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Overview of ‘Concussion In Sport’
SymposiumSymposium
Margo Mountjoy M.D.Sports Medicine
Health and Performance Centre
January 17, 2013
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Statistics
Incidence of sport-related concussion in
Canada estimated to be 30, 000 per year.
Likelihood of an athlete in a contact sport Likelihood of an athlete in a contact sport
sustaining a concussion
Up to 19% per season
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Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
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What is a Concussion?
“... a complex
pathophysiological process
affecting the brain, affecting the brain,
induced by traumatic
biomechanical forces”
McCrory et. Clin J Sports Med 19(3): 185-195, 2009
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•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
•Most concussions have a quick onset of symptoms that
resolve almost immediately
•Most changes that happen with the brain affect how it
functions, rather then its structure.
•As a result tests like MRI, CT Scans, X-ray do not show
findings
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Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
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Clinical Diagnosis of Exclusion
Symptoms
•Headache
•Dizziness
•Nausea
Physical signs • Loss of consciousness
• Balance difficulties
• Seizure
• Sleep disturbance•Nausea
•Blurred vision
•Ringing in the ears
•Slurred speech
• Sleep disturbance
Behavioural changes• Irritablity
• Emotional lability
• Personality changes
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Clinical Diagnosis of Exclusion
Cognitive impairment
Slowed reaction times
Impaired calculation
Memory disturbance
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Field of Play Assessment
1.Standard emergency clinical assessment
2. Cervical spine injury
3. Intracranial injury 3. Intracranial injury
4. Loss of consciousness
5. Serial assessments over first few hours
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Under no circumstances should the athlete return to play on the same day!!!
Remove from field of play
Field of Play: Management
Medical assessment
Monitor for signs of deterioration
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Office AssessmentHistory
Mechanism of injury
Early symptoms and signs
History of previous concussions
Co-morbidities
Current symptomatology
Physical Examination
Neurological examination
BESS testing
SCAT2 (to be renamed SCAT3 plus a new Child SCAT!)
“Concussion Recognition Tool –CRT”
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Investigations: Current and Future
•Neuropsychological testing
•Genetic testing
•F MRI
•King Devick (eye tracking)
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Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
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Treatment
• Physical Rest
• No sport
•Cognitive Rest
•Minimize screen time
•Time from school • Avoid active play
• No gym at school
•Time from school
•Regular sleep
•Avoidance of ETOH/drugs
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Clinical Treatment
First address if any….
•Cervical spine injury•Cervical spine injury
•Headache
•Depression
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Symposium Overview
Definition
Diagnosis
Treatment
Return to play
Special populations
Prevention
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Return to Play
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Return to Play
•Must pass the graded exertion (previous slide)
•Must feel confident to RTP
•New helmet if needed•New helmet if needed
•Other behaviours/ factors
•Other multiple/ recent injuries
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Symposium OverviewDefinition
Diagnosis
Treatment
Return to play
Special populations
Prevention
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Special Population: Pediatric
•Age specific physical and cognitive rest issues
•Symptom resolution may take longer
•Extend symptom free period before starting RTP protocol
•Extend length of the graded exertion protocol
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Special Population: Elite vs. Non-Elite
No difference in treatment!
An athlete is a person/ patient first!An athlete is a person/ patient first!
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Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
![Page 26: Overview of ‘Concussion In Sport’ Symposium · Overview of ‘Concussion In Sport’ Symposium ... X-ray do not show findings. Symposium Overview Definition Diagnosis Treatment](https://reader031.vdocuments.net/reader031/viewer/2022020215/5b3d733e7f8b9a28308be979/html5/thumbnails/26.jpg)
Prevention: Pre-Event Screening
•Number of prior concussions
•Non-sport head injuries
•Previous facial/ dental injuries
•Type of player (aggressive)
•Ability to take a hit•Ability to take a hit
•Baseline SCAT taken?
•Protective equipment
Helmet age
Helmet fitting
Mouth guard
Full face mask
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Prevention: Athlete Skills and Education
�Be a good skaterWork on balance and agility
�Keep your head upPractice stick handling
�Keep your arms upWhen going into boards use hands & arms to absorb shock
�Approach boards on an angle�Approach boards on an angle
�Know the Danger Zone3-4 feet from boards
�Neck Strengthening� May help reduce concussions
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Prevention: Athlete Skills
•Don’t hit from behind
•If you see the numbers, don’t hit
• Control your stick responsibly
• Do not make suicide passes
•Don’t hit to the head
•Hit with shoulders, not elbows, hands, or stick
• Communicate with teammates
• RESPECT YOUR OPPONENTS!!!!
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Prevention: Sport Rule Changes
�Federation rule changes
�Implementation & monitoring
�“Zero” tolerance head checking�“Zero” tolerance head checking
�Body checking – pee wee hockey
�Political Legislation- Lystedt Law