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“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 • • • • • • • • 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 • • • • • Matthew C. Petznick, D.O. Specialties: Sports Medicine Family Practice Locations: 2500 W. Strub Rd., Suite 230 Sandusky, OH 44870 419-625-1200 • • • 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 • • • • • -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. . EMAIL: [email protected] THANK YOU