Heads Up! Adam Kleeburger , 2011 Dr . Brian Christie , Division of - PowerPoint PPT Presentation

Division of Medical Sciences Heads Up! Adam Kleeburger , 2011 Dr . Brian Christie , Division of Medical Sciences, University of Victoria Island Medical Program, University of British Columbia Director , UVic Concussion Lab, Rm 194 McKinnon Building Phone: 250 ‐ 472 ‐ 5997; Email: brainlab@uvic.ca Online appointment booking: https://instan t‐scheduling. com/sch.php?kn=1905924

Division of Medical Sciences Media portrayal of concussions G. Courtnall M. Richter

Division of Medical Sciences Think of three sports you expect to see concussions in: Football Hockey Boxing

Division of Medical Sciences Famous athletes with concussions you don’t hear as much about: Bonus Question: What famous Canadian sports figure suffered a severe head injury on March 28,1950?

Division of Medical Sciences Roger Staubach, Age 71 Gordie Howe, Age 86 Gordie Howe had brain surgery to relieve fluid build up after a hit in 1950. Joe Frazier , Age 66

Division of Medical Sciences Learning Objectives: 1. What is a concussion? 2. Concussion incidence in BC 3. Concussion Diagnoses in Adults and Children 4. Standardized Concussion Assessment T ool (SCA T). 5. Management of Symptoms 6. Return to Play/Return to Academics 7. New Vistas in Concussion Assessment and Treatment

Division of Medical Sciences What are ConcussionS? 1. From Latin Concutere “ to shake violently ” or concussus “ striking together ” 2. Mild Traumatic Brain Injury – widely accepted clinical medical term 3. Muhammad ibn Zakariya Razi : Persian physician may have been first to use the term “ cerebral concussion ” and defined it as “ a transient loss of function with no physical damage ” 4. Modern Definition can vary depending upon the health professional: No loss of consciousness ‐ loss of consciousness <30 minutes Post ‐ traumatic amnesia for <30 minutes ‐ >24 hours Dizziness/nausea/mental confusion <24 hours – 2 ‐ 3 weeks 5. Headache is the most common physical symptom (others include: dizziness, vomiting, balance issues, light and/or sound sensitivity, vision problems, <2% convulsions from motor function impairments. 6. Cognitive symptoms include confusion, lack of focus, amnesia, confusion, irritability, slow to respond, confusion, loss of interest, lethargy, sleep problems.

Division of Medical Sciences Concussions are caused by the movement of the brain inside the skull.

Division of Medical Sciences Concussions are caused by the movement of the brain inside the skull.

Division of Medical Sciences Helmets don’ t prevent concussions. Helmets help prevent localized head injuries, like skull fractures. Fit and comfort are what is important.

Division of Medical Sciences Concussions in BC Data is from the BC Injury and Prevention report from January 2013. From 2001 ‐2010, for children and youth ages 0 ‐ 19 years, there were: 268 head injury deaths Majority were transport ‐ related (91%) 1,619 concussion ‐ related hospitalizations (in patient) Leading causes were falls, transport related, and struck by/against an object In a one year period there were: 6,675 concussion ‐ related emergency department visits in the Lower Mainland (out patient) Leading causes were falls, sports and recreational activities, and struck by/against an object Males account for 60 ‐ 70 percent of head injuries resulting in death, and concussion ‐ related hospitalizations and emergency department visits

Division of Medical Sciences Sports Related Concussions in BC

Division of Medical Sciences There are different ways to look at incidence rates Cause of TBI varies with age : 0 ‐ 4 (child abuse / assault) 10 ‐ 14 (sports injury) 15 ‐ 19 (motor vehicle accidents) 65 and older (falls) High risk groups: • Alcohol/substance abuse • High risk behaviour • Male gender (2:1) • History of prior TBI • Psychiatric illness • ADHD • Lower socio ‐ economic status • Lower levels of education • Unemployment

Division of Medical Sciences Is Concussion data in BC accurate?

Division of Medical Sciences When players are surveyed AFTER the season about symptoms they had during the season, without using the word concussion, the incidence rate increases 10 – 50 times the reported rate by medical professionals.

Division of Medical Sciences Assessing a concussion – Best current practice is to have some sort of baseline. • SCA T3 Sport Concussion Assessment T ool 3 (Free test) – Glasgow coma scale, Sideline Assessment Maddocks Score, Symptom evaluation – Standard Assessment of Concussion SAC (cognitive), Balance Error Scoring System BESS – Coordination Examination (finger to nose test) – There is a childrens version of the test • ImPACT Immediate Post ‐ Concussion Assessment Cognitive T est ($25 ‐ $40 up front, more later ) • Computerized cognitive tests, Attention, working memory , processing speed, response variability , nonverbal problem solving. • Quantitative Measures (King‐ Devick, Neurotracker , Reaction Time, Olfaction, etc.) • The future of concussion testing?

Division of Medical Sciences http://physicians.cattonline.com/scat Any child suspected of having a concussion should be removed from play, and then seek medical evaluation. The child must NO T return to play or sport on the same day as the suspected concussion. The child is not to return to play or sport until he / she has successfully returned to school / learning, without worsening of symptoms. Medical clearance should be given before return to play. Released in 2013 Main Components: Glasgow coma scale (Sideline assessment) Symptom Evaluation (Child and Parent) Cognitive and Physical Evaluation Neck Exam Balance Exam Coordination Exam Delayed Recall

ical Sciences Division of Med Page 1: Information for onsite/sideline assessment. GCS < 15 Indicator of more serious injury and need for Medical Assessment

ical Sciences Division of Med Page 2. Symptom Evaluation Memory assessment Focus/mental agility Neck Balance

dical Sciences Division of Me Standardized Instructions for test administration and interpretation.

ical Sciences Division of Med Post ‐injury alerts, return to play guidelines, px advice.

Division of Medical Sciences Primary Care History – Baselines? Physical examination Diagnosis Monitoring Reassurance

Division of Medical Sciences Lack of Mood Lack of restorative restorative Mood sleep sleep Pain (e.g., Motivation Pain (e.g., headaches) Motivation headaches) Cognitive Performance Pre ‐ injury Pre ‐ injury TBI Cognitive problems problems TBI (ADHD & Performance (ADHD & LD) LD)

Division of Medical Sciences 3. Management of Symptoms The first 24 hours REST REST REST If progression of symptoms or worsening then reassessment.

Division of Medical Sciences 4. Supervised return to play

Division of Medical Sciences 4. Return to academics

Division of Medical Sciences Slower recovery is common in children • 30% of children have persistant symptoms (Yeates, 2012) • Understanding the child brain is particularly challenging due to ongoing developmental changes • Outcomes can be worse after injury in infancy / preschool years • Delayed consequences

Division of Medical Sciences Misattribution bias • belief that one has a “permane nt brain damage ” • pre ‐occup ation with minor physiological symptoms • causes a vicious cycle between physical complaints and emotional arousal Neuropsych Assessment?

Division of Medical Sciences 5. New Vistas in Concussion Assessment Neurotracker; King ‐ Devick

Division of Medical Sciences MOT as an Indicator of Awareness • Can the person track motion throughout the visual field? • Motion tracking is the foundation of awareness. • Motion tracking does not require a high level of visual acuity. MOT as an Indicator of Attention • Can the person prioritize key stimuli while ignoring less important stimuli? • (Selective attention) • Can the person focus and maintain attention on objects in motion? • (Dynamic attention) • Can the person predict motion paths of objects hidden from view? • Can the person predict altered motion paths from collisions? • Can the person spread attention between multiple key points? • (Distributed attention) • Can the person sustain attention for several seconds without interruption? • (Sustained attention)

Division of Medical Sciences Neurotracker is a high performance athlete training tool to enhance sports vision and awareness. Dr . Jocelyn Faubert, Creator “ We ’ d like to show that using the neurotracker alters brain chemistry and enhances brain plasticity. ” Dr . Len Zaichkowsky “ The players love it, but if they have some sort of head injury they find it difficult to play. ”

Division of Medical Sciences

Division of Medical Sciences

Division of Medical Sciences

Division of Medical Sciences LOC = Loss of conciousness