 2010
 Skateboards/scooters:
23,114
 Winter sports: 16,948
 Horseback riding: 14,466
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17. Gender Differences
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18. Mechanism of Injury
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19. Mechanism of Injury
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21. Pathophysiology
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22. Metabolic Abnormalities
 Potassium, glutamate and glucose are
immediately released from affected brain cells
 Calcium enters these disturbed cells
 Neurotransmitter release occurs with loss of
autoregulation on the affected area
 Decreased cerebral blood flow
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23. Neurometabolic Changes and Concussion
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24. Injury Aftermath
 An energy crisis in the brain
 The brain is vulnerable to further damage
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25. Emergency Symptoms
 Changes in alertness and consciousness
 Seizures
 Muscle weakness on one or both sides
 Persistent confusion
 Remaining unconsciousness (coma)
 Repeated vomiting
 Unequal pupils
 Unusual eye movements
 Walking problems
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27. Concussion Symptoms
 Headache  Feeling slowed down
 Nausea/Vomiting  Foggy
 Balance Problems/  Difficulty with
Dizziness memory/concentration
 Fatigue/Drowsiness  Double vision
 Trouble sleeping  Ringing in ears
 Irritability/Sadness  Sensitivity to light/noise
 Nervousness/more
emotional
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28. Observed Signs of Concussion
 Appears dazed, stunned
 Confused about assignment/position
 Forgets an instruction
 Moves clumsily
 Answers questions slowly
 Loses consciousness (even briefly)
 Exhibits mood/ behavior/personality changes
 Can’t recall events before hit
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29. Cumulative Effects
 Increased severity of
symptoms with
subsequent concussions
 Unknown effects on
the developing brain
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30. Second Impact Syndrome
 Experiencing a second
concussion before signs and
symptoms of a first
concussion have resolved
may result in rapid and
typically fatal brain swelling.
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31. Second Impact Syndrome
 Athletes should never to
return to sports while
they're still experiencing
symptoms of concussion.
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32. Post Concussion Syndrome
 20-25% of patients who suffer a
concussion residual symptoms
 Estimated < 5% of sports related
concussions
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33. Post Concussion Syndrome
Symptoms
 Headache
 Dizziness
 Sensitivity to light and sound
 Blurred vision
 Concentration, attention, and memory
problems
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34. Post Concussion Syndrome
 Most people recover fully
from post concussion
syndrome within 3-6 months.
 However, 7-15% of people
will experience symptoms 1
year post injury.
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35. Long Term Effects of Concussions
 Chronic Clinical Changes seen in NFL players
- Increased risk of cognitive impairment
- Increased risk of depression
 Chronic Traumatic Encephalopathy (CTE)
- Damaged Tau Protein as seen in AD
- Diagnosed in a college football player
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37. Concussion Management
 ANY Signs or Symptoms: NO RETURN
TO ANY SPORTS ACTIVITY
 Rest
 Gradual Return to Play
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38. Clinical Dilemma of Concussion
 There is no proven treatment-the injury must
run its course
 The severity of the concussion is not fully
known until it has resolved
 Uncertainty about when it is safe to return to
competition
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39. Concussion Management
REMOVE athlete from play
REFER to medical provider
REST no sports, no texting, no tv
RETURN only with medical clearance
Children’s Hospital, Boston, Sports Concussion Clinic
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40. We Don’t Know……
 How many concussions are too many?
 When the brain is really back to “normal”?
 If pharmocotherapy could help?
 Why are more injury prone?
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41. Prevention
 Teach safe techniques in
practice and play
 Encourage recognition
and reporting of
concussion symptoms
 Be aware that injuries are
more common in
younger athletes
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42. Prevention
 Use available assessment
tools
 Monitor developments
at advanced levels of
play and legislative
efforts
 Head and spine injury
prevention programs
(Think First)
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43. Education
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45. Videos About Concussions
Can Be Seen On
https://www.nanonline.org/NAN/_Research
_Publications/Concussions_in_Sport.aspx
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46. Resources
 Mayo Clinic http://www.mayoclinic.com
 The Center for Sports Concussion at Idaho
State University www.knowconcussion.org
 Center for Disease Control www.cdc.gov
 Medicine Plus www.nlm.nih.gov
 Sports Concussion Center of NJ
http://www.sportsconcussionnj.com/?1f6c31
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47. Resources
Concussion tear-off pad: a resource for
coaches, physical education teachers, school
nurses, community youth sports personnel, and
emergency response professionals. It is a pad of
50 sheets which can be torn off and sent home
with parents or students.
http://www.sportsconcussion.com/pdf/resource
s/tear-off%20pad%202010.pdf
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48. Thank you!
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