CANTU Program: Concussion Awareness Neurological Training & - - PowerPoint PPT Presentation

J ESSICA G RAVEL, PT, DPT M ATT W HITE, ATC, ME D

O U T P A TI E N T C O N C U S SI O N C O O R D I N A TO R H E A D A T H L E T I C T R A I N E R O A K G R A N T P R O J E C T M A N A G E R C O N C O R D W E S T F O R D 3 1 0 B A K E R A V E 1 3 3 L I T T L E T O N R D , S U I T E 3 1 5 C O N C O R D , M A 0 1 7 4 2 W E S T F O R D , M A 0 1 8 8 6 P H O N E ( 9 7 8 ) 2 8 7 - 8 2 5 0 P H O N E ( 9 7 8 ) 5 8 9 - 6 8 5 3

CANTU Program: Concussion Awareness Neurological Training & Understanding

Objectives

 Identify:

What a concussion is Truths about concussions How to recognize a concussion Signs/Symptoms observed What to do in the event a concussion occurs Risks of returning to play with a concussion

 Apply concussion safety measures

What is a concussion

 A traumatic brain injury

due to a bump, blow, or jolt to the head or by a hit to the body causing the head and brain to move rapidly within the skull resulting in a disruption in normal brain activity

 All concussions are

serious

What is a concussion?

 A concussion causes a chemical change within the

brain

 Decreased blood flow to the brain  Increased energy demand



The brain is more vulnerable to a second concussion during this time of cell imbalance.

What is a concussion?

 Two Phases to a Concussion:

1.

The initial impact caused by linear and rotational biomechanical forces

2.

The chemical changes that could evolve over a period of minutes to days. This explains why some symptoms may be delayed in emerging.

The TRUTH about Concussions

 You do NOT need to lose consciousness to have a

concussion

 You do NOT need to hit your head to sustain a

concussion

 Helmets do NOT prevent concussions  Females experience more concussions than males

competing in the same sport

 Concussion symptoms are NOT obvious immediately

The TRUTH about Concussions

 The younger the individual, the longer the recovery

time after a concussion

 Routine diagnostic imaging (MRI, CT scan) will

come back normal after a concussion

 After one concussion, the individual is more

susceptible to have another concussion

 Once a person has suffered an initial concussion, their

chances of a 2nd are 3-6 times greater than a person who has never sustained a concussion

Statistics on Concussions

 Estimated 1.6-3.8 million sports and recreation concussions

• ccur annually

 5-10% of athletes will experience a concussion in any given

sports season

 CDC estimates 69% of athletes with a possible concussion

reported they played with concussion symptoms

 Sports-related concussions seen in ED

 Children ages 12 to 15 (47%)  16-19 year olds (29%)  8-11 years (19%)  7 years or younger (5%)

Leading Causes of Concussion (seen in ER)

 Falls  Playing Sports  Motor-vehicle related injury  Unintentionally being struck by or against an

• bstacle

 Assaults

** Only 1 in 6 concussions are diagnosed **

Concussion Rates Among High School Athletes by Sport, 2008-2010

Sport Incidence Rate per 10,000 Athletic Exposures Football 6.4 Boys Ice Hockey 5.4 Boys Lacrosse 4.0 Girls Lacrosse 3.5 Girls Soccer 3.4 Girls Field Hockey 2.2 Wrestling 2.2 Girls Basketball 2.1 Boys Soccer 1.9 Boys Basketball 1.6 Girls Softball 1.6 Cheerleading 1.4 Baseball 0.5

Possible Signs Observed

 Physical Signs:

LOC/impaired conscious state Clumsy, poor coordination or balance Gait disturbances Nausea/vomiting Appears dazed or confused Slurred speech

Behavioral Changes Cognitive Impairment

 Display unusual or

inappropriate emotions

 Inappropriate playing

behavior

 Shows behavior or

personality changes

 Confusion  Unsure of game, score,

• pponent, time, date, or place

 Forgets plays  Answers questions slowly  Poor concentration  Slow reaction time  Fogginess  Forgets events prior to injury  Forgets events after injury

Possible Signs Observed

Symptoms of a Concussion

 Physical Symptoms:

 Headaches (85%)  Dizziness (70-80%)  Difficulty with balance  Nausea/vomiting  Excessive fatigue  Difficulty sleeping  Double or blurred vision  Sensitivity to light or sound

 Emotional Symptoms:

 Irritability  Restlessness  Anxiety  Depression  Mood swings  Aggression  ↓ tolerance to stress

 Cognitive Symptoms:

 Confusion  Difficulty with memory and

attention

 Difficulty thinking clearly  Feeling slowed down  Difficulty with executive

functioning

 Difficulty with critical thinking  Difficulty with word retrieval

**Any pre-existing learning problems tend to become exacerbated (i.e. ADHD, OCD, learning disability)

What to do after a concussion?

 Immediately remove the athlete from the activity or

sport

 Notify parents about the possible concussion  Keep the athlete out of play the day of the injury and

until cleared to return by a health care professional.

 Seek medical attention by a health care professional

for concussion evaluation

 Physical rest is important to allow the brain to heal

Danger Signs/Red Flags

 Call 911 if any of the following signs are present:

 Individual looks very drowsy or cannot be awakened  Convulsions or seizures  Cannot recognize people or places  Severe or increasing headache  Weakness, numbness, or decreased coordination  One pupil is larger than the other  Slurred speech  Repeated nausea or vomiting  Loss of consciousness/deteriorating conscious state  Increasing confusion, restlessness, or agitation  Double vision  Athlete complains of neck pain

Risks of Returning to Play

 Second Impact Syndrome:

 Occurs when a second concussion is sustained before the first

concussion has properly healed, causing rapid brain swelling

 Seen only in young individuals (≤ 23 years old)

 Post-Concussion syndrome:

 85-90% of concussed athletes will heal from their

concussion within 1-2 weeks

 Post-concussion syndrome: 3 or more of the following symptoms

lasting greater than 4 weeks with or without exertion

• Headache
• Dizziness
• Fatigue
• Sleep Disturbances
• Difficulty Concentrating
• Memory Difficulty
• Irritability
• Intolerance of stress/emotion

Concussion Rehabilitation

Comprehensive Medical Evaluation

1.

Symptom checklist

• 2. Mechanism of concussion

3.

Concussion history

• 4. Physical exam

5.

Cognitive exam

Occupational Therapy

May help patients complaining of:

 Headaches, discomfort around

eyes, squinting, difficulty

• pening eyes

 Difficulty focusing when

looking far to near

 Difficulty reading or using the

computer

 Light and screen sensitivity  Difficulty navigating through

environments

 Double vision/blurred vision  Difficulty following movement

• r looking at movement

 Impaired eye-hand

coordination

 Decreased quality of

handwriting

 Impaired ability to locate

• bjects

Occupational Therapy:

C O G N I T I V E R E T R A I N I N G

Speech Pathology

May help patients complaining of:

 Decreased

attention/memory

 Difficulty with word

retrieval

 Slower processing speed  Limited cognitive

endurance

 Difficulty problem solving  Difficulty with executive

functioning:

 Organization  Preplanning  Follow through  Critical thinking  Self- analysis

 Difficulty with return to

learn in academic setting

Speech Pathology:

Return to Classroom

 Return to school needs to be gradual and controlled  May require academic accommodations:

 Shortened school day initially with systematic increase  Scheduled breaks as needed in a quiet place (15-20min)  Limit cafeteria exposure (noise, commotion, light)  Preprinted class notes  Added time for assignments/projects (slower processing time)  Excuse nonessential work  No doubling the workload to include make up work and new

work simultaneously

 One test per day  Extra test taking time (including MCAS, SAT, ACT)

Physical Therapy

May help patients complaining of:

 Headaches  Dizziness and nausea  Decreased

balance/history of falls

 Neck pain, tightness, and

stiffness

 Light sensitivity  Decreased neck, shoulder,

and mid-back strength

 Poor posture  Decreased exercise

tolerance

 Decreased neck range of

motion

Physical Therapy

Concussion Safety

 Important for determining pre-concussion visual

tracking, cognitive and balance functioning

 If a concussion occurs, the baseline can be compared

with the patient’s performance on their post- concussion results.

 Minimum age: 10 years old  Includes:

 ImPACT (Immediate Post Concussion Assessment and

Cognitive Testing)

 King Devick Test  Balance Error Scoring System (BESS)

Baseline Concussion Screening

Concussion Safety Practices

 Using proper protective equipment (helmets)

 Properly fitted, maintained, and worn correctly

 Follow safety rules for sports and activities  Appropriate officiating  Practice good sportsmanship  Create an Action Plan in the event a concussion occurs  Educate athletes on importance of reporting head injury  Educate coaches and parents on the signs/symptoms of

a concussion

 Complete baseline concussion screening

Take home points

 Adolescents do NOT need to lose consciousness to

sustain a concussion

 Symptoms can take minutes to days to occur  Adolescents should NEVER return to activity on the

day of the concussive injury

 Baseline concussion screening is helpful in return to

activity decisions

 ***Remember: When in doubt, sit them out***

Thank you!!! Any Questions???

Please visit our website for further information regarding our team and concussion program: emersonhospital.org/concussion