Concussion Management and Awareness ActDave Boyland, PT, DPT, SCS, ATCMaggie Reinhard, PT, DPT, ATCGoldwyn & Boyland Physical Therapy

The Law•A student diagnosed with a concussion is not to be

returned to athletic activities until at least 24 hours have passed without symptoms and the student has been assessed and cleared by a medical provider to begin a graduated return to activities.

The 3rd International Conference on Concussion in Sport

•Panel of Sports Medicine Physicians, Neurologists, Psychologists, Athletic Trainers, Researchers, Athletes, Coaches, etc.

•Endorsed by FIFA, IOC, IRB, IIHF

The 3rd International Conference on Concussion in Sport

•Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.▫Eliminated the terms “complex” and “simple”

concussion•Established Return to Play (RTP) Guidelines

Direct/Indirect Observation

•Any student suspected of having a concussion either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body must be removed from athletic/physical activity and observed until an evaluation can be completed by a medical provider.

The Team•Medical Director•School Nurse•Certified Athletic Trainer•Director of Physical Education/Athletics•School Administrator•Teacher•Coach•Student•Parent/Guardian

Training Course•NYSED approved training course▫Heads up to Clinicians (CDC)

•Every 2 years

Who Must Take the Course?•School Nurse•Certified Athletic Trainer•Physical Education Teacher•Coach

Neurocognitive Computerized Testing

• Impact•CogSport•Headminders•ANAM (Automated Neuropsychological Assessment

Metrics)

Identification•Amnesia•Confusion•Headache•LOC•Balance Difficulty/Dizziness•Double or Blurred Vision•Sensitivity to Light and/or Sound•Nausea/Vomiting/Loss of Appetite

Identification• Irritability/Sadness/Changes in Personality•Feeling Sluggish or Light-headed•Concentration or focusing problems•Slowed Reaction Times•Fatigue/Sleep Issues

Immediate Referral•Headache that Worsens•Seizures•Looks drowsy or cannot be awakened•Repeated Vomiting•Slurred Speech•Unable to recognize people or places•Weakness or Numbness•Unsteady Gait•Dilated or Pinpoint Pupils

Sideline Assessment Tools•SCAT 2•SAC•BESS

SAC

Diagnosis•Licensed Physician•Nurse Practitioner•Physician Assistant

Post-concussion Management•Cognitive Rest▫Avoidance of participation or exposure to:

Computer and Video Games Television Viewing Texting Reading or Writing Studying or Homework Taking a Test or Completing a Significant Project Loud Music Bright Lights

School Responsibility•Providing Accommodations▫Shorter School Day▫Rest Periods▫Peer Note Takers▫Extended Time for Tests and Assignments

Post-concussion Management•Physical Rest▫Adequate Sleep▫Taking Frequent Rest Periods and Naps▫Avoiding Exertion

Post-concussion Management•24 Hours SYMPTOM FREE•Clearance for Return to Activity▫Private Medical Provider▫Medical Director

Return to Activity• Phase 1▫Low impact, non-strenuous light aerobic activity

• Phase 2▫Higher impact, higher exertion, moderate aerobic activity

• Phase 3▫Sport specific, non-contact activity, low resistance weight training

• Phase 4▫Sport specific, non-contact activity, higher resistance weight

training• Phase 5▫Full contact training drills, intense aerobic activity

Return to Activity•Phase 6▫Return to full activity without restrictions▫Determined by Medical Director

Second Impact Syndrome (SIS)•A Severe, Life Threatening Condition That Causes

Irreversible Brain Damage, Hemorrhage, And Cerebral Edema▫Almost Exclusively In Individuals Under Age 25

References•http://www.nysphsaa.org/safety/pdf/NYSEDGuidelin

esforConcussionManagement.pdf•http://preventingconcussions.org•McCrory P, Meeuwisse W, Johnston K etal.

Consensus Statement on Concussion in Sport: The 3rd International Conference on Concussion in Sport Held in Zurich, November 2008. J Ath Training. 2009;44:434-448.

•Wojtys EM, Hovda D, Landry G et al. Concussion in Sports. Am J Sports Med. 1999;27:676-687.

Questions?