Concussion Among Youth: School and Sports

Danielle Pagani, MPH, CHESCommunity Outreach Specialist

dpagani@bianj.org

www.bianj.orgHelpline: 732-783-6172*

Objectives

u Define concussion also known as mTBIu Discuss common causes of head injuries among youth and concern nationwide

u Review functions of the brainu Explore expectations of roles (i.e. healthcare professionals)u Review signs and symptoms

u Discuss recovery process (i.e. management tips, return to learn and return to play protocols)

u Identify prevention tips and strategies

u Review resources and BIANJ Programs and Services

A concussion is a mild traumatic brain injury (mTBI)

u Occurs from a bump, blow, or jolt to the head, face, and neck

u Indirect blow elsewhere on the body transmits “impulsive” force to the head

u Movement can cause brain to move around in the skull and cause chemical changes

(CDC, 2019)

The concern nationwide

►Sports- or recreation-related TBIs are becoming more commonly seen in emergency rooms

►These include injuries from football, bicycling, soccer and basketball as well as playground activities

(Sarmiento, Thomas, Daugherty, et al., 2019)

Common causes of head injuries among children and adolescents

►Falls

►Car crashes

►Pedestrian and bike crashes

►Sports related trauma (sports concussion)

►Inflicted injury

►Being hit by a sharp object at high speed

(Schutzman, 2019)

Frontal LobeInitiationProblem solvingJudgmentInhibition of behaviorPlanning/anticipationSelf-monitoringMotor planningPersonality/emotionsAwareness of abilities/limitsOrganizationAttention/concentrationMental flexibilitySpeaking

Temporal LobeMemoryHearingExpressive and receptive languageComprehension of languageMusical awarenessOrganization &sequencing skills

Parietal LobeSense of touchDifferentiation of size, color, shapeSpatial perceptionVisual perception

Occipital LobeVisual perception and inputReading (perception and recognition of printed words)

CerebellumCoordinationBalanceSkilled motor activity

Brain StemBreathingHeart rateArousal/ConsciousnessSleep/wake functionsAttention/concentration

The Brain(Brain Injury Association of America, n.d.)

When you sustain a concussion….IT GOES BEYOND THE PLAYING FIELD!

u Academics

u Social Relationships

u Behavior

u Emotions

Your Role

Know: Signs and symptoms.

Assess: Observe changes in child’s typical behavior.

Manage: Keep open communication with coaches, parents, teachers, health care providers and follow concussion recovery guidelines.

You are the first line of defense in concussion awareness

►On site at the time of the event

►Immediate signs and symptoms

►Continue monitoring

►Medical evaluation

Evaluating Concussions

When it happens, Where it happens

Who can diagnose a

concussion?

(BIANJ, 2019)

►Family physician, pediatrician or sports medicine physician who is knowledgeable in the identification and management of concussion.

u Originally published in September 2018

► 19 guidelines

► Diagnosis

► Prognosis

► Management and Treatment

► Recommendations are for healthcare providers

► www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html

CDC Pediatric mTBI Guideline

(CDC, 2020)

Neuropsychologist

u Provide comprehensive neurocognitive testing

u Determine which functions of the brain have been affected and what they mean in everyday life

u Define cognitive strengths and weaknesses

(APA, 2019)

Signs and symptoms

►Immediate signs

►Physical Symptoms

►Cognitive Symptoms

►Emotional and/or Mood Symptoms

►Changes in sleep patterns

(CDC, 2019)

Immediate Signs

u Confusionu Loss of balance/appears clumsyu Disoriented to time and placeu Changes in mood, behavior, or personalityu Loss of consciousness (even briefly)*u Slowly answers questions

(CDC, 2019)

Physical Symptoms

(CDC, 2019)

►Headache/head discomfort

►Blurry vision

►Loss of balance

►Ringing in the ears

►Feeling “foggy”

►Dizziness

►Fatigue/exhaustion

►Sensitivity to light & sound

►Numbness/tingling sensations

►Vomiting

Cognitive Symptoms

(CDC, 2019)

►Confusion

►Memory Loss

►Executive functioning

►Difficulty focusing/ concentrating

►Slower rate to process information

►Slowed reaction time

Emotional or Mood Symptoms

u Irritability

u Anxiety/nervousness

u Sadness

u More emotional

(CDC, 2019)

Which is a symptom of concussion?

A. Sleeping too much

B. Not sleeping enoughC. Cannot fall asleepD. All the above ALL THE ABOVE!!!!!

(CDC,2019)

CALL 911 if person has one or more of the following signs/symptoms

► One pupil larger than the other► Repeated vomiting or nausea, convulsions or seizures

► Inability to wake up or drowsiness► A headache that does not go away or gets worse► Slurred speech, numbness, weakness or decreased coordination

► Confusion, unusual behavior, restlessness► Loss of consciousness (passing out)*

(CDC, 2019)

Recovery

u Indicators that may prolong recovery

u Management tips

u Return to School

u Concussion Management Teams

u Return to Play

Indicators for Prolonged Recovery

►Prior history of concussion/migraines?

►Other physical or psychological conditions?

►Is there a learning disability or ADHD?

►Is the student taking any medications?

Managing a Concussion

Activities to Avoid►Video games►Driving►Movies in theaters►Concerts► Sports►Amusement parks► Texting► Surfing the internet

Rest► Cognitive rest► Physical rest► Sleeping

*Any other activity that aggravates symptoms

(CDC, 2019)

Return to School Plan

u No activityu Gradual reintroduction of cognitive activityu Homework at home before school work at

schoolu School re-entryu Gradual reintegration into schoolu Resumption of full cognitive workload

School Accommodations

u Reduce assignmentsu Build in rest periodsu Give additional time

to complete worku Outline and order

steps for big tasks

u “To Do” listsu Written directionsu Written schedulesu Meet one-on-one

with teachers

(CDC, 2019)

► Elementary School

► Middle School

► High School

A concussion can affect a child differently among each group

Develop a CMT Step-by-Step

u Determine staffu Academic Monitorsu Symptom Monitors

u Determine communication method

u Decide on forms

u Training

Return to Play

Return to Play – Total of Six StepsSteps 1-3Step 1: Back to regular activities► For example, school

Step 2: Light aerobic activity u Objective is to increase heart rate

Step 3: Moderate activityu Objective is to continue to increase heart rate with body or head movement

(CDC, 2019)

Return to Play – Steps 4-6

Step 4: Heavy, non-contact activity u Objective is for individual to participate in non-contact

sport-specific drills

Step 5: Practice and full contactu Objective is to return to activity in a controlled practice

Step 6: Competitionu Objective is for individual to return to activity without any

restrictions or limitations

(CDC, 2019)

Why is Graduated Return to Play Important? u Post-Concussion Syndrome

u Prolonged recovery and residual symptoms

u Cumulative effects of multiple concussions

u Second Impact Syndromeu Loss of cerebrovascular autoregulation causing brain swelling, herniation,

fatality

(American Association of Neurological Surgeons, n.d.)

Recommendations when working with coaches

►Stay update to date on concussion guidelines

►Communication is key

►Provide written instructions from child’s healthcare provider on return to play

►Ask coach to provide support during recovery

Prevention

Suggestions for Youth

If you THINK you or someone you know has a concussion you should:

► Report it

► Get checked out

► Give your brain time to heal

(CDC, 2019)

“TEAM UP SPEAK UP”

www.concussionfoundation.org/programs/team-up-speak-up

Preventing Concussions (in sports and other recreational activities)

► ALWAYS PLAY BY THE RULES

► ALWAYS CHECK EQUIPMENT

► ALWAYS PRACTICE GOOD SPORTSMANSHIP

► ALWAYS USE PROPER TECHNIQUE FOR YOUR SPORT

► ALWAYS FOLLOW RETURN TO PLAY PROTOCOL

NEVER PLAY WITH

SYMPTOMS!

(CDC,2020)

“When in Doubt – Sit Them OUT!”

u Proper management of concussion is the best precaution against more serious injury

u You only have ONE brain, PROTECT IT!

Resources

Brain Injury Alliance of New Jersey► Concussion: What Youth Sports Coaches Need to Know

► bianj.org/youth-coaches-course/

► Understanding Concussion: Diagnosis, Treatment and Recovery

► Sportsconcussion.bianj.org/concussion-cme-activity

► Brain Injury Primer

► Includes 3 units: Brain Injury in Students, Concussion in the Classroom, and Concussion in Youth

Sports

► bianj.org/online-course-professionals/

Resources

Centers for Disease Control and Prevention – HEADS UP Online Training Courses► Training for Healthcare Providers

► Concussion Training Course for Youth Sports Coaches

► Concussion Training Course for High School Sports Coaches

► www.cdc.gov/headsup/resources/training.html

National Federation of State High School Associations (NFHS) Learning Center► Concussion in Sports

► Concussion in Students

► www.nfhslearn.com/courses?searchText=Concussion

CDC Free App for Kids

To address concussion safety among kids ages 6-8, CDC created:

►HEADS UP Rocket Blades App

►www.cdc.gov/features/concussion-safety-kids/index.html

CONNECT WITH US

u facebook.com/biaofnj

u twitter.com/braininjurynj

u youtube.com/brainhealthnetwork

u instagram.com/braininjuryallianceofnj

u www.bianj.org

References

American Psychological Association. (2019). Concussion and How a Neuropsychologist Helps. Retrieved from https://www.apa.org/HELPCENTER/CONCUSSIONS

Brain Injury Association of America. (n.d.). Functions of the Brain. Retrieved from https://www.biausa.org/brain-injury/about-brain-injury/basics/function-of-the-brain

Brain Injury Alliance of New Jersey (BIANJ). (2019). Management. Retrieved from https://sportsconcussion.bianj.org/management/

Centers for Disease Control and Prevention (CDC). (2019, Dec 23). HEADS UP to Schools: Teachers, Counselors, and School Professionals. Retrieved from https://www.cdc.gov/headsup/schools/teachers.html

CDC. (2019, Feb 12). Concussion Danger Signs. Retrieved from https://www.cdc.gov/headsup/basics/concussion_danger_signs.html

CDC. (2019, Feb. 12). Recovery from Concussion. Retrieved from https://www.cdc.gov/headsup/basics/concussion_recovery.html

CDC. (2019, Feb. 12). Returning to Sports and Activities. Retrieved from https://www.cdc.gov/headsup/basics/return_to_sports.html

CDC. (2019, Feb. 12). What Is a Concussion?. Retrieved from https://www.cdc.gov/headsup/basics/concussion_whatis.html

References

References

CDC. (2019, Jan.). A Fact Sheet for Athletes. Retrieved from https://www.cdc.gov/headsup/pdfs/youthsports/factsheet_athletes_ages11-13-a.pdf

CDC. (2019, Jan.) A Fact Sheet for Youth Sports Parents. Retrieved from https://www.cdc.gov/headsup/pdfs/youthsports/parents_eng.pdf

CDC. (2019, Mar. 5). Brain Injury Basics. Retrieved from https://www.cdc.gov/headsup/basics/index.html

CDC. (2019, Mar. 11). Symptoms of Traumatic Brain Injury (TBI). Retrieved from https://www.cdc.gov/traumaticbraininjury/symptoms.html

CDC. (2020. Feb. 27). Brain Injury Safety Tips and Prevention. Retrieved from https://www.cdc.gov/headsup/basics/concussion_prevention.html

CDC. (2020, Jan. 3). Care of Children with Concussion (mTBI). Retrieved from https://www.cdc.gov/features/pediatric-mtbi-guideline/index.html?deliveryName=USCDC_201-DM6571

CDC. (2020, Mar. 6). CDC Pediatric mTBI Guideline. Retrieved nhttps://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html

Sarmiento K, Thomas KE, Daugherty J, et al. Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among Children — United States, 2010–2016. MMWR Morb Mortal Wkly Rep 2019;68:237–242 DOI: http://dx.doi.org/10.15585/mmwr.mm6810a2external icon

Schutzman, S. (2019, June 12). Patient education: Head injury in children and adolescents (Beyond the Basics).Retrieved from https://www.uptodate.com/contents/head-injury-in-children-and-adolescents-beyond-the-basics

Address: 825 Georges Road 2nd FloorNorth Brunswick, NJ 08902

Helpline: 732-783-6172 (at this time)Email: info@bianj.orgWebsite: www.BIANJ.org

Presentation was developed by Public Education Coordinators/ Education and Outreach Team at the Brain Injury Alliance of New Jersey.

Danielle Pagani, MPH, CHESCommunity Outreach Specialistdpagani@bianj.org732-745-0200 x 243

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