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Concussions
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- 2. What is aconcussion? 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 aconcussion? 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 commoncauses 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 Researchshows 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 HeadVestibular* 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 (“RedFlags”) 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.
- 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
- 14. Can the athletereturn 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
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- 16. What to doif 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 TheImPACT 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
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- 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.
- 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!
- 26. Preventing Concussions Teachingproper 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