Download Concussion Information for Parents

Concussion
Presentation, Management, and Prevention
Brandon D. Larkin, M.D.
Primary Care Sports Medicine
St. Peters Bone and Joint Surgery
What is a concussion?
A brain injury
Caused by a bump or blow to the
head or body, even if mild
May result from a fall or from players
colliding with each other or with
obstacles
Changes the way the brain normally
works
What is a concussion?
Can’t see it.
May be referred to as
– “Ding”
– “Bell rung”
Signs and symptoms
may be noticed
– Right after the injury
– Days or weeks later
What is a concussion?
Can occur without loss of
consciousness.
Can occur in any sport, during
games or practices, or during
unorganized activity.
Statistics
Up to 3.8 million
sports- and recreationrelated concussions
per year.
1/10 of sports-related
injuries require
hospitalization.
20% of high school
and 40% of college
football players will
sustain a head injury.
2 to 4 times greater
risk of recurrence.
High
High Risk
Risk Sports
Sports
Football/Rugby
Gymnastics
Hockey
Wrestling
Lacrosse
Equestrian Sports
Martial
Arts/Boxing
Signs of a Concussion
Appears dazed or
stunned
Is confused about
assignment or position
Forgets an instruction
Is unsure of game,
score, opponent
Moves clumsily
Signs of a Concussion
Answers questions
slowly
Loses consciousness
Shows behavior or
personality changes
Can’t recall events
prior to hit or fall
Can’t recall events
after hit or fall
Symptoms Reported by Athlete
Headache or
“pressure” in head
Nausea or vomiting
Balance problems
or dizziness
Double or blurry
vision
Sensitivity to light
Sensitivity to noise
Feeling sluggish,
hazy, foggy, or
groggy
Concentration or
memory problems
Confusion
Does not “feel
right”
Symptom Explanations
“I’ve gone from HD to standard
definition.”
“I feel like I’m underwater.”
“I feel one step behind the rest of
the world.”
What should you do when you
suspect a concussion?
Keep the athlete out of play.
– “When in doubt, take them out.”
– Should never return while symptomatic.
– Concussions take time to heal.
– Returning too early increases the risk of
a second concussion.
What should you do when you
suspect a concussion?
Seek medical
attention right away.
– Coaches and parents
should not judge the
severity of the injury
themselves.
– A professional
experienced in
evaluating concussion
should guide return to
play.
Important Information
for the Physician
Cause of injury and force of the hit
or blow to the head
Any loss of consciousness
Any memory loss immediately
following the injury
Any seizures immediately following
the injury
Number of previous concussions
What should you do when you
suspect a concussion?
Open lines of
communication.
– Athletes should tell
parents and coaches.
– OK to tattle on
teammates.
– Parents should be
advised to have child
seen by a physician.
– Coaches should be told
if a child has had a
recent concussion in
any sport.
What should you do when you
suspect a concussion?
Allow the athlete to return only with
permission from a health care
professional with experience in
evaluating for concussion.
– Emergency room physicians cannot
clear an athlete to return.
– Dire consequences with early return.
Current Protocol
Evaluation of injured athlete on the
sideline or in the athletic training
room.
Clearance by a physician once
symptoms have resolved.
Graduated return to play protocol.
SCAT2
Sport Concussion
Assessment Tool
Utilized by FIFA, IOC,
International Ice Hockey
Federation
Combines signs,
symptoms, memory,
cognitive and neurologic
function to guide
management
Sport
Concussion
Assessment
Tool
GCS
GCS
Scaled 3-15
13-15 MBI
(Minimal Brain
Injury)
9-12 Moderate
Injury
<8 Severe Injury
Neuropsychological Testing
In most cases, cognitive recovery
overlaps with the time course of
symptom recovery.
Commonly follows symptom
resolution.
Suggests that NP testing should be
used in RTP protocols.
ImPACT is a sophisticated, research-based computer test
developed to help clinicians evaluate recovery following
concussion.
ImPACT is a 20-minute test battery that can be
administered in the pre-season for a baseline and
post-injury to track a concussion.
ImPACT promotes an athlete’s full recovery from injury and
assists clinicians in making a safe return-to-play decision
and reducing the chance of follow-up concussions.
ImPACT’s technology assesses eight key neurocognitive
domains.
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–
–
–
–
–
–
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Impulse Control
Sustained Attention
Visuomotor Processing Speed
Visual and Verbal
Memory (immediate/delayed)
Working Memory
Selective Attention
Reaction Time
Response Variability
Pediatric and Adolescent
Concussion
Longer recovery
May require
modifications for
cognitive rest
Limit ALL activities
that require
concentration and
attention
More cautious RTP
Complications
Postconcussive syndrome
– Prolonged symptoms
Decreased memory and attention
span
Decreased mental processing
Irritability
Fatigue
Sleep problems
Headaches
“Foggy” feeling
Complications
Decreased mental
function
– Requires testing by
neuropsychologist
– Repeated concussions
may have a cumulative
effect
– May lead to permanent
problems
Complications
Second impact syndrome
– Brain swelling
– Likely to result in significant brain
damage and death
– May be caused by a mild second injury
in a symptomatic athlete
Follow
-up Care
Follow-up
Care
Avoid contact activities
Avoid sedating
medications
– Narcotics,
antihistamines
May note difficulty with
reading, homework, and
testing
Ice, Tylenol, light diet
What to watch for
after a head injury
Should not be left
alone
Awaken every 2-3
hours?
Normal signs in the
first 2 days
– Fatigue and desire for
extra sleep
– Headache
– Nausea and vomiting
– Problems with thinking,
concentration, attention
span
Seek immediate medical attention!
Marked change in personality
– Confusion
– Irritability
Worsening headache, especially with nausea and
vomiting
Numbness, tingling, or weakness in arms or legs,
changes in breathing patterns, or seizure
Eye and vision changes
–
–
–
Double vision
Blurred vision
Unequal-sized pupils
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
Prevention
Education
– Talk with athletes, parents, and coaches
about the dangers and potential longterm consequences of concussion
– cdc.gov/concussioninyouthsports
Prevention
Teach athletes, parents, and coaches
that it’s not smart to play with a
concussion.
– “Playing hurt shows strength and
courage”
– No pressure to return
– Don’t allow athletes to persuade
coaches and parents that they are “just
fine”
Prevention
Prevent long-term problems
– Repeat injury may slow recovery or
increase risk of long-term problems
– Don’t forget the second impact
syndrome
– Have players evaluated before returning
– “It’s better to miss one game than the
whole season.”
Quiz Time!
1. A concussion is a brain injury.
TRUE
2. Concussions can occur in any
organized or unorganized
recreational sport or activity.
TRUE
3. You can’t see a concussion and
some athletes may not experience
and/or report symptoms until hours
or days after the injury.
TRUE
4. Following a coach’s rules for safety
and the rules of the sport, practicing
good sportsmanship at all times, and
using proper sports equipment are
all ways that athletes can prevent a
concussion.
TRUE
5. Concussions are caused by a fall or
by a bump or blow to the head or
body.
TRUE
6. Concussion can happen even if the
athlete hasn’t been knocked out or
lost consciousness.
TRUE
7. Nausea, headaches, sensitivity to
light or noise, and difficulty
concentrating are some of the
symptoms of concussions.
TRUE
8. Athletes who have a concussion
should not return to play until they
are symptom-free and have received
approval from a doctor or health care
professional.
TRUE
9. A repeat concussion that occurs
before the brain recovers from the
first can slow recovery or increase
the likelihood of having long-term
problems.
TRUE