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Recognition and Care of Concussion Seattle Sport Concussion Program: Philip D. Heywood MS, ATC, AT/L Orthopedics and Enter department name here Sports Medicine Objectives: Definition and Pathophysiology Concussion facts


  1. Recognition and Care of Concussion Seattle Sport Concussion Program: Philip D. Heywood MS, ATC, AT/L Orthopedics and Enter department name here Sports Medicine

  2. Objectives: • Definition and Pathophysiology • Concussion facts • Recognizing Concussions • Caring for the concussed athlete (RTP) • Washington State Law Orthopedics and Sports Medicine

  3. What is a Concussion? “A complex pathophysiological process affecting the brain, induced by biomechanical forces.” -Zurich Concussion Statement 2012 • Complex – no “easy” concussions • Pathophysiological – function and microscopic structure problems • Biomechanical forces – a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head Orthopedics and Sports Medicine

  4. What is a Concussion? Common features of a concussion: • Rapid onset of usually short-lived neurological impairment which typically resolves spontaneously • A range of clinical symptoms that may or may not involve loss of consciousness (LOC). Less than 10% of sports concussions involve loss of consciousness Orthopedics and Sports Medicine

  5. Pathophysiology of Concussions • A concussion is a disturbance in brain function. • Results in a variety of nonspecific symptoms • Certain chemical levels are altered at the cellular level. • Blood supply to the brain decreases. • The brain’s demand for glucose increases. • The result is a metabolic imbalance referred to as an The result is a metabolic imbalance referred to as an • “energy crisis. energy crisis.” ” “ • This Energy crisis leaves neuronal tissue vulnerably • The brain needs time to recover and heal Orthopedics and Sports Medicine

  6. Concussion Basics • If the brain was like a computer a concussion would be a software issue, not a major hardware problem • Imaging (CT and MRI) shows structure, not function • Routine Imaging will be normal in most cases • Normal imaging does not equal normal function! • Normal imaging does not equal normal function! Orthopedics and Sports Medicine

  7. Concussion: Epidemiology • 3.8 million recreation or sports related concussions among children and adults Langois et al, J Head Trauma Rehab, 2006 • 144,000 Emergency Department visits for concussion in children 0-19 years of age annually Meehan & Manix, J Peds 2010 and 2011 Orthopedics and Sports Medicine

  8. Concussion: Epidemiology High School Reporting Information Online & NCAA Injury Surveillance System (2005-2006) • 8.9 % all high school athletic injuries • 5.8 % all collegiate athletic injuries • 16.8% had previous concussion (that season or prior season) • Sports Concussion Rates • Football • Girls soccer • Boys soccer • Girls basketball Orthopedics and Gessel et al, J Athl Trning 2007 Sports Medicine

  9. Concussion: Epidemiology in High School Athletes • Concussion rate per 1000 athlete-exposures • Football: 0.47 • Girl’s soccer: 0.36 60% higher • Boy’s soccer: 0.22 • Girl’s basketball: 0.21 300% higher • Boy’s basketball: 0.07 Gessel LM et al. “Concussions Among United States High School and Collegiate Athletes” Journal of Athletic Training 2007; 42:495-503 Orthopedics and Sports Medicine

  10. Gender Comparable Sports • Girls had a higher rate of concussions than boys • Concussions represented a greater proportion of all injuries in girls’ sports • Girls had a greater proportion of concussions due to player-playing surface contact and player-equipment contact Marar,M et al. AJSM online 01/27/12 Orthopedics and Sports Medicine

  11. Concussion: Epidemiology • Risk for future sports concussion: • 1 previous concussion: 1.5x risk • 2 previous concussions: 2.8x risk • 3+ previous concussions: 3.5x risk Guskiewicz, JAMA 2003 Orthopedics and Sports Medicine

  12. Concussion: Epidemiology • ������������������������������������������������������� • ��������������������������������������������������������� ������������������� • ���������������������������������������������������� ����������������������������������������������� ���������� Boden, AJSM 2007 Orthopedics and Sports Medicine

  13. Concussion Symptom Resolution 25% had symptom resolution within one day 40% had symptom resolution within three days (except girl’s track and field and swimming Marar,M et al. AJSM online 01/27/12 Orthopedics and Sports Medicine

  14. Concussion Basics: Knowing your Athletes • A concussion should be suspected in the presence of ANY ONE OR MORE of the following: • Symptoms Symptoms • (Headache, nausea, ringing in ears) (Headache, nausea, ringing in ears) • Physical signs Physical signs • (unsteadiness, LOC, Appears dazed) (unsteadiness, LOC, Appears dazed) • Impaired brain function Impaired brain function • (e.g. confusion, difficulty remembering) (e.g. confusion, difficulty remembering) • Abnormal behavior Abnormal behavior • (e.g. severe anger, sadness) (e.g. severe anger, sadness) Orthopedics and Sports Medicine

  15. Treatment: Immediate Response • Any athlete with a suspected concussion should… IMMEDIATELY BE REMOVED FROM PLAY IMMEDIATELY BE REMOVED FROM PLAY • Should Not… BE LEFT ALONE and should not drive a motor vehicle BE LEFT ALONE • Seek Medical Attention right away if: You notice any change in behavior/ worsening worsening of symptoms of symptoms Loss of consciousness more then 1 minute, Vomiting more Loss of consciousness more then 1 minute, Vomiting more then once , double vision, excessive drowsiness then once excessive drowsiness or inability to recognize familiar people. • Seek Health Care Professional afterwards • No Alcohol • Do NOT use aspirin or anti-inflammatory medication Orthopedics and Sports Medicine

  16. Concussion Basics: Knowing your Athlete • If you suspect a concussion remove athlete from play and have them evaluated by a Licensed Health Care Provider trained in the evaluation and management of concussion: • Medical Doctors (MD) • Doctor of Osteopathy (DO) • Advanced Registered Nurse Practitioner (ARNP) • Physicians Assistant (PA) • Licensed Certified Athletic Trainers (AT/L) • As a coach what should I expect from my player’s healthcare providers? Orthopedics and Sports Medicine

  17. What My Team’s Health Care Provider Should Know SCAT3 SCAT3 Child Zurich Consensus Statement Orthopedics and Sports Medicine

  18. Recognizing when a concussion occurs SYMPTOMS Symptoms may include one or more of the following: Cognitive Somatic Affective Sleep Confusion Headache Emotional lability Drowsiness Post-traumatic amnesia Fatigue Irritability Sleeping less (PTA) Disequilibrium, dizziness Sleeping more Retrograde amnesia Nausea/vomiting Trouble falling asleep (RGA) Visual disturbances Loss of consciousness (photophobia, (LOC) blurry/double vision) Disorientation Phonophobia Feeling “in a fog” Vacant stare Inability to focus Delayed verbal and motor responses Slurred/incoherent speech Excessive drowsiness Orthopedics and Sports Medicine

  19. Recognizing when a concussion occurs: Decreased Brain Function Orientation Memory Function 1 point for each correct answer Failure to have immediate/ delayed recall of words may suggest a concussion What month is it? 0 1 •List 5 separate words and have athlete repeat them What is the date today? 0 1 immediately and after 5min What is the day of the week? 0 1 Example: What year is it? 0 1 Candle, Paper, Sugar, Iron, Sunset What time is it right now? 0 1 Orientation score of _________of 5 Concentration - Months in Reverse Order Ask the patient to state the months backwards starting from the current month. Circle omissions. Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-Apr-Mar-Feb-Jan OR -Days of the Week Backwards Ask the patient to state the days of the week backwards starting from the current day. Circle omissions. Fri-Thur-Wed-Tue-Mon-Sun-Sat Orthopedics and Sports Medicine

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