concussion: determining safe return to activity in the college health setting brian vesci, ma, atc...
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Concussion: Determining Safe Return to Activity in the College Health Setting
Brian Vesci, MA, ATCSenior Athletic Trainer
Boston [email protected]
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Disclosures
Neither I, Brian Vesci, nor any family members, have any relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation
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Concussion History1
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Physical and Cognitive Rest2,3
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Graduated Return to Activity3
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Rehabilitation Stage Exercise Recommendation Objective
1. No activity Complete physical and cognitive rest
Recovery
2. Light aerobic activity Walking, swimming, stationary bike (at 70% max heart rate); no resistance exercises
Increase heart rate
3. Activity-specific exercise Activity related drills but no head impact
Add movement
4. Noncontact training drills More complex drills, may start light resistance training
Exercise, coordination, increased cognitive load
5. Full-contact participation After medical clearance, participate in normal training
Restore confidence, assessment of functional skills
6. Return to play Normal game play
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Increased Risk of Injury Post Concussion2,3,4,5
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Higher Level Language Function6,7Boston University Athletic Training Services
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BU Center for the Study of Traumatic Encephalopathy
http://www.bu.edu/cste/
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Medial Temporal Lobe8
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65 Year old control 73 Year old boxerJohn Grimsley
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Frontal Cortex8
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65 Year old control 73 Year old boxerJohn Grimsley
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18 Year Old Frontal Cortex8
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The Future
Serum s100b protein levels9,10
>0.32 μg/L <0.10 μg/L
Docosahexaenoic acid (DHA)11,12
Silent information regulator 2 (Sir2)
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References1. Valovich McLeod TC, Bay RC, Heil J, McVeigh SD. Identification of Sport and Recreational
Activity Concussion History Through the Pre-Participation Screening and a Symptom Survey in Young Athletes. Clinical Journal of Sport Medicine. 2008;18(3):235-240.
2. Guskiewicz KM, Bruce SL, Cantu RC, Michael SF, Kelly JP, McCrea M, Putukian M, McLeod TCV. National Athletic Trainers’ Association position statement: management of sports-related concussion. J Athl Train. 2004;39(3):280-297.
3. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Consensus statement on concussion in sport: the 3rd international conference on concussion in sport held in Zurich, November 2008. Brit J Sports Med. 2009;43:176-184.
4. Faul M, Xu L, Walk MM, Coronado VG. Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
5. McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, Kelly JP. Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery. 2009;65(5):876-883.
6. Brooks J, Fos LA, Greve KW, Hammond JS. Assessment of executive function in patients with mild traumatic brain injury. Trauma. 1999;46(1):159-163.
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References7. Lipton ML, Gulko E, Zimmerman ME, Friedman BW, Kim M, Gellella E, Gold T, Shifteh K,
Ardekani BA, Branch CA. Diffusion-tensor imaging implicates prefrontal axonal injury in executive function impairment following very mild traumatic brain injury. Radiology. 2009;252(3):816-824.
8. Boston University Center for the Study of Traumatic Encephalopathy. http://www.bu.edu/cste/case-studies/. Updated May 3, 2011. Accessed May 30, 2011.
9. Townend WJ, Guy MJ, Pani MA, Martin B, Yates DW. Head injury outcome prediction in the emergency department: a role for protein S-100B? J Neurol Neurosurg Pshychiatry. 2002;73:542-546.
10. Biberthaler P, Linsenmeier U, Pfeifer K, Kroetz M, Mussak T, Kanz K, Hoecherl EF, Jonas F, Marzi I, Leucht P, Jochum M, Mutschler W. Serum S-100B concentration provides additional information for the idication of computed tomography in patients after minor head injury: a prospective multicenter study. SHOCK. 2006;25(5):446-453.
11. Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acids supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma. 2004;24(10):1587-1595.
12. Conklin SM, Gianaros PJ, Brown SM, Yao JK, Hariri AR, Manuck SB, Muldoon MF. Long-chain omega-3 fatty acid intake is associated positively with corticolimbic gray matter volume in healthy adults. Neuroscience Letters. 2007;421:209-212.
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