Concussion in Sports
Concussion in Sports
Athletic Training Services
• Causes: o o
Bump, blow or jolt to the head Hit to body that causes the brain to move rapidly back and forth
• Effects: o
o
Rapid onset of short-lived impairment of neurological function that resolves spontaneously Signs & symptoms may evolve over a number of minutes to hours
• A disruption of normal brain function after a traumatic event o
o
Symptoms reflect a functional disturbance rather than a structural injury No abnormality is seen on standard imaging such as a CT or MRI
• Results in a graded set of clinical symptoms that may or may not involve loss of consciousness o o
Symptoms resolve in a gradual manner However, in some cases symptoms may be prolonged.
• • • • • • • • • • •
Headache Dizziness Fatigue Nausea or Vomiting Memory Loss Confusion Difficulty Concentrating Light & Noise Sensitivity Vision Problems Balance Problems Behavior Changes – irritability, sadness, nervous or anxious
• • • • • • • • • • •
Loss of or fluctuating level of consciousness Repeated vomiting Slurred speech or inability to speak Worsening headache Seizures Increased irritability or confusion Unusual behavior changes Weakness or numbness in arms or legs Pupils become unequal in size Increased drowsiness or inability to awaken Unable to recognize people or places
• Report injury to athletic trainer as soon as possible • Report teammate’s injury to the athletic trainer or coach if they are unable or reluctant to do so o o
If no athletic trainer available, report to coach Coach will contact athletic trainer
• Athletic trainer performs sideline test o
Signs & symptoms of concussion may also be associated with other conditions – heat illness, cardiac events
• Refer to ED if red flag signs/symptoms are present • Refer to medical professional with concussion management training if symptoms do not resolve within 3 days or if symptoms worsen
• There are approximately 1.6 – 3.8 million sportsrelated concussions in the U.S. every year • 33% of all concussions occur in practice • High school athletes account for 130,000 300,000 each year • Athletes age 16-19 sustain 29% of all sportsrelated concussions • Approximately 90% of all concussions will resolve in 10 -14 days
• As of April, 2012, Wisconsin became the 36th state to enact a youth concussion law. • As of 2015, all 50 states and the District of Columbia have enacted some form of concussion law, affecting high school and/or youth sports activities
• Wisconsin Law States… o
o
o
Parents of students under age 19 must sign a concussion information form before their children are able to participate on a sports team. Any student-athlete suspected of having a concussion must be removed from play. Student-athletes who are removed cannot return to play until obtaining WRITTEN clearance from a qualified medical professional
• World’s concussion experts o
Generally recognized gold standard
• National & international sports organizations o
IOC, FIFA, NFL, IRB, NHL, MSL, NCAA, NFHS
• Revision and updated recommendations o o o
1st Conference – Vienna 2001 2nd Conference – Prague 2004 3rd Conference – Zurich 2008
• All concussions are the same • You can tell right away if someone has a concussion • An athlete must be knocked out or lose consciousness to suffer a concussion • You must wake someone with a concussion every hour • It’s ok to “play through” or “tough out” a concussion or return to participation before fully recovered • Helmets, helmet add-ons, headgear and mouth guards can help prevent concussion • Boys get more concussions than girls
• It is possible to have a concussion have not show any visible signs • Concussion symptoms may not appear for 72 hours • Only 10% of all concussions result in loss of consciousness • Concussions can occur without direct head impact • If a sports-related brain injury is undetected, it may result in Second Impact Syndrome
Why baseline test? • The baseline test can be compared to a postinjury test should the athlete suffer a head injury during sports activity • Comparing the baseline and post-concussion scores allow schools, teams and healthcare providers to determine the athlete’s ability to return to school and athletic participation
• What ImPACT is: o
o
o
o
One important piece of the overall concussion evaluation and management process. A tool that can help health care professionals track recovery of cognitive processes following concussion. A tool to help communicate post-concussion status to athletes, coaches, parents, clinicians. A tool that helps health care professionals and educators make decisions about academic needs following concussion.
• What ImPACT is NOT: o
o
o
A cure-all for concussion, as there is no such thing. As long as contact to the head occurs, concussion will continue to happen. A tool to diagnose concussion, which should always be diagnosed by a qualified health care provider. A substitute for medical evaluation and treatment.
• Stage 0: No school –Total rest (2-3 days) o Low level of cognitive and physical activity • Stage 1: Partial school day (1-3 hours) o Attend 1-3 classes with rest breaks • Stage 2: Full school day with maximal supports o Attend most classes with 2-3 rest breaks
• Stage 3: Full school day with moderate supports o Attend all classes with 1-2 breaks • Stage 4: Full school day with minimal supports o Attend all classes with 0-1 breaks • Stage 5: Full school day with no supports o Full class schedule, no rest breaks
Sport specific return to participation when athlete has been symptom-free for 24 hours Athlete must remain symptom-free during and 24 hours following each stage to advance to the next stage. If they return and do not resolve or become significantly worse, contact healthcare provider
• Stage 1: Light aerobic activity - 20 – 30 minutes • Stage 2: Moderate activity • Stage 3: Heavy, non-contact practice • Stage 4: Full contact practice • Stage 5: Competition
• You don’t have to hit your head to suffer a concussion • Symptoms can be vague, so talk to your athletic trainer if you have questions • If symptoms linger more than 1 week, seek treatment from a healthcare provider with experience in concussion management • Remember… “Return to Learn” comes before “Return to Participation”
The issue of concussions are not the injury itself, it is the mismanagement of the injury that is the true problem of concussion.
Concussion Care Network Erin O’Tool, MD 8825 S Howell Ave, Oak Creek Goran Jankovic, MD 3811 Spring St, Racine Mark Bradley, DO N64 W24086 Main Street, Sussex Jennifer Scheeler, MD 8825 S Howell Ave, Oak Creek
Athletic Training Services
• Causes: o o
Bump, blow or jolt to the head Hit to body that causes the brain to move rapidly back and forth
• Effects: o
o
Rapid onset of short-lived impairment of neurological function that resolves spontaneously Signs & symptoms may evolve over a number of minutes to hours
• A disruption of normal brain function after a traumatic event o
o
Symptoms reflect a functional disturbance rather than a structural injury No abnormality is seen on standard imaging such as a CT or MRI
• Results in a graded set of clinical symptoms that may or may not involve loss of consciousness o o
Symptoms resolve in a gradual manner However, in some cases symptoms may be prolonged.
• • • • • • • • • • •
Headache Dizziness Fatigue Nausea or Vomiting Memory Loss Confusion Difficulty Concentrating Light & Noise Sensitivity Vision Problems Balance Problems Behavior Changes – irritability, sadness, nervous or anxious
• • • • • • • • • • •
Loss of or fluctuating level of consciousness Repeated vomiting Slurred speech or inability to speak Worsening headache Seizures Increased irritability or confusion Unusual behavior changes Weakness or numbness in arms or legs Pupils become unequal in size Increased drowsiness or inability to awaken Unable to recognize people or places
• Report injury to athletic trainer as soon as possible • Report teammate’s injury to the athletic trainer or coach if they are unable or reluctant to do so o o
If no athletic trainer available, report to coach Coach will contact athletic trainer
• Athletic trainer performs sideline test o
Signs & symptoms of concussion may also be associated with other conditions – heat illness, cardiac events
• Refer to ED if red flag signs/symptoms are present • Refer to medical professional with concussion management training if symptoms do not resolve within 3 days or if symptoms worsen
• There are approximately 1.6 – 3.8 million sportsrelated concussions in the U.S. every year • 33% of all concussions occur in practice • High school athletes account for 130,000 300,000 each year • Athletes age 16-19 sustain 29% of all sportsrelated concussions • Approximately 90% of all concussions will resolve in 10 -14 days
• As of April, 2012, Wisconsin became the 36th state to enact a youth concussion law. • As of 2015, all 50 states and the District of Columbia have enacted some form of concussion law, affecting high school and/or youth sports activities
• Wisconsin Law States… o
o
o
Parents of students under age 19 must sign a concussion information form before their children are able to participate on a sports team. Any student-athlete suspected of having a concussion must be removed from play. Student-athletes who are removed cannot return to play until obtaining WRITTEN clearance from a qualified medical professional
• World’s concussion experts o
Generally recognized gold standard
• National & international sports organizations o
IOC, FIFA, NFL, IRB, NHL, MSL, NCAA, NFHS
• Revision and updated recommendations o o o
1st Conference – Vienna 2001 2nd Conference – Prague 2004 3rd Conference – Zurich 2008
• All concussions are the same • You can tell right away if someone has a concussion • An athlete must be knocked out or lose consciousness to suffer a concussion • You must wake someone with a concussion every hour • It’s ok to “play through” or “tough out” a concussion or return to participation before fully recovered • Helmets, helmet add-ons, headgear and mouth guards can help prevent concussion • Boys get more concussions than girls
• It is possible to have a concussion have not show any visible signs • Concussion symptoms may not appear for 72 hours • Only 10% of all concussions result in loss of consciousness • Concussions can occur without direct head impact • If a sports-related brain injury is undetected, it may result in Second Impact Syndrome
Why baseline test? • The baseline test can be compared to a postinjury test should the athlete suffer a head injury during sports activity • Comparing the baseline and post-concussion scores allow schools, teams and healthcare providers to determine the athlete’s ability to return to school and athletic participation
• What ImPACT is: o
o
o
o
One important piece of the overall concussion evaluation and management process. A tool that can help health care professionals track recovery of cognitive processes following concussion. A tool to help communicate post-concussion status to athletes, coaches, parents, clinicians. A tool that helps health care professionals and educators make decisions about academic needs following concussion.
• What ImPACT is NOT: o
o
o
A cure-all for concussion, as there is no such thing. As long as contact to the head occurs, concussion will continue to happen. A tool to diagnose concussion, which should always be diagnosed by a qualified health care provider. A substitute for medical evaluation and treatment.
• Stage 0: No school –Total rest (2-3 days) o Low level of cognitive and physical activity • Stage 1: Partial school day (1-3 hours) o Attend 1-3 classes with rest breaks • Stage 2: Full school day with maximal supports o Attend most classes with 2-3 rest breaks
• Stage 3: Full school day with moderate supports o Attend all classes with 1-2 breaks • Stage 4: Full school day with minimal supports o Attend all classes with 0-1 breaks • Stage 5: Full school day with no supports o Full class schedule, no rest breaks
Sport specific return to participation when athlete has been symptom-free for 24 hours Athlete must remain symptom-free during and 24 hours following each stage to advance to the next stage. If they return and do not resolve or become significantly worse, contact healthcare provider
• Stage 1: Light aerobic activity - 20 – 30 minutes • Stage 2: Moderate activity • Stage 3: Heavy, non-contact practice • Stage 4: Full contact practice • Stage 5: Competition
• You don’t have to hit your head to suffer a concussion • Symptoms can be vague, so talk to your athletic trainer if you have questions • If symptoms linger more than 1 week, seek treatment from a healthcare provider with experience in concussion management • Remember… “Return to Learn” comes before “Return to Participation”
The issue of concussions are not the injury itself, it is the mismanagement of the injury that is the true problem of concussion.
Concussion Care Network Erin O’Tool, MD 8825 S Howell Ave, Oak Creek Goran Jankovic, MD 3811 Spring St, Racine Mark Bradley, DO N64 W24086 Main Street, Sussex Jennifer Scheeler, MD 8825 S Howell Ave, Oak Creek
