A concussion is a type of traumatic brain injury caused by a blow or hit to the head that causes the brain to move rapidly within the skull. This results in chemical changes in the brain, and symptoms may include headache, dizziness, fatigue, and difficulty concentrating. While often called "mild" injuries, concussions are serious and cannot be seen on x-rays or CT scans. Athletes who have previously sustained a concussion are at greater risk for future concussions. Proper diagnosis and a gradual return to activity under medical supervision are important for recovery.
2. What is a concussion?
CDC definition:
A type of traumatic brain injury (TBI) caused by a blow, jolt or bump to
the head or a hit to the body that forces the head to move rapidly back
and forth
NATA definition:
Trauma-induced alteration in mental status that may or may not involve
loss of consciousness
This causes the brain to move around within the skull
This results in stretching, twisting, or bouncing which causes damage to the
brain and ultimately chemical changes.
You do not have to lose consciousness to sustain a concussion!
How many of my concussions at RHS have had LOC?
3. What is a concussion?
Often called a “mild” TBI because it usually is not life threatening.
However, they are very serious conditions
They cannot be diagnosed by x-ray or CT scans
Unlike brain bleeds or other traumatic brain injuries, concussions cannot
be seen because they involve chemical changes, not physical changes
We have to use other methods to diagnose a concussion (will talk more
about that later)
Once an athlete has a sustained a concussion, it becomes much easier for
the athlete to sustain secondary concussions (just like if you’ve sprained
your ankle, it’s easier to have another ankle sprain)
4. Causes
Most common causes of concussion:
Motor vehicle accidents
Falls
Sports
Risk Factors
Playing a high-risk sport
History of concussions BIGGEST risk factor
Will talk about CTE later
5. Risk Factors
Research shows that someone who has already received
one concussion is 1-2 times more likely to receive
a second one. If that individual has had two concussions, “a
third is 2-4 times more likely, and if they've had
three concussions, then they are 3-9 times more likely to
receive their fourth concussion.
6. Signs and Symptoms
Head Vestibular* Mental Mood Sleeping Vision/Neuro
Headache Nausea/
vomiting
Feeling slowed down Fatigue/low energy Drowsiness during
the day
Blurry vision
Pressure in head Dizziness or “seeing
stars”
Feeling “in a fog” More emotional Trouble falling asleep
or staying asleep
Sensitivity to light
Neck pain Feeling off balance “Don’t feel right” Irritability (cranky) Sleeping more or less
than usual
Tunnel vision
Sensitivity to noise Trouble concentrating Anxious/nervous Numbness and
tingling
Memory problems
Confusion
*Vestibular: sensory system found within the inner ear that is responsible for maintaining balance,
coordination, and awareness of spatial orientation
7. Serious Symptoms (“Red Flags”)
One pupil larger than the other
Double vision
Slurred speech
Repeated vomiting
Loss of consciousness
Cervical spine pain
Numbness/tingling or weakness in arms and legs
Seizure
Deteriorating conscious state
Increasingly restless, agitated, or combative
Remember Kevin from “The Crash Reel?”
8. Evaluating a Concussion
SCAT5 = “Sideline Concussion Assessment Tool”
I uploaded a copy of the SCAT5 to your OneNote notebook.
Medical and concussion history
“Red flags” (the symptoms from the previous slide)
Immediate memory
Delayed memory
Symptoms
Cognition
Concentration
Neurological screen
Balance
Just asking the athlete how they feel isn’t enough. You must be thorough, since all concussions present differently and are not “one size
fits all.” Athletes will lie about or minimize their symptoms to return to the game. The SCAT5 tests all of the different areas of the brain.
9.
10.
11. High Risk Sports
• Football
• Hockey
• Rugby
• Cheerleading
• Soccer
• Lacrosse
• Basketball
• Wrestling
Can happen in any sport though!
I have had many athletes sustain non-sport
related concussions
• Car accidents
• Clumsiness (walking into doors, falling)
• Fights and other poor decisions
12. Fun fact: 2/3 of
cheerleading
concussions are
from two-level
pyramids
13.
14. Can the athlete return to the game?
Can the athlete return to the game if you suspect a
concussion? NO!
Sometimes concussions just start out as a headache
and symptoms may not appear until the next day. That
is why a thorough screening is important.
It is also important to know your athletes and their
personalities
16. What to do if you have a concussion?
Remove from play immediately!
Not “wait until halftime, wait until the end of the inning, etc”
Seek immediate medical attention if the athlete has any of the “red flag”
symptoms
Otherwise, follow up the next day with a doctor or the athletic trainer
Remember the sports medicine team? This care team may involve:
Team physician
Neurologist
Athletic trainer
School counselor
17. ImPACT Test
The ImPACT test is a computerized neurocognitive test that measures different parts of your
brain’s function
Memory, reaction time, concentration, etc
If you have been tested for ADHD, dyslexia, or other learning disabilities, they use a similar test
Gives objective data to an injury with subjective symptoms
Objective = numbers
Subjective = how you feel
Athlete takes baseline test prior to season (when brain is healthy), then takes another test after
their injury when their brain isn’t healthy. The athletic trainer and doctor will compare the results.
Athlete should be back to baseline before return to their sport.
Just a tool in the toolbox; not the only factor we focus on
RHS baseline tests all high risk sports
21. Recovery and School
Lots of sleep
Stay off phone, tablet, electronics
Eat and hydrate well, just like when you are sick
Emotional stress (may need help managing stress from missing their sport and
getting behind on schoolwork)
May have to modify school – think about how some of these symptoms may affect
a typical school day.
Half days
Printing out notes instead of using tablet
Naps in clinic during the day
Extra time to complete assignments or extra breaks
Postpone tests
22. Returning to Sports
To return to sport, the athlete must be:
Back to school 100% with no additional academic accommodations
Symptom-free
Passed ImPACT test (if they have one)
Return slowly to activity
Day 1: light exercise (ex: stationary bike)
Day 2: more intense cardio (ex: run 2 miles)
Day 3: sport specific drills (non-contact; ex: footwork, passing, stick skills, etc)
Day 4: sport specific drills with padding (light contact)
Day 5: return to practice/games (full contact)
Must have 24 hours between each step! Remember it may take 24 hours for symptoms to appear.
23.
24. Second Impact Syndrome
Very rare condition that happens in the younger population (when brain is still growing and developing)
95% of cases < 18 years old
Occurs when someone sustains a second concussion before the first concussion has fully healed
Causes rapid and severe brain swelling
Patient loses consciousness and secondary brain injury occurs
The brain loses its ability to self-regulate pressure and blood volume flowing, which causes rapid and severe brain swelling.
Very high fatality rate - if not fatal, severe brain injury will occur
50% mortality rate
Nearly 100% disability rate
This is why we are cautious about removing athletes for the rest of the game, and slowly returning to activity
Georgia high school student died from this last year
Preston Plevretes Story on Youtube – I encourage you to watch this!
25.
26. Preventing Concussions
Teaching proper technique
“Heads Up” football program formed by CDC
Neck strengthening/control
Headers in soccer
Tackling in football/rugby
Not letting head whip back and hit ground
Education (athletes, parents, coaches)
Helmets and extra headgear do not prevent concussions – they prevent skull
fractures
Remember, a concussion is caused by SHAKING the brain
Concussions are a chemical, not physical change in the brain
Reporting symptoms
The earlier you intervene, the less playing time you will miss
You can’t tape up a concussion and get through the season and
fix it later like other injuries – can’t rush a concussion