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 • Recognizing Concussions • Caring for the concussed athlete (RTP) • Washington State Law Orthopedics and Sports Medicine
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
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
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
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
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
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
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
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
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
Concussion: Epidemiology • ������������������������������������������������������� • ��������������������������������������������������������� ������������������� • ���������������������������������������������������� ����������������������������������������������� ���������� Boden, AJSM 2007 Orthopedics and Sports Medicine
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
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
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
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
What My Team’s Health Care Provider Should Know SCAT3 SCAT3 Child Zurich Consensus Statement Orthopedics and Sports Medicine
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
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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