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Sport concussion 2010

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Sport concussion 2010

  1. 1. Sport Concussion<br />A Publication of<br />The Sport Medicine Council of Alberta 1<br />
  2. 2. The Purpose of this Course<br />To raise awareness on the seriousness of sport concussions.<br />To decrease the number of sport related concussions. <br />To provide insight into the newest information on concussion management and prevention. <br />2<br />Sport Concussion 3<br />
  3. 3. Look on the bright side<br />3<br />For a few seconds you forgot you were a Calgary Flame<br />Sport Concussion 3<br />
  4. 4. Some Humor<br />4<br />Sport Concussion 6<br />
  5. 5. The Myths of Concussions<br />Its not a serious injury<br />A second hit to the head will make the concussed person feel better<br />Concussions get better within 7 days<br />Its only a short-term injury<br />You have to lose consciousness<br />Others…<br />5<br />Sport Concussion 84<br />
  6. 6. The Challenge of Concussions<br />6<br />Sport Concussion 84<br />
  7. 7. What is a Concussion?<br />Section 2<br />7<br />A Publication of<br />The Sport Medicine Council of Alberta 5 <br />
  8. 8. Definition<br />“A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”. <br />8<br />Sport Concussion 6<br />
  9. 9. Diagnostic Tests<br />Concussions involve a disruption of brain function rather than structural damage.<br />The majority of time CT scans or MRI tests show no obvious damage. <br />9<br />Sport Concussion 42<br />
  10. 10. Neurometabolic Changes and Concussion<br />Trauma/Concussion<br />Diffuse axonal injury<br />Massive release of K+ ions<br />Glycolysis for K + pumps<br />Sport Concussion 7<br />
  11. 11. Neurometabolic Changes and Concussion<br />Sport Concussion 7<br />
  12. 12. fMRI<br />12<br /> Sport Concussion 3<br />
  13. 13. fMRI<br />13<br /> Sport Concussion 3<br />
  14. 14. Impact Mechanics <br />A contrecoup injury is a result of axial rotation with acceleration, this causes an injury away from the actual impact site. <br />14<br />Sport Concussion 12<br />
  15. 15. Concussion Rates<br />15<br />A Publication of<br />The Sport Medicine Council of Alberta 5 <br />
  16. 16. How Often Do Concussions Occur? <br />On average, 3-5% of all sport and recreational injuries are head injuries.<br />The majority of sport related head injuries are mild.<br />The most common cause of sport related head injuries are falls.<br />16<br />Sport Concussion 15<br />
  17. 17. How Often Do Concussions Occur? <br />Patients younger than 20 years old are more likely to suffer a sports related head injury. <br />Males are more frequently injured. These statistics are changing as more females engage in contact sports. <br />Very few head injuries are hospitalized.<br />17<br />Sport Concussion 16<br />
  18. 18. Recognition of Concussions<br />It is common for athletes to underreport the incidence of sport concussions. <br />Often athletes do not associate their symptoms with those of a concussion. <br />18<br />Sport Concussion 17<br />
  19. 19. Athletic Trainers Report<br />Athletic Trainers from Canada and the United States identified head injuries as 5% of their total sports injuries. <br />X Top sports? <br />19<br />Sport Concussion 18<br />
  20. 20. Top Causes of Concussions<br />Female<br />Soccer<br />Horseback Riding<br />Cycling<br />Ice Hockey<br />Snowboarding<br />Male<br />Ice Hockey<br />Cycling<br />Football<br />Soccer<br />Snowboarding<br />20<br />Sport Concussion 19<br />
  21. 21. Sport Specific Rates <br />Hockey: <br />High School: 17.6/1000 hours<br />Peewee: 23.1/1000 hours<br />Bantam: 10.7/1000 hours <br />Peewee: <br />Children under age 6 had twice<br />the head injuries as older<br />children.<br /><ul><li>Hockey
  22. 22. Professional (Europe): 14.3% of all injuries; 0.16/1000 hours
  23. 23. College (Canadian Intercollegiate): 7.5% of injuries; 1.5/1000 hours
  24. 24. High School (US): 18.7/1000 hours</li></ul>21<br />Sport Concussion 21<br />
  25. 25. Peewee Hockey<br />N = 125 (86% response rate)<br />Average age: 11.5 years-old with 5.6 years of playing experience<br />No. of players with concussion: 11 (incidence rate = 9.87%) 16 total<br /> 7 players with 1 concussion<br /> 3 with 2 concussions<br /> 1 with 3 concussions(1 non hockey related)<br />Mechanism of Injury: player contact (n = 10)<br /> hits from behind (n = 4)<br /> fall (n = 1)<br /> collision into boards (n = 1)<br />Avg # of practices missed: 3.25 (range 0 – 6)<br />Avg #. of games missed: 2.00 (range 0 – 4)<br />Avg duration of symptoms: 7.03 days (range 1 - 21 days)<br />No. subjects with ED visit: n = 1<br />No. with previous concussion: n = 2<br />22<br />Sport Concussion 21<br />
  26. 26. Common Signs/Symptoms<br />Section – 4<br />23<br />A Publication of<br />The Sport Medicine Council of Alberta 22<br />
  27. 27. Common Signs/Symptoms <br />Nausea, vomiting <br />Dizziness<br />Confusion<br />Fatigue<br />Light headedness<br />Headaches<br />Irritability<br />Disorientation<br />Seeing bright lights<br />Feeling of being stunned<br />Depression<br />Inappropriate behavior<br />Decreased work/playing ability<br />Inability to perform daily activities<br />Cognitive and memory dysfunction<br />Sleep disturbances<br />Vacant stare<br />Poor balance <br />24<br />Sport Concussion 24<br />
  28. 28. Any 1 Symptom<br />Signs/symptoms may vary for each athlete.<br />A concussion should be suspected in the presence of any one symptom.<br />25<br />Sport Concussion 25<br />
  29. 29. Nausea<br />Be cautious if nausea is a significant symptom. <br />Some athletes will suffer a mild cognitive impairment for longer periods of time when nausea is present. <br />26<br />Sport Concussion 27<br />
  30. 30. How Do I Manage a Suspected Concussion?<br />Section 5 <br />27<br />A Publication of<br />The Sport Medicine Council of Alberta 28<br />
  31. 31. Recovery Model <br />Concussion Recovery Model vs. Orthopedic Recovery Model <br />Concussions need to be managed differently than orthopedic injuries. <br />“No pain. No gain.” Does not apply. <br />28<br />Sport Concussion 8<br />
  32. 32. Removing a Player from Play<br />Remove the player from the current game or practice.<br />Do not leave the player alone; monitor for signs and symptoms.<br />Do not administer medication.<br />Inform coach, parent or guardian about the injury.<br />Sport Concussion 31<br />
  33. 33. Return Within a Game?<br />Be very cautious<br />Hockey Canada: If player is asymptomatic after 15 minutes, can return…<br />Not if LOC, Neck Injury, ANY symptom<br />Must be evaluated by qualified professional<br />Sport Concussion 31<br />
  34. 34. When in Doubt, Sit Them Out!<br />No athlete with a concussion should continue to play or return to a game after sustaining a concussion. <br />Center for Disease Control<br />International Concussion<br />Guidelines (Zurich, 2009)<br />31<br />Sport Concussion 33<br />
  35. 35. Deteriorating Neurological Function <br />Athletes need to be carefully monitored for the first 24-48 hours. If any of the below symptoms occur refer them to the emergency department. <br />Headaches that worsen<br />Seizures<br />Looks drowsy or can’t be awakened<br />Repeated vomiting<br />Slurred speech<br />Can’t recognize people or places<br />Increased confusion, unusual behavioral change, or irritability<br />Weakness or numbness in arms or legs<br />Neck pain<br />32<br />Sport Concussion 34<br />
  36. 36. Screening/Diagnosis <br />Section 6<br />33<br />A Publication of<br />The Sport Medicine Council of Alberta 35 <br />
  37. 37. Simple or Complex<br />Concussions can be classified as either simple or complex.<br />34<br />Sport Concussion 36<br />
  38. 38. Simple Concussion<br />A simple concussion usually resolves without complication in 7-10 days. <br />This is the most common type of head injuries, accounting for 75% of all concussions.<br />35<br />Sport Concussion 37<br />
  39. 39. Complex Concussion<br />A complex concussion involves persistent symptoms and prolonged cognitive impairment. <br />36<br />Sport Concussion 38<br />
  40. 40. Post Concussion Syndrome<br />Following a concussion, an athlete can suffer from long term sleep disturbances, memory and concentration troubles, depression and even psychiatric problems. <br />37<br />Sport Concussion 39<br />
  41. 41. Other Issues <br />38<br />A Publication of<br />The Sport Medicine Council of Alberta 35 <br />
  42. 42. History of Concussion<br />Athletes with a history of concussion are at an increased risk of:<br />Future concussions (3 to 5 x more likely)<br />Worse on-field presentations following their next concussion<br />Experiencing acute changes in their memory performance and reaction times<br />Slowed recovery<br />39<br />Sport Concussion 45<br />
  43. 43. 3 Concussions<br />After an athlete has sustained 3 concussions, serious consideration should be given to removal from contact sports. <br />However, each athlete should be considered on an individual basis.<br />Athletes with a history of 3 or more concussions have a slower recovery rate than athletes with one prior concussion.<br />40<br />Sport Concussion 46<br />
  44. 44. How Many is too Many? <br />There is no magic number of how many concussions are too many. <br />This must be evaluated individually. <br />Return to play decisions should be guided by neuropsychological test results and symptoms reported by the athlete regardless of the number of concussions. <br />41<br />Sport Concussion 48<br />
  45. 45. Long Term Consequences<br />Studies from retired NFL players suggested<br />Increased incidence <br />Depression (2 to 4x higher than normal population)<br />Cognitive Difficulties<br />Chronic Traumatic Encephalopathy<br />42<br />Sport Concussion 48<br />
  46. 46. Does Age Affect Recovery Time? <br />High school athletes may exhibit slower recovery after sports related concussions compared to collegiate athletes.<br />43<br />Sport Concussion 49<br />
  47. 47. Younger Athletes <br />Younger athletes are more prone to complex concussions than college athletes. <br />Younger athletes show more signs of mood disturbance (irritability, lower frustration tolerance) than older athletes. <br />44<br />Sport Concussion 50<br />
  48. 48. Second Impact Syndrome<br />It is thought to occur when an athlete suffers a second blow to the head while recovering from an initial concussion.<br />This can happen up to 14 days post injury.<br />The result is a catastrophic increase in intracranial pressure which, in rare cases, can lead to death.<br />It most often occurs in athletes under 21 years of age. <br />This is very rare and there is still debate on when it occurs. <br />45<br />Sport Concussion 51<br />
  49. 49. Return to Activity<br />Section 8<br />46<br />A Publication of <br />The Sport Medicine Council of Alberta 58 <br />
  50. 50. 47<br />Sport Concussion 6<br />
  51. 51. Medical Doctor Evaluation<br />An athlete should be evaluated by a medical doctor after any blow to the head. <br />Hockey Canada’s Guidelines<br />48<br />Sport Concussion 32<br />
  52. 52. Medication<br />Only take medications your medical doctor has prescribed only after medical assessment.<br />Do not drink alcohol or <br /> take non-prescription drugs. <br />49<br />Sport Concussion 56<br />
  53. 53. Medical Decision<br />Return to play is a medical decision that should not be made by a parent, coach, trainer or athlete.<br />Each case must be handled individually<br />7 Day rule does not apply<br />An athlete should complete a sport specific rehabilitation program and cleared by a medical doctor. <br />50<br />Sport Concussion 61<br />
  54. 54. Pocket SCAT2<br />Sport Concussion <br />
  55. 55. Symptoms in Sports concussion<br />Everyone “feels fine”<br />Always ask:<br />1.“On a scale of 0 to 100%, how do you feel?”<br />2.“what makes you not 100%?”<br />3. Checklist – SCAT2<br />Sport Concussion <br />
  56. 56. 6 Return to Activity Steps <br />If it is decided that an athlete will return to play a stepwise process must be followed.<br />(Available in the SCAT-2)<br />53<br />Sport Concussion 62<br />
  57. 57. Graded Exertion Protocol<br /><ul><li> 24 hours per step
  58. 58. If there is recurrence of symptoms at any stage, return to previous step</li></li></ul><li>Step 1<br /><ul><li>CORNERSTONE =rest until asymptomatic
  59. 59. Rest from activity
  60. 60. No training, playing, exercise, weights
  61. 61. Beware of exertion with activities of daily living
  62. 62. Cognitive rest
  63. 63. No television, extensive reading, video games?
  64. 64. Caution re: daytime sleep</li></ul>REST = ABSOLUTE REST!<br />Sport Concussion <br />
  65. 65. Step 2<br />Light aerobic exercise. No resistance or weight lifting. <br />56<br />Sport Concussion 64<br />
  66. 66. Step 3<br />Sport specific activities and training.<br />57<br />Sport Concussion 65<br />
  67. 67. Step 4<br />Drills without body contact. May add light resistance training and progress to heavier weights. <br />58<br />Sport Concussion 66<br />
  68. 68. Step 5<br />Begin drills with body contact.<br />59<br />Sport Concussion 67<br />
  69. 69. Step 6<br />Game play. <br />60<br />Sport Concussion 68<br />
  70. 70. Progress Symptom-Free <br />With this stepwise process, an athlete should continue to progress through the levels unless any post-concussion symptoms occur. <br />61<br />Sport Concussion 69<br />
  71. 71. 24 Hours Rest <br />If post-concussion symptoms occur, the athlete should rest 24 hours before returning to that activity. <br />62<br />Sport Concussion 70<br />
  72. 72. Neuropsychological Testing<br />Section 9 <br />63<br />A Publication of<br />The Sport Medicine Council of Alberta 71 <br />
  73. 73. Baseline Assessment<br />Complete a pre-season, baseline cognitive assessment and symptom score for each athlete. <br />In the event of a concussion, compare an athlete’s post-concussion symptoms to their baseline scores. <br />64<br />Sport Concussion 72<br />
  74. 74. Software Companies<br />ImPACT : Immediate Post-concussion Assessment and Cognitive Testing. <br />www.impacttest.ca<br />$25 for baseline, $10 for post-testing<br />Glen Sather Clinic (U of A)<br />CogSport ® <br />www.cogsport.com<br />65<br />Sport Concussion 53<br />
  75. 75. ImPACTImmediate Post-Concussion Assessment and Cognitive TestingComputerized Neurocognitive Testing<br />Mark Lovell, Ph.D.-UPMC Dept. of Orthopaedic Surgery<br />Micky Collins, Ph.D.-UPMC Dept. of Orthopaedic Surgery<br />Joseph Maroon, M.D.-UPMC Dept. of Neurological Surgery<br />
  76. 76. ImPACTPost-Concussion Evaluation<br /><ul><li>Demographic/Concussion history questionnaire
  77. 77. Concussion Symptom Scale
  78. 78. 21 Item Likert scale (e.g. headache, dizziness, nausea, etc)
  79. 79. Eight neurocognitive measures
  80. 80. Measures domains of memory, working memory, attention, reaction time, mental speed
  81. 81. Verbal Memory, Visual Memory, Reaction Time, Processing Speed Summary Scores
  82. 82. Detailed clinical report
  83. 83. Outlines demographic, symptom, neurocognitive data
  84. 84. Automatically computer scored</li></li></ul><li>Clinical ProtocolNeurocognitive Testing<br />Day 5-10<br />24-72 Hours<br />Concussion<br />Baseline Testing<br />Beyond if necessary<br />
  85. 85. Implementation<br />Account is set up under the name of the organization<br />Organization appoints an administrator<br />Administrator provides account name and passcode to athletes allowing them access to testing<br />Baseline tests completed on-line (anywhere)<br />When test is complete and baseline determined, a confirmation is sent to the team administrator and athlete<br />
  86. 86. Follow-up<br />Follow-up tests are completed on-line (anywhere)<br />ONLY a designated health professional can access testing results <br />
  87. 87. Composite Summary of Results<br />In addition to the individual scores for each module described, ImPACT 2.0 also yields summary composite scores for Verbal Memory, Visual Memory, Reaction Time, Processing Speed and Impulse Control. <br />Numeric Display of all Composites over Time<br />
  88. 88. Verbal Memory Composite<br />Is comprised of the average of the following scores: <br />Total percent correct score from Module 1 (Word Discrimination)<br />2) Total correct hidden symbols from Module 4 (Symbol Matching)<br />3) Percent of total letters correct from Module 6 (3 Letters)<br />Graphic Display of Verbal Memory Composite over time <br />
  89. 89. Other Issues<br />73<br />A Publication of<br />The Sport Medicine Council of Alberta 71 <br />
  90. 90. Mouth Guards <br />Mouth Guards have not been proven to prevent concussions. <br />Mouth Guards are required by many Athletic Associations because they reduce trauma of jaw, facial and dental injuries. <br />74<br />Sport Concussion 78<br />
  91. 91. Helmets <br />Helmets are known to reduce the risk of intracranial injury however, there is no helmet that can prevent all head injuries. <br />An athlete should wear the correctly sized helmet and one specific to the activity (hockey, football, snowboard, bike).<br />75<br />Sport Concussion 79<br />
  92. 92. The Good<br />Sport Concussion 80<br />
  93. 93. Prevention cont.<br />New technologies and changes in equipment<br />SWAT Hockey does not indorse any specific manufactures product.<br />
  94. 94. The Bad<br />Sport Concussion 80<br />
  95. 95. Force to the Head in just 6 milliseconds<br /> A bare head A good helmet<br />Sport Concussion 82<br />
  96. 96. Upcoming technology<br />A pair of football cleats….. 150 dollars<br />Football pads……………… 250 dollars<br />Registration in football……. 250 dollars<br />Protecting your head…….. Priceless<br />Sport Concussion 80<br />
  97. 97. Thank-You for Coming!Dr. Martin Mrazik6-135 Education NorthUniversity of Alberta <br />81<br />Sport Concussion 85<br />

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