Concussions

1. Concussions

2. The A,B,C’s of Concussions and Much More

3. What is a Concussion? • According to The 3rd International Conference on Concussion in Sport • “ A concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head”. • “ A concussion typically results in a rapid onset of short-lived impairment of neurologic function that resolves spontaneously”.

4. What is a Concussion? 3. “Concussions may result in neuropathologic changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury”. 4. “Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness (LoC)

5. FACTS & FIGURES: • According to the American College of Sports Research, there are over 2 million concussions per year… • 85% of which are never diagnosed • 50% of football players may experience one concussion each year • 35% have had more than one • Effects of concussions are cumulative in athletes who Return-to-Play (RTP) prior to complete recovery. • Premature RTP following a concussion can lead to potentially serious consequences resulting from Second Impact Syndrome (SIS) which may cause permanent brain damage or even death.

6. FACTS & FIGURES: • Less than 50% of all high schools nationally have certified athletic trainers. • 63% of all concussions occur in football

7. How Does a Concussion occur? A concussion occurs when a violent blow to the head causes the brain to slam against the skull beyond the ability of the cerebrospinal fluid to cushion the impact (see diagram) Remember that concussions are not exclusive to contact sports (i.e. football, hockey) as there are high incidences in non-contact sports (i.e. cheerleading, gymnastics)

8. How does a Concussion get Classified? Grade I: A mild concussion, occurs when there is a head injury, and perhaps some confusion, but full memory of the event. For Grade I Concussions: The athlete can return if they are asymptomatic for at least 15 minutes. Grade II: A moderate concussion, with confusion, and difficulty recalling the event, but no loss of consciousness. For Grade II Concussions:The athlete can return to play after one week, if asymptomatic during that time period. Grade III: A severe concussion, when there is a loss of consciousness and no memory of the event. For Grade III Concussions:The athlete is removed from competition and transported to the emergency department. Length of time out of competition can be discussed with the physician.

9. SIGNS & SYMPTOMS OF A CONCUSSION • Loss of Consciousness (LoC) • Confusion • Post-Traumatic Amnesia (PTA) • Retrograde Amnesia (RGA) • Disorientation • Delayed Verbal and Motor Responses • Inability to Focus • Headache • Nausea/Vomiting • Excessive Drowsiness • Visual Disturbances (Photophobia, Blurry Phono/Photophobia Vision, Double Vision) • Disequilibrium • Feeling “In a Fog”; “Zoned Out” • Vacant Stare • Emotional Lability • Dizziness • Slurred/Incoherent Speech

10. WHAT DO I DO NOW THAT A CONCUSSION HAS BEEN SUSPECTED?

11. WHAT DO I DO NOW THAT A CONCUSSION HAS BEEN SUSPECTED? • Remove the athlete from play • Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion • As a coach, recording the following information can help health care professionals in assessing the athlete after the injury, if there is not one provided on-site : • Cause of the injury and force of the hit or blow to the head or body • Any loss of consciousness (passed out/knocked out) and if so, for how long • Any memory loss immediately following the injury • Any seizures immediately following the injury • Number of previous concussions (if any) • Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion • Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play

12. Graded Symptom Checklist (GSC) Issued by the National Athletic Trainers’ Association, the checklist should be used at the time of a head injury and at least four times afterward: at 2 to 3 hours, 24 hours, 48 hours and 72 hours after the injury, or until all symptoms have cleared. The checklist can help determine whether a concussion has occurred, its severity and whether a player is fit to return to the game. But the checklist is also important to use later, on the recommended schedule, because symptoms of a concussion are sometimes delayed. A player who sustained a direct or indirect blow to the brain may feel all right initially, then develop symptoms hours or days later. TOOLS USED BY MEDICAL PROFESSIONALS TO ASSESS A SUSPECTED CONCUSSION

13. TOOLS USED BY MEDICAL PROFESSIONALS TO ASSESS A SUSPECTED CONCUSSION • Play It S.A.F.E. Program • Concussion Management Education • Pre-Season Baseline Testing • Neuro-Physical • Neuro-Cognitive • Sideline Assessment (see diagram) • Follow-Up Evaluation • Return to Play Decision

14. Concussion…Well will they be ready to play this Friday?

15. Protocols for Return-to-Play following a Concussion

16. Wii-habilitation for RTP Protocols following a Concussion • Functional/ Neurologic/ Cognitive exam that determines the athletes levels of: • Memory and concentration • Vision • Hearing • Balance • Coordination • Reflexes

17. What Can I Do to Help Prevent a Concussion from Occurring? As a coach or parent, you play a key role in preventing concussions and responding properly when they occur. Here are some steps you can take to help prevent concussions and ensure the best outcome for your athletes, the team, league or school.

18. Preventative Equipment Issues • Enforce the standard use of helmets for protecting against catastrophic head injuries and reducing the severity of cerebral concussions. • Ensure that all equipment meets either the National Operating Committee on Standards for Athletic Equipment (NOCSAE) or American Society for Testing and Materials (ASTM). • Enforce the standard use of mouth guards for protection against dental injuries.

19. Prevention • Preseason • Check with your league, school, or district about concussion policies. • Concussion policy statements can be developed to include a commitment to safety, a brief description about concussion, and information on when athletes can safely return to play (i.e. an athlete should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play). Parents and athletes should sign the concussion policy statement at the beginning of each sports season. • Involve and get support from other parents and/or league or school officials to help ensure that the concussion policy is in place before the first practice. • Create a concussion action plan. • To ensure that concussions are identified early and managed correctly, have an action plan in place before the season starts. This plan can be included in your school or district’s concussion policy. • Educate athletes and other parents or coaches about concussion. • Before the first practice, talk to athletes and parents, and other coaches and school officials about the dangers of concussion and potential long-term consequences of concussion. Explain your concerns about concussion and your expectations of safe play. Show the videos and pass out the concussion fact sheets for athletes and for parents at the beginning of the season and again if a concussion occurs. Remind athletes to tell coaching staff right away if they suspect they have a concussion or that a teammate has a concussion. • Monitor the health of your athletes. • Make sure to ask if an athlete has ever had a concussion and insist that your athletes are medically evaluated and are in good condition to participate. Some schools and leagues conduct preseason baseline testing (also known as neurocognitive tests) to assess brain function—learning and memory skills, ability to pay attention or concentrate, and how quickly someone can think and solve problems. These tests can be used again during the season if an athlete has a concussion to help identify the effects of the injury. Prior to the first practice, determine whether your school or league would consider conducting baseline testing.

20. During the Season: Practices and Games Insist that safety comes first. Teach and practice safe playing techniques. Encourage athletes to follow the rules of play and to practice good sportsmanship at all times. Make sure athletes wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly. Teach athletes it’s not smart to play with a concussion. Rest is key after a concussion. Sometimes athletes, parents, and other school or league officials wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let your athlete convince you that they’re “just fine.” Prevent long-term problems. If an athlete has a concussion, their brain needs time to heal. Don’t let them return to play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short time period (hours, days, weeks)—can slow recovery or increase the chances for long-term problems. Work closely with league or school officials. Be sure that appropriate individuals are available for injury assessment and referrals for further medical care. Enlist health care professionals (including school nurses) to monitor any changes in the athlete’s behavior that could indicate that they have a concussion. Ask athletes or parents to report concussions that occurred during any sport or recreation activity. This will help in monitoring injured athletes who participate in multiple sports throughout the year. Prevention

21. Prevention • Postseason • Keep track of concussion. • Coaches should work with other school or league officials to review injuries that occurred during the season. Discuss with others any needs for better concussion prevention or response preparations. Review your concussion policy and action plan. • Discuss any need for improvements in your concussion policy or action plan with appropriate health care professionals and school and league officials.

22. Other Points to Ponder • It is of utmost importance to initiate an Emergency Action Plan (EAP), for all types of injuries. • Communicate with the local EMT’s, administrators, athletic trainers, etc. that will be covering your events • There is always a possibility of an athlete returning too soon which increases the risk of 2nd Impact Syndrome (SIS) • when an athlete, who has already sustained a head injury, sustains a second  head injury before symptoms have cleared from the first injury. • Psychological/Sociology components of returning an athlete back to full competition following a concussion. …and most importantly of all WHEN IN DOUBT, SIT THEM OUT

23. Resources Videos Links http://www.biodex.com/rehab/concussionprogram/concussionprogram_feat.htm http://www.knowconcussion.org/pdfs/graded_symptom_checklist.pdf http://www.cdc.gov/concussion/sports/prevention.html http://azsportsconcussions.com http://www.cdc.gov/ConcussioninYouthSports • 60 Minutes http://www.cbsnews.com/video/watch/?id=5377319n&tag=cbsnewsMainColumnArea.5 • ESPN: Outside the Lines http://espn.go.com/video/clip?id=3094263&categoryid=null • ESPN – E:60 http://sports.espn.go.com/espn/e60/news/story?id=5162747

24. For More Information Please Visit Champion Fitness Physical Therapy @ champfit.com