lauren church sport, health & physical education vancouver island university
TRANSCRIPT
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Concussions in Ice Hockey
Lauren ChurchSport, Health & Physical Education Vancouver Island University
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Risk Factors
Facial protection In-game fatigue Ice size Collision type &
frequency Chin strap &
mouthguard use Age Gender
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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/.