1. 1. Concussion 101 The Sports Medicine Podcast SportsMedicinePodcast.com
2. 2. Concussion Rules and Laws 50 states have concussion laws
3. 3. Concussion Rules and Laws 33 states have seat-belt use laws
4. 4. Concussion Rules and Laws California AB 25 - 2012 Mandates removal of suspected concussion from play Concussion and head injury info sheet signed yearly California AB 1451 - 2013 Training for coaches every 2 years California AB 588 - 2014 Extends requirements to private and charter schools
5. 5. Concussion Rules and Laws CIF Rule 313 from 2010 A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. The student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the education and management of concussion and receives written clearance to play from that health care provider.
6. 6. Concussion Rules and Laws CIF Rule 313 from 2010 A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. The student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the education and management of concussion and receives written clearance to play from that health care provider.
7. 7. What is a concussion? Zurich 2012 Concussion is a brain injury and is dened as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in dening the nature of a concussive head injury include
8. 8. 1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. 2. Concussion typically results in the rapid onset of short- lived impairment of neurologic function that resolves spontaneously. However in some cases symptoms and signs may evolve over a number of minutes to hours. 3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reect a functional disturbance rather than a structural injury and as such, no abnormality is seen on standard structural neuroimaging studies. 4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However it is important to note that in some cases, post-concussive symptoms may be prolonged. What is a concussion? Zurich 2012
9. 9. How Concussions Happen
10. 10. What is a concussion? Direct blow to head or Blow to other part of body with force transmitted to head
11. 11. What is a concussion? Disturbance in brain function Brain shaken back and forth Loss of consciousness NOT required
12. 12. What is NOT a concussion? Bleeding in or around the brain Stroke Skull fracture Seizure
13. 13. Symptoms of Concussion Initial symptoms Headache Fatigue Dizziness Difficulty thinking Loss of consciousness
14. 14. Symptoms of Concussion Delayed symptoms Sleep disturbances Frustration/agitation Forgetfulness Fatigue Symptoms of Concussion
15. 15. Sports at Risk of Concussions Sport Boys Girls Football 11.2 NA Lacrosse 6.9 5.2 Soccer 4.2 6.7 Wrestling 6.2 NA Basketball 2.8 5.6 Field Hockey NA 4.2 Softball NA 1.6 Baseball 1.2 NA Source: National Academy of Sciences, Datalys Center (2010-12) PER 10,000 ATHLETIC EXPOSURES
16. 16. Management of concussions Sideline management Exam by medical staff SCAT3 form
17. 17. Sport Concussion Assessment Tool SCAT3
18. 18. Management of concussions Neuroimaging - CT or MRI Limited use in concussions Used for ruling out other conditions with specific findings on exam
19. 19. Recovery from concussions CORNERSTONE = initial period of rest until acute symptoms resolve Physical Rest No training, playing, exercise, weights Beware of exertion with activities of daily living Cognitive Rest No television, extensive reading, video games? Caution re: daytime sleep
20. 20. Recovery from concussions About 40% resolve in 1-3 days Most 85% to 90% resolve in 7 -10 days Children and teens may take longer.
21. 21. Return to Play - Step #1 Physical and cognitive rest Physical No training or practice Cognitive Limited reading, studying Limit computers, phones Limit music, video games
22. 22. Return to Play - Step #2 Light Aerobic Exercise Walking, stationary bike No weight lifting Objective Increase heart rate
23. 23. Return to Play - Step #3 Sport Specific Exercise Add running drills No heading -soccer Non contact Objective Add Movement
24. 24. Return to Play - Step #4 Non-contact Drills More complex drills Passing drills in football and soccer No heading if soccer Objective Exercise, coordination, cognitive load
25. 25. Return to Play - Step #5 Full Practice Medical Clearance Full contact practice Should not be on any medications for the concussion
26. 26. Return to Play - Step #6 Return To Game Play Should have 24 hours between each step If symptoms occur then return back to next lower level
27. 27. Neuropsych testing for concussions Should NOT be sole basis of management decisions, but an aid to clinical decision making Important component in overall assessment and RTP
28. 28. Chronic Traumatic Encephalopathy CTE Neurodegenerative disease First reported in 1928 Protein deposts in brain Repetitive trauma to brain (maybe) Not related to number of concussions (lower impacts?)
29. 29. Prevention of concussions Mouthguards May decrease biomechanical force but no studies show decrease in concussions Helmets Probably no decrease in concussions May prevent head trauma
30. 30. Summary Many different causes Remove from practice or game if suspected Medical Evaluation for full return to play Most resolve in 7 to 10 days Gradual return to play and return to school Difficult to prevent
31. 31. Questions?