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 “Ding”, “Bell rung”, “Loopy”, “Seeing stars” are all terms we associate with head injuries. The underlying concern is that a head injury has occurred. The importance of initially assessing the injury and following up to monitor symptoms to ensure a more serious injury has not occurred.

Concussion or mild traumatic brain injury (MTBI) is a pathophysiological process affecting the brain induced by direct or indirect biomechanical forces. The First International Conference on Concussion in Sport, Vienna Concussion may result from a direct blow to the head or elsewhere on the body from an impulsive force transmitted to the head. 2. Concussion may cause an immediate and short lived impairment of neurological function. 3. Concussion may cause neuropathological changes 4. Concussion may cause a gradient of clinical syndromes that may or may not involve a loss of consciousness (loc). 5. Concussion is most often associated with normal results on conventional neuroimaging studies.

 Estimates of 500,000 sports concussions per year  CDC in 2006 estimated the number to be closer to million per year  At risk age group  0-4 years  years  >65 years

 Concussion rate per 1000 athlete exposures  Football 0.47  Girl’s soccer0.36  Boy’s soccer0.22  Girl’s basketball0.21  Boy’s basketball 0.07 Gessel LM et al “Concussion Among United States High School and Collegiate Athletes” Journal of Athletic Training, 2007; 42:

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 Olfactory – smell (familiar such as coffee or chocolate)  Optic - vision  Occulomotor - eye movement or reaction to light  Trochlear - eye movement downward or lateral  Trigeminal - clench teeth  Abducens – hold eyes in an abducted position  Facial - facial movements smile or frown  Acoustic - hearing  Glossopharyngeal – ability to swallow  Vagus - gag reflex or say “ahh”  Spinal Accessory – shoulder shrug  Hypoglossal – stick out tongue (if injured tongue deviates to the injured side)

 Orient to place and time (who, what, where, when)  Balance test (Rhomberg)  Short term and long term memory  Eye tracking near and far  Ability to concentrate (serial 7’s, months of the year, numbers in reverse)  Exertional Activity (sprint, push ups, jumping jacks)  SCAT 2 

 Changes in level of consciosness  Posttraumatic amnesia  Anterograde – difficulty remembering things after the injury  Retrograde – difficulty remembering things before the injury  Headache  Tinnitus  Nausea  Photophobia  Dizziness  Blurred vision  Difficulty concentrating

 Grade I (mild)  No LOC  Posttraumatic amnesia lasting <30 minutes  Post concussion signs and symptoms lasting <24 hrs.  Grade II (moderate)  LOC <1 minute  Posttraumatic amnesia lasting >30 min, <24 hrs.  Post concussion signs and symptoms lasting >24 hrs. <7 days  Grade III (severe)  LOC >1 minute  Posttraumatic amnesia >24 hrs.  Post traumatic signs or symptoms lasting >7 days.

 It is important to grade concussions, but not until symptoms have resolved.  At anytime an athlete loses consciousness they must be removed from activity.  Never let an athlete that has sustained a concussion return to activity until they have been properly evaluated by the medical staff

 Grade I (mild)  First concussion – may return to play if asymptomatic for one week  Second concussion – return to play in two weeks if asymptomatic at the time for one week  Third concussion – Terminate season return to play next season if asymptomatic

 Grade II (moderate)  First concussion - return to play if asymptomatic for two weeks  Second concussion – minimum 1 month may than return if asymptomatic for one week. Consider terminating season  Third concussion – terminate season may return to play next season if asymptomatic

 Grade III (severe)  First concussion – minimum one month than return to play if asymptomatic for 1 week  Second concussion – terminate season, may return to play next season if asymptomatic  Third concussion – consider no further contact sports *Terminate season if at anytime an individual has an abnormal CT or MRI

 Once symptom free the athlete should be reassessed to establish they have returned to baseline.  Athlete should have an incremental increase in activity with an initial cardiovascular challenge, followed by sport specific activities.  The athlete can be released back to activity as long as no signs or symptoms return  If signs or symptoms return the individual goes back to day one of recovery

 Occurs from rapid swelling of the brain following a second impact before the brain has recovered from an initial injury. The second impact may be relatively minor and often does not even involve a blow to the head. This syndrome is most likely to occur in individuals less than 20 years of age.

 Athletes suspected of having a concussion must be cleared by a “medical provider”  Bylaw 313 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. A 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 evaluation and management of concussion and receives written clearance to return to play from that health care provider.  LICENSED HEALTH CARE PROVIDERS  What licensed health care providers are trained in the evaluation and treatment of concussions/brain injuries and authorized to allow the athlete to return to play?   The “scope of practice” for licensed health care providers and medical professionals is defined by California state statutes. This scope of practice will limit the evaluation to a medical doctor (MD) or doctor of osteopathy (DO).

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