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Concussion PartoftheRFU“Don’tbeaHEADCASE”concussionawarenessand educationprogramme LaunchedJan2013 Supersededpreviouscampaign– “Useyourhead”launchedin2007. Formoreinformationvisit www.englandrugby.com/headcase. Forresourcesemail– [email protected] Follow @EnglandRugbyCoach and @RugbySafe Welcome

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Page 1: 140912 Concussion Presentation for pdf - Amazon S3...Microsoft PowerPoint - 140912 Concussion Presentation for pdf.pptx Author HoodK Created Date 9/12/2014 10:35:39 AM

Concussion�

• Part�of�the�RFU�“Don’t�be�a�HEADCASE”�concussion�awareness�and�education�programme�� Launched�Jan�2013

• Superseded�previous�campaign�– “Use�your�head”�launched�in�2007.

For�more�information�visit�� www.englandrugby.com/headcase.�

For�resources�email�– [email protected]

Follow � @EnglandRugbyCoach and@RugbySafe

Welcome

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Concussion�– the�landscape�has�changed

Zachary�LysadtLaw

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RFU�Survey�09/10�of�16�– 18�year�olds

• Regarding�personal�concussion�history:–66.2%�of�this�group�did�not�leave�the�field�after�a�concussion;–37.9%�did�not�report�their�concussion.�–Only�9.8%�of�concussed�players�waited�the�stipulated�3�weeks�before�returning�to�play.���

• Coaches�=�key�source�of�information

Players’�Source�of�Information�on�Concussion

0%

10%

20%

30%

40%

50%

60%

70%

80%

Teammate26.3%

Coach�68% Parent�24.6% First�aider30.9%

Dr/Physio25.7%

Other�7.4%

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RFU�Concussion�Risk�Management�Strategy�– Summary�

EducationPrevention� Management� Research Communication

Evidence�based,�independently�reviewed,�and��effectiveness�evaluated�

Across�communities�of�practice�(Priority�=�coaches)

What�is�concussion?�

• The�brain�is�injured�as�a�result�of�a�blow�to�the�head�or�body• It�is�a�traumatic�brain�injury• ?�Functional�disturbance�– routine�brain�scans�are�normal�• Variable�impact�threshold�• Loss�of�consciousness�in�only�10�� 15%�of�cases• Recognition�can�be�difficult• Symptoms�may�be�delayed�up�to�72�hours• Usually�expect�complete�recovery��• Repetitive�concussions,�particularly�before�full�recovery�can�

have�potential�for�serious�and/or�long�term�consequences

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What�have�we�started�to�understand?

• Concussion�takes�longer�to�resolve�than�previously�thought– Microscopic�injury�rather�than�functional�disturbance

• The�brain�is�more�vulnerable�to�further�injury�immediately�after�and�during�recovery�from�a�concussion:– Risk�of�further�concussion�– likely�to�be�more�severe�and�prolonged�– Other�injury�� slowed�reactions�and�poor�coordination�– Further�brain�injury�– very�rare�but�fatal�brain�injury�in�young�players�

(second�impact�syndrome)

• Repetitive�concussions:– Increase�the�risk�of�prolonged�concussion�symptoms�– May�cause�early�onset�cognitive�and�memory�impairment�in�latter�life– Potential�association�with�degenerative�brain�disease�in�latter�life.�

Short�term�effects�� a�bit�of�science

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Symptom�Recovery

Source:�McCrea�et�al.,�2013,�p.�26.

GSC�– Graded�Symptom�Checklist

Where�do�head�injuries�occur?�

• Road�traffic�collisions�e.g.�cars,�cyclists• Falls�e.g.�playground�or�around�school�• Assaults�e.g.�Saturday�nights�out!• Sport�and�recreational�activities

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Concussion�Rates�

Sport Concussion�rate�per�1000�player�hours

Horse�racing�(Amateur) 95

Horse�racing�(Jumps) 25

Horse�racing�(Flat) 17

Boxing�(professional) 13

Australian�football�(professional) 4�� 20

Rugby�union�(professional) 7�– 11

Ice�Hockey�(NHL) 1.5???

Rugby�Union�(Youth) 1 – 2

Rugby�union�(amateur�adult) 1�– 1.5

Soccer�football�(FIFA) 0.4

NFL�football�(NFL) 0.2???

Source�– 4th Int Concussion�Conference�Presentation�– Dr�M�Turner��+�subsequent�publications�

Prevention

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ALL�have�a�part�to�play

BUT�– Coaches�have�the�key�role�because:• Primary�source�for�concussion�information�for�players• Set�culture�within�the�team/squad/club• Develop�players:– Techniques�– Influence�behaviours– Provide�information/education�

• Select�who�plays�and�plan�training�sessions• Often�first�or�only�adult�on�scene• Manage�replacements�

Prevention

• Reduction�in�head�trauma�is�key:– Tackle�technique– Player�behaviour�in�contact– Zero�tolerance�of�foul�play:

• Collision�“tackles”• High�tackle• Tip/spear�tackle• Taking�out�player�in�the�air• Targeting�head�in�contact�and�punching�

– Playing/training�ground�conditions�

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Injuries�by�Event�� Youth

On�Field�Management

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TAKE�CONCUSSION�SERIOUSLY�RECOGNISE�– know�the�symptoms�and�signs�of�concussion.� Remember�you�do�not�need�to�be�knocked�out�to�have�a�concussion.�REMOVE�– any�player�with�suspected�concussion,�right�away.�Continuing�to�play�increases�their�risk�of�more�severe�injury,�and�longer�lasting�concussion�symptoms,�as�well�as�increasing�their�risk�of�other�injury.RECOVER�– take�time�to�fully�recover�as�you�would�with�any�other�injury.�

RETURN – all�players�must�follow�a�step�wise�Graduated�Return�to�Play�(GRTP)�and�must�not�go�back�to�rugby/sport�until�they�have�been�cleared�to�do�so�by�a�doctor

For�more�information�visit�� www.englandrugby.com/headcase

RECOGNISE

• Obvious:– Actual�or�suspected�loss�of�consciousness– Convulsion�or�posturing�– Loss�of�coordination/balance– Vomiting– Confusion–Memory�loss– Clearly�dazed

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RECOGNISE

• Less�obvious:– Nausea– Drowsy– Irritable– Emotional– Fatigue/low�energy– Anxious/nervous– Poor�memory– Neck�pain

– Headache/pressure�in�head

– Dizziness– Blurred�vision– Sensitive�to�light/noise– Difficulty�concentrating– Feeling�in�a�fog– “Don’t�feel�right”

RECOGNISE�

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REMOVE

1. First�Aid�principles��2. Head�injury�+�reduced�conscious�level�+/� neck�pain�

=�treat�as�NECK�INJURY�and�DO�NOT�move.���3. Concussion/suspected�concussion�=�REMOVE4. NO�RETURN�5. If�in�doubt�sit�them�out6. Player�to�be�assessed�by�healthcare�professional

Danger�Signs

• Danger�Signs�=�dial�999– Deteriorating�conscious�level– Increasing�confusion��or�irritability– Severe�or�increasing�headache– Repeated�vomiting– Unusual�behaviour– Seizure/convulsion– Double�vision�of�deafness–Weakness/tingling/burning�in�limbs

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What�to�do�next�– CHILDREN?�

• Injury�event�but�no�suspected�concussion�or�other�injury:– Assess�and�observe– BUT�“if�in�doubt�sit�them�out”

• Suspected�concussion�but�no�LOC,�no�seizure,�no�significant�memory�loss,�no�danger�signs:– REMOVE– Notify�parents/carer�and�provide�HI�instructions�– Player�to�be�assessed�by�a�doctor�(school�nurse�if�not�possible)�that�day

• Any�LOC,�seizure,�significant�memory�loss,�danger�signs,�or�concerned:– REMOVE�(if�safe�to�do�so,�if�not,�do�not�move�and�wait�for�ambulance)– Dial�999�for�ambulance�service�– Notify�parents/carer

RECOVER�&�RETURN�� RTP�Guidelines���

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RECOVER�&�RETURN

• RECOVER:�– Rest:

• Initially�avoid�TV,�computers,�reading,�load�noises/flashing�lights• From�exercise��e.g.�PE,�sport�training�sessions��(no�different�from�ankle�sprain!)���

• May�require�a�few�days�off�school/work��� usually�only�one�or�two�if�symptoms�e.g.�headache,�dizziness,�fatigue.�

• RETURN:– To�academic�activities�before�return�to�sport�– Graduated�Return�to�Play– Medical�clearance�to�return�to�play��

Graduated�Return�To�Play

Stage� Rehabilitation�Stage�

Exercise�Allowed� Objective�

1 Rest Complete�physical�and�cognitive�rest�without�symptoms� Recovery�

2 Light�aerobic�exercise Walking,�swimming�or�stationary�cycling�keeping�intensity,�<70%�maximum�predicted�heart�rate.�No�resistance�training.�

Increase�heart�rate��and�assess�recovery

3 Sport�specific�exercise�

Running�drills.�No�head�impact�activities.�

Add�movement�and�assess�recovery

4 Non�contact�training�drills�

Progression�to�more�complex�training�drills,�e.g.�passing�drills.�May�start�progressive�resistance�training.�

Add�exercise�+�coordination,�and�cognitive�load.�Assess�recovery

5 Full�Contact�Practice� Normal�training�activities� Restore�confidence�and�assess�functional�skills�by�coaching�staff.�Assess�recovery�

6 Return�to�Play� Player�rehabilitated� Safe�return�to�play�once�fully�recovered.�

Note:• Must�be�symptom�free�after�each�stage�before�progression• Students�must�return�to�academic�work�symptom�free�before�return�to�play�

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Example�RTP�Pathway�� SchoolDay�� Rehabilitation�Stage� Exercise�Allowed� Notes��

1�– 14� REST� Activities��of�daily living Return�to�academic�studies�

Sun Stage 2�Light�aerobic�exercise�

PE��lessons�or�own�run/swim/cycle�–low�intensity�Mon Clearance�by�GP Recommended�

TueStage�3�+�4

Sport specific�– non�contact�

Normal�PE�Lessons�+�rugby�training�sessions�Non�contact�Progressive�increase�in�complexity,�intensity�and�decision�making

Monitor�symptoms�using�PCRT�(SCAT�3�for�HCP)

Review�techniques�and�high�risk�behaviours

Wed

Thu

Fri

SatOwn�run/swim/cycle – high�intensity�

Sun

MonStage�5� Full�Contact�Practice�

Clearance�by�GP��

Tue

Wed Stage�6 Return�to�Play�

Note: • Must�be�symptom�free�after�each�stage�before�progression• Students�must�return�to�academic�work�symptom�free�before�return�to�play�

Example�RTP�Pathway�– Club�(Youth)

Day�� Rehabilitation�Stage� Exercise�Allowed� Notes��

1�– 14� REST� Activities��of�daily living Return�to�academic studies

Mon

Stage 2��+�3�Light�aerobic�exercise�+�

Sport specific�– non�contact�

PE��lessons�Own�run/swim/cycle�– progressive�intensity�School/�Club�rugby�training�sessions���non�contact�

Clearance�by�GP Recommended�

Tue

Monitors�symptoms�using�PCRT�(SCAT�3�for�HCP)

Review�techniques�and�high�risk�behaviours

Wed

Thu

Fri

SatStage�4�

Non�contact��training�Progressive�increase�in�complexity,�intensity�and�decision�makingOwn�run/swim/cycle – high�intensity�

Sun

MonStage�5� Full�Contact�Practice��at�school/club

Tue Clearance�by�GP��

Wed Stage�6 Return�to�Play�

Note: • Must�be�symptom�free�after�each�stage�before�progression• Students�must�return�to�academic�work�symptom�free�before�return�to�play�

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Repeated�Concussion�Guidance

Second�concussion�in�a�12�month�period

Must�be�assessed�by�GP�(referral�to�concussion���specialist)

If�cleared�� Conservative�RTP�

Technique/Behaviour�Modification��

HEADCASE�Website

"Having�reviewed�the�RFU's�HEADCASE�resource�as�an�independent�expert,�I�think�that�it�is�an�excellent�source�of�information�for�those�involved�with�rugby.�It�is�an�accurate,�thorough�and�appropriate�source�of�information,�based�on�the�most�up�to�date�medical�consensus. The�RFU�should�be�applauded�for�making�this�available�in�such�an�accessible�format.“�� Dr�Richard�Greenwood,�Centre�for�Neurological�Diseases,�Queens�Square�Hospital,�University�College�London.�

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Questions?

EnglandRugby.com/[email protected]

• Prevent�head�trauma�

• 4�Rs =�Recognise – Remove�–Recover�– Return

• Majority�recover�without�problems��BUT�follow�the�guidelines�for�management�and�RTP�to�protect�your�players�and�yourself

EXPERTS�AGREE�BENEFITS�OF�RUGBY�OUTWEIGH�RISKS�

Summary�