Lauren Church Sport, Health & Physical Education Vancouver Island University

57 individuals have dealt with a concussion 3 individuals with multiple concussions or head injuries 1102 man games missed in the NHL

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area 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

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area 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

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area 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

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area 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

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 ObservedSigns 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 Concussion 4

There are at least 27 systems proposed 1 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 this 3

GradeMcGill Scale 3 1No 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 2PTA < 30 minutes and/or LOC < 5 minutes 3PTA > 30 minutes and/or LOC > 5 minutes

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

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

Facial protection In-game fatigue Ice size Collision type & frequency Chin strap & mouthguard use Age Gender

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, 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), Lovell, M. R., Collins, M. W. & Maroon, J. C. (2011). Concussion resource center. Retrieved March 29, 2011, from 5. McCrory, P., et al. (2009). Consensus statement on concussion in sport – the 3 rd international conference on concussion in sport, held in Zurich, November Journal of Clinical Neuroscience, 16, TSN. (2011). NHL injuries. Retrieved April 12, 2011, from