Welcome to todays School Nurse Webinar Return to Play Act of 2013 - - PowerPoint PPT Presentation

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Welcome to todays School Nurse Webinar Return to Play Act of 2013 - - PowerPoint PPT Presentation

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Welcome to todays School Nurse Webinar Return to Play Act of 2013 Webinar September 27, 2013 To set up your audio to listen to todays webinar, please complete the following steps. Open the Tools menu Select Audio Then select

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Children’s Healthcare of Atlanta

Welcome to today’s School Nurse Webinar

Return to Play Act of 2013 Webinar September 27, 2013

  • To set up your audio to listen to today’s webinar,

please complete the following steps.

– Open the Tools menu – Select Audio – Then select Audio Setup Wizard – Follow the steps to select the correct speakers, head set, or audio settings to listen to the webinar.

  • When finished please return to this screen.
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Children’s Healthcare of Atlanta

Disclosure Statement

Return to Play Act of 2013 Webinar September 27, 2013

GNA# 2013-0830-01 Contact hours:1.0

  • The Planners & Speakers for this program have declared no

financial affiliations related to this topic.

  • Successful completion of this program includes attendance

at 100% program and completion of an evaluation with Survey Monkey:

https://www.surveymonkey.com/s/DRHNNQQ

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CONCUSSION:

The Facts and Controversy

Da vid M Po po li, MD Pe dia tric a nd Ado le sc e nt Spo rts Me dic ine

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Children’s Healthcare of Atlanta

The Statistics

  • 2008 (ED data)

– 60 million youth 5-14 yr.. in organized sports – 3.8 million concussions from sport and recreation – Underestimated due to under-reporting (1)

  • 2009-2010 (H.S. Reporting Information Online)

– 192 High Schools – 1056 Concussions

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Children’s Healthcare of Atlanta

Objectives

  • Define concussion
  • Explain concussion pathway
  • Discuss treatment and prevention
  • Georgia Return to Play Act 2014
  • Discuss controversies
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Children’s Healthcare of Atlanta

Definition

  • Consensus Guidelines 2012
  • Characteristics

1. Direct or impulsive force 2. Rapid onset 3. Functional 4. Clinical symptoms 5. No abnormality on standard imaging

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Children’s Healthcare of Atlanta

This is Not a “Bump on the Head”

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Children’s Healthcare of Atlanta

The Big Picture

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Children’s Healthcare of Atlanta

What’s Really Happening

Twist/Stretch “Leaks” Electrical discharge Recharge

Mechanical Injury leads to

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Children’s Healthcare of Atlanta

Assessment -- Symptoms

  • Loss of Consciousness
  • Amnesia, retrograde or anterograde
  • Disorientation
  • Appearing dazed
  • Acting confused
  • Forgetting game rules or play assignments
  • Inability to recall score or opponent
  • Inappropriate emotionality
  • Physical incoordination
  • Imbalance
  • Seizure
  • Slow verbal responses
  • Personality changes
  • Headache
  • Headache
  • Nausea or vomiting
  • Difficulty balancing
  • Vision changes
  • Photophobia
  • Phonophobia
  • Feeling “out of it”
  • Difficulty concentrating
  • Tinnitus
  • Drowsiness
  • Sadness
  • Hallucinations
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Children’s Healthcare of Atlanta

Assessment – What You’ll Be Told

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Children’s Healthcare of Atlanta

Assessment – What You’ll Be Told

  • Symptoms
  • School performance
  • Activity tolerance
  • Sleep
  • Appetite
  • Mood
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Children’s Healthcare of Atlanta

Assessment – What You’ll See

  • Mental status
  • Coordination/Balance/Walking
  • Strength
  • Sensation
  • Neuropsychological testing
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Children’s Healthcare of Atlanta

Computerized Neuropsychological Testing

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Children’s Healthcare of Atlanta

Computerized Cognitive Testing

10 20 30 40 50 60 70 80 90 100 Baseline Post Injury 1 Post Injury 2 Post Injury 3

Verbal Memory Visual Memory Processing Speed Reaction Time

6 Days Post 16 Days Post 23 Days Post

Percentile

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Children’s Healthcare of Atlanta

Management

  • Physical and cognitive rest
  • Academic accommodations
  • RTP stages
  • Imaging*
  • Medication*
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Children’s Healthcare of Atlanta

Academic Accommodations

  • Acute (Days 0-13)

– Time off if needed and Letter of Accommodation and SST Meeting

  • Sub Chronic (Days 14-28)

– Facilitate Transition to Longer Term Accommodations if needed

  • 504 plans
  • Individualized Educational Program
  • Chronic (Days 28+)

– Engage other Specialties and Consider Additional Diagnosis

(6)

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Children’s Healthcare of Atlanta

Georgia Return to Play Act

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Children’s Healthcare of Atlanta

Georgia Return to Play Act

  • All public and private schools which provide youth athletic activities

are required:

– Provide information to parents on the nature and risk of concussion and head injuries – Establish a concussion management and return to play policy to include:

  • An Information sheet prior to the beginning of each athletic season
  • Youth athlete must be removed from play if exhibiting symptoms
  • Youth athlete must be cleared by a healthcare provider before return to play
  • Public recreational programs are also required to provide information

to parents on the nature and risk of concussion and head injuries

  • Georgia Department of Public Health shall endorse one or more

concussion recognition education courses to inform Georgia citizens of the nature and risk of concussions in youth athletics

  • Effective date: January 1, 2014
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Children’s Healthcare of Atlanta

Georgia Return to Play Act

  • To help schools & recreational leagues comply with

the new law, Children’s concussion team has created resources to help with these new requirements. – Concussion Reference Guide – Educational Fact Sheets – Return to School & Activities Guideline – Guardian Concussion Notification Sheet Visit choa.org/concussionlaw to download these materials.

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Children’s Healthcare of Atlanta

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Children’s Healthcare of Atlanta

Return to Play

Sta g e E xe rc ise Go a l 1 No ne Re c o ve ry 2 L ig ht Ae ro b ic I nc re a se HR 3 Spo rt-Spe c ific Add mo ve me nt 4 No n-Co nta c t Drills Co o rdina tio n 5 Co ntro lle d-Co nta c t Drills Re sto re Co nfide nc e 6 F ull Co nta c t Pra c tic e Ga me Re a dy 7 Co mpe titio n Pla y

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Children’s Healthcare of Atlanta

Cumulative Effects

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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

  • Emotional
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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

  • Emotional
  • Cognitive
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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

  • Emotional
  • Cognitive
  • Gait
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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

  • Emotional
  • Cognitive
  • Gait
  • Parkinsonism
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Children’s Healthcare of Atlanta

Chronic Traumatic Encephalopathy

  • Emotional
  • Cognitive
  • Gait
  • Parkinsonism
  • MND
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Children’s Healthcare of Atlanta

Prevention

  • Mouthguards
  • Helmets
  • Rules/regulations
  • Style of play
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Children’s Healthcare of Atlanta

More Information

  • Children’s Healthcare of Atlanta
  • Centers for Disease Control and Prevention