lauren church sport, health & physical education vancouver island university
TRANSCRIPT
Concussions in Ice Hockey
Lauren ChurchSport, Health & Physical Education Vancouver Island University
Why Is This An Issue?
Previous Head Injuries or Concussions6
01234
57 individuals have dealt with a concussion
3 individuals with multiple concussions or head injuries
1102 man games missed in the NHL
Why Is This An Issue?
2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2
267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)
25 percent of adults & 25 to 50 percent of players could not recall any concussion symptoms or only one symptom
Why Is This An Issue?
2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2
267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)
50 percent of players & 20 percent of adults incorrectly stated that concussions are treated with medication or physical therapy
Why Is This An Issue?
2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2
267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)
25 percent of players did not know if an athlete experiencing concussion symptoms should continue playing
Why Is This An Issue?
2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2
267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)
66 percent of players did not know it was possible to sustain a concussion without losing consciousness
What Is a Concussion?
“A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”5
Clinical, pathological and biomechanical injury constructs may be used to define the nature
Signs and Symptoms
Signs Observed Signs Reported by Athlete
- Appears to be dazed or stunned - Is confused about assignment- Forgets plays - Is unsure of game, score or opponent - Moves clumsily - Answers questions slowly - Loses consciousness (even temporarily)- Shows behaviour or personality change - Forgets events prior to incident (retrograde amnesia)- Forgets events after incident (anterograde amnesia)
- Headache - Nausea- Balance problems or dizziness - Double or fuzzy vision- Sensitivity to light or noise- Feeling sluggish - Feeling “foggy”- Change in sleep pattern- Concentration or memory problems
Table 1. Common Signs and Symptoms of a Concussion4
Grading Scales
There are at least 27 systems proposed1 Typically the 3 systems used are:
Cantu American Academy of Neurology Colorado Medical Society
75% of concussions do not result in a loss of consciousness; therefore, new scales have been developed which address this3
Grading Scales
Grade McGill Scale3
1 No loss of consciousness (LOC) & No post-traumatic amnesia (PTA)
1A – No post-concussive symptoms (PCS), only seconds of confusion 1B – PCS and/or confusion resolved in 15 minutes
1C – PCS and/or confusion not resolved in 15 minutes
2 PTA < 30 minutes and/or LOC < 5 minutes
3 PTA > 30 minutes and/or LOC > 5 minutes
On Ice Assessment
Number of different tools available Hockey Canada – Sport Concussion Assessment Tool 2
(SCAT 2) 8 components ▪ Symptom evaluation ▪ Physical signs score ▪ Glasgow coma scale (GCS)▪ Sideline assessment – Maddocks score ▪ Cognitive assessment ▪ Balance examination▪ Coordination examination▪ Cognitive assessment
These combine for a total score
Return to Play
Step One: Rest
Step Two:Light Exercise
Step Three: Sport Specific
Activity
Step Four:Drills Without Body Contact
Step Five:Drills With
Body Contact
Step Six: Return to
Game Play
5
Risk Factors
Facial protection In-game fatigue Ice size Collision type &
frequency Chin strap &
mouthguard use Age Gender
References
1. Bender, S. D., Barth, J. T., & Irby, J. (2004). Historical perspectives. In M. R. Lovell, R. J. Echemendia, J. T. Barth & M. W. Collins (Eds.), Traumatic brain injury in sports: An international neuropsychological perspective (pp. 3-21). Lisse, the Netherlands: Swets & Zeitlinger.
2. Cusimano, M. D. (2009). Canadian minor hockey participants’ knowledge about concussion. Canadian Journal of Neurological Sciences, 36, 315-320.
3. Johnston, K. M., Lassonde, M., & Ptito, A. (2001). A contemporary neurosurgical approach to sport-related head injury: The McGill concussion protocol. Journal of the American College of Surgeons, 192(4), 515-524.
4. Lovell, M. R., Collins, M. W. & Maroon, J. C. (2011). Concussion resource center. Retrieved March 29, 2011, from http://impacttest.com/concussion/overview.
5. McCrory, P., et al. (2009). Consensus statement on concussion in sport – the 3rd international conference on concussion in sport, held in Zurich, November 2008. Journal of Clinical Neuroscience, 16, 755-763.
6. TSN. (2011). NHL injuries. Retrieved April 12, 2011, from http://tsn.ca/nhl/injuries/.