Download Concussions - Fisher-Titus Medical Center

“CONCUSSIONS:
A HEADACHE OF A
PROBLEM”
OCTOBER 12 2015
BRIAN SIDDALL, M.A., AT, ATC
SUPERVISOR OF A.T. SERVICES
HEADLINES
• Teaching Athletes About Concussion Risks Does Not
Change Their Behavior.
• LSU Experiments with New Technology to Diagnose Head
Injuries.
• Helmet Sensors, Head Bands, Skull Caps, Computerized
Mouth Guards on the Market – Aimed to Make Contact
Sports Safer.
• Study Links Energy Drinks and T.B.I. to Teens
5 Things to do if You Think You
Have a Concussion
1. Get OFF the Field
• Get off the field of play and tell your coaches,
parents, or athletic trainer.
2. Do NOT Play Thru the Concussion
• It will only make the injury worse.
• The brain will use up all of it’s energy reserves
while trying to heal - so it needs to borrow
energy stores from m muscles and other areas
of the body.
• By continuing to work out; you deprive the brain
of energy it needs to recover and symptoms last
longer.
3. Seek a Medical Evaluation
• Select appropriate health care provider trained in
concussion management.
• State Law requires medical clearance before can
RTP.
• Concussions are difficult injuries to assess.
Unfortunately we do not have one single test to
diagnosis a concussion or predict the length of
recovery.
4. Rest is Important
• Rest is important for the reasons previously
described.
• Pacing your daily activities and modifying your
academic requirements are important.
5. Follow the RTP Protocol
• Following the recommended five step return to play
protocol helps athletes know whether symptoms are
completely gone before risking further injury.
• 1. Light aerobic activity
• 2. Moderate Activity
• 3. Heavy, noncontact activity
• 4. Practice and full contact
• 5. Competition
TEACHING POINTS
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The Right Response to Concussions
Current State Laws / OHSAA Guidelines
Assessment of Concussions
Physician's / Athletic Trainer’s Role in Concussion
Management
Return to Play
Return to Learn
Prevention
What every Parent Should Know About Head
Injuries.
The Right Response to Concussions
• Head Injuries must be properly diagnosed and
treated to avoid long-lasting consequences.
• While preventing an injury is always the best,
limited progress has been made in keeping
athletes free of concussions in sports with a high
risk of head injuries.
• Headgear, Changing the Rules, and Exercises
to Strengthen Neck Muscles.
The Right Response to Concussions
• Attribute the rise in reported concussions among
athletes to an increase in awareness, not an
increased risk. Coaches and athletes are bettered
educated – resulting in athletes self-reporting and
coaches less likely to have them return to play.
• The most essential rule is that no player
suspected of having sustained a concussion
should return to activity that day or at any time
until a trained medical processional verifies the
athlete is free of any signs of concussion.
The Right Response to Concussions
• Properly diagnosing a concussion can depend
on knowing an athlete’s cognitive and physical
abilities before an injury. ( Pre-Season
Baseline )
• If a concussion is suspected, these or
comparable tests should be administered and
the results compared with the preseason
findings.
The Right Response to Concussions
• A safe and effective recovery demands players
rest and keep a low-stress environment. The
goal of cognitive rest is to protect the brain from
mental challenges that can increase symptoms
and delay recovery.
• Once all S&S are gone, a gradual return to
activity can begin.
CONCUSSIONS
• A concussion consists of
clinical symptoms stemming
from the brain being shaken
by external forces.
• Sometimes called a “Mild
TBI”.
• Highest concussion rates are
found in football, wrestling,
soccer and girl's basketball.
• Approximately 10% of all
high school athletic injuries
were concussions.
Roughly 80 to 90 percent of
concussions resolve themselves in
seven to 10 days, but a number of
athletes have experienced symptoms
for much longer.
Girl’s Sports – Twice the Concussion Rate
• More willing to report
• Head Size
• Neck Strength
• Girth – Body Mass
OHSAA
• Updated Concussion Regulations in
Response to Ohio House Bill 143
• This law does add several aspects to previous
OHSAA regulations.
• Important Changes From Previous
Regulations Include:
CHANGES – EFFECTIVE APRIL 26, 2013
1. Upon renewal of PAP –coaches must complete
a Concussion course authorized by the NFHS or
the CDC. This course must be taken each time
the PAP is renewed.
CHANGES – EFFECTIVE APRIL 26, 2013
2. RETURN TO PLAY PROTOCOL:
If a player is removed from practice or
competition due to suspected concussion or
head injury, the coach or referee shall not
permit the player, ON THE SAME DAY THE
PLAYER IS REMOVED, to return to that
practice or competition.
RTP will be permitted thereafter only with
written authorization by physician or
authorized health care provider.
MEDICAL AUTHORIZATION TO RETURN
TO PLAY WHEN A STUDENT HAS BEEN
REMOVED DUE TO A SUSPECTED
CONCUSSION
• PRESENT THIS FORM TO THE SCHOOL
ADMINISTRATOR
• Note: The school must retain this form
indefinitely as a part of the student’s
permanent record. [ Up-dated 6/2015 ]
CHANGES – EFFECTIVE APRIL 26, 2013
3. STUDENT AND PARENT REQUIREMENTS:
All students and their parents or legal guardians
shall review and sign the “Concussion
Information Sheet” which has been developed by
the Ohio Department of Health and will be
distributed by OHSAA member schools to all
students and parents prior to each sports season.
Preparticipation Physical Evaluation Form will
reflect this new concussion law on page 6 consent
form.
INJURY ASSESSMENT
• A detailed concussion history is an important
part of the evaluation of the injured athlete.
• Sports Concussion Assessment Tools include
the SCAT3 and Child SCAT3 – easily searchable
on the Internet.
• Forms used in the assessment of possibly
concussed athletes.
Sideline Assessment of Concussion
What You Should Do If Suspect a Concussion
• Player should be safely removed from the
practice or game for evaluation.
• The player should not be left alone, and serial
monitoring for deterioration is essential in the
first few hours following a possible concussion.
• Attention and Memory can be tested with some
of the components in SCAT3. (Maddock’s Score)
Just asking about time, place and surrounding
people has shown to be unreliable in the
sports setting.
Sideline Assessment of Concussion
When to transport to an emergency facility:
Concussion
The Physician’s
Role in Assessment
and Return to Play
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Matthew C. Petznick, D.O.
Specialties:
Sports Medicine
Family Practice
Locations:
2500 W. Strub Rd., Suite 230
Sandusky, OH 44870
419-625-1200
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Accreditations
Board Certified Osteopathic Board of Family
Medicine
Board Certified American Osteopathic Association
of Sports Medicine
Specialty Description
Sports Medicine
- Ultrasound Guided Injections: Intra-articular
hip, ankle, shoulder and various small joints,
Sacro-iliac joint injection, Nerve hydrodissection:
carpal tunnel, cubital tunnel,
Joint/muscle/tendon examination,
Viscosupplementation, Platelet rich plasma (PRP)
injections for chronic tendinosis (future)
- Injuries: Treatment of non-operative orthopedic
problems both sport and non-sport related, Sport
injury prevention, Specialized in keeping athletes
competing while healing
Education & Training
Fellowship: Sports Medicine Fellow, University of
Toledo, Toledo, OH
Residency: Firelands Regional Medical Center,
Sandusky, OH
Degree: Ohio University College of Osteopathic
Medicine
Key Features of the First Medical Consult
• Comprehensive history
• Assessment of mental
status, cognitive
functioning, gait and
balance.
• Detailed neurological exam
(Vestibular Screening)
Key Features of the First Medical Consult
• Determination of clinical status of the athlete.
• Improvement or deterioration since time of injury
• Medications that maybe prescribed to address S/S
• Modifications to D.L.A. and School Attendance
Key Features of the First Medical Consult
• Determination for
neuro-imaging to
exclude the
possibility of a
more severe
brain injury.
Concussion
The Athletic Trainer’s
Role in Assessment
and Return to Play
RETURN TO PLAY
• The assessment of cognitive function should be an
important component in any RTP protocol.
• Cognitive recovery overlaps with symptom recovery
and commonly follows symptom resolution.
• See SAC (Standardized Assessment of Concussion)
in SCAT 3 Forms.
Return to Play Following Concussion
Normal testing (“at baseline”) and clinical impression determine
beginning of return to play progression .
No set time for completion.
No set time period for completion
Return to Play
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-INDIVIDUALIZED!!
-Proceed to next level only if asymptomatic
-Each step should take 24 hours
-Start when asymptomatic at rest
-If symptoms recur, drop back to last
asymptomatic level after a 24 hour period of rest
Return to Learn:
Transitioning students with head injuries
back to class
• Cognitive demands (e.g., school) can exacerbate
symptoms and prolong recovery
• Simple accommodations to ease student’s transition
back into the classroom.
•
If the student stays at home, s/he must avoid extensive computer use,
texting, video games, television, loud music, and music via headphones.
These activities make the brain work harder to process information and
can exacerbate symptoms, thereby slowing down recovery.
SYMPTOMS – 10 DAYS +
• Ten to 15 percent of concussed athletes
go on to have persistent S/S post 10
days.
• Need to consider other pathologies:
► Structural Damage
► Neuro-Transmitter
► Psychological Disorder
Concussion Management
3 LAYERS:
• Game Rules
An once of prevention
is worth a pound of
cure”
- Benjamin
Franklin
“
•Coaching Technique
•Equipment
Prevention
• Safety First!
– Follow the rules of the game
– Encourage good sportsmanship
– Teach safe playing technique
– Protective equipment that is properly fitted,
well maintained, and worn at all times
– Never return a symptomatic athlete to play
All education must be focused around
the following statement from the CDC:
• “All concussions are not created equally. Each
player is different, each injury is different, and all
injuries should be evaluated by the team medical
staff”.
• www.cdc.headsup
• www.healthyohioprogram.org/concussion
What every parent should know
about concussions
• What makes a child’s brain unique
• Recognizing signs and symptoms
• Return to play and return to learn
What makes a child’s brain unique
• Concussions are a type of mtbi and believed to
result from a traumatic shaking of the brain.
• Because child’s brain have less mass in relation
to the skull, their brains experience more
acceleration (brain can hit skull with more force)
• A child’s brain also appears to be far more
plastic or impressionable than an adult’s. Thus,
less resistant to trauma.
Recognizing signs and symptoms
• Research shows that parents have
misconceptions regarding definition, symptoms,
and treatment of concussions.
• Parents are in prime position to recognize the
signs and symptoms of a concussion in their
child.
• Parents can pick up the subtle signs of problems
associated with a previous concussion.
Signs & Symptoms - Four Categories
• Physical
• Cognitive
• Emotional
• Sleep Patterns
Return to play and return to learn
• Communication gaps in the medical community
• Cornerstone initially is REST – physical & cognitive
• Concussions are a metabolic crisis for the brain
because blood flow and glucose delivery are
impaired. The brain needs energy to function
normally and heal itself. (If brain is over active-may
not get as much energy as it normally needs to
function normally).
Return - Continued
• Children with concussions symptoms may have
to modify classroom work and instruction.
• Resuming physical activity should be
progressive as well.
• Following these guidelines can help parents to
be protective of their children’s brains and
potentially prevent long-term effects or tragic
consequences.
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EMAIL:
[email protected]
THANK YOU