CANTU Program: Concussion Awareness Neurological Training & Understanding 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
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: The initial impact caused by linear and rotational 1. biomechanical forces The chemical changes that could evolve over a period of 2. 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 2 nd 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 occur 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 obstacle 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
Possible Signs Observed Behavioral Changes Cognitive Impairment Display unusual or Confusion inappropriate emotions Unsure of game, score, Inappropriate playing opponent, time, date, or place behavior Forgets plays Shows behavior or Answers questions slowly personality changes Poor concentration Slow reaction time Fogginess Forgets events prior to injury Forgets events after injury
Symptoms of a Concussion Physical Symptoms : Cognitive Symptoms : Headaches (85%) Confusion Dizziness (70-80%) Difficulty with memory and attention Difficulty with balance Difficulty thinking clearly Nausea/vomiting Excessive fatigue Feeling slowed down Difficulty sleeping Difficulty with executive functioning Double or blurred vision Difficulty with critical thinking Sensitivity to light or sound Difficulty with word retrieval Emotional Symptoms : Irritability Restlessness **Any pre-existing learning Anxiety problems tend to become Depression exacerbated (i.e. ADHD, OCD, Mood swings learning disability) Aggression ↓ tolerance to stress
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 Symptom checklist 1. 2. Mechanism of concussion Concussion history 3. 4. Physical exam Cognitive exam 5.
Occupational Therapy
Occupational Therapy: May help patients complaining of: Headaches, discomfort around Double vision/blurred vision eyes, squinting, difficulty Difficulty following movement opening eyes or looking at movement Difficulty focusing when Impaired eye-hand looking far to near coordination Difficulty reading or using the Decreased quality of computer handwriting Light and screen sensitivity Impaired ability to locate objects Difficulty navigating through environments
Speech Pathology 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 Difficulty with executive attention/memory functioning: Organization Difficulty with word retrieval Preplanning Follow through Slower processing speed Critical thinking Limited cognitive Self- analysis endurance Difficulty with return to Difficulty problem solving learn in academic setting
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
Physical Therapy May help patients complaining of: Headaches Decreased neck, shoulder, and mid-back strength Dizziness and nausea Poor posture Decreased balance/history of falls Decreased exercise tolerance Neck pain, tightness, and stiffness Decreased neck range of motion Light sensitivity
Concussion Safety
Baseline Concussion Screening 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)
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
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