Myth or Fact? Everyone with a concussion needs a CT scan or MRI right away? A concussion requires loss of consciousness? Male and female athletes have the same chance of sustaining a concussion? An athlete needs to be hit on the head to sustain a concussion? Drowsiness and fatigue are common symptoms of concussion? Children recover at the same rate as adults? MYTH FACT Question 1, 2, 3, 4 & 6 = myth Question 5 = fact

What is a Concussion? A concussion is a jarring injury of the brain resulting in disturbance of cerebral function Concussion are not detected on routine X-rays, CT scans, or MRIs It affects the way an athlete may think and remember things, and can cause a variety of symptoms

What Causes a Concussion? Any blow to the head, face or neck, or a blow to the body which causes a sudden jarring of the head may cause a concussion Examples: a ball to the head, being checked into the boards in hockey

Signs & Symptoms of a Concussion

What Should You Do If An Athlete Gets A Concussion? The athlete should stop playing the sport right away If an athlete is knocked out, call an ambulance to take them to a hospital immediately. Do not move the athlete or remove athletic equipment, as there may also be a cervical spine injury; wait for paramedics to arrive Should be seen by a doctor as soon as possible that day They should not be left alone An athlete with a concussion should not go back to play that day, even if they say they are feeling better

Length of a Concussion The signs and symptoms of a concussion often last for 7-10 days but may last much longer. In some cases, athletes may take many weeks or months to heal. Having had previous concussions may increase the chance that a person may take longer to heal.

Rowan’s Law: How the death of one teen is serving as a wake-up call….

Rowan’s Law: Rowan Stringer, a high school Rugby player from Ottawa, Ontario, passed away 3 years ago from Second Impact Syndrome due to multiple concussions suffered within a short period of time. A coroner’s inquest into her death resulted in 49 recommendations to be implemented in an effort to prevent another tragedy such as this from happening in the future. Rowan’s Law, which passed unanimously at the Ontario Legislature on June 7, 2016 On Friday May 3, 2013, Rowan was playing in a high school rugby tournament and in the last game of the day; she was tackled and removed from that game complaining of a headache. She had a game after school the following Monday (May 6) and was feeling great and ready to play. During that game someone stepped on her head and the headache returned; however, she did not tell anyone of this return in symptoms. On Wednesday (May 8), she had yet another game, which would be her last. She was tackled to the field, which resulted in a loss of consciousness that she never recovered. Doctors tried to relieve the swelling in her brain but were unable to do so. The recommendations from the coroner’s inquest include: Increased education and awareness for parents, coaches, athletes, and teachers surrounding concussion injuries Better tools for coaches and trainers to identify concussions Concussion policies in place at all school boards and sports associations across Ontario Increased education and training for healthcare professionals to better treat and manage concussions In honour of Rowan Stringer, the legislation establishes that the last Wednesday in September as “Rowan’s Law Day”.

What is Second Impact Syndrome: Second Impact Syndrome: is a second blow to head before brain has healed from initial concussion Video click here to start video

About Second Impact Syndrome An athlete who is recovering from a concussion, but who has not yet fully recovered, is at risk for second impact syndrome Typically, the athlete suffers post-concussion symptoms after the first head injury. Before these symptoms have cleared, which may take minutes, hours, days or weeks, the athlete returns to competition and receives a second blow to the head, This can cause massive swelling in the brain  Since the brain is contained inside the rigid bone of the skull, this swelling causes compression of the brain.  The brain is squeezed through small holes within the skull known as "herniation"  Herniation can lead to decreased blood flow to the brain, and ultimately, to the athlete's death

Returning to Play Guidelines After a medical examine, and under the Return To Play recommendations of a Doctor. Step 1: No activity, only complete rest. Limit school, work and tasks requiring concentration. Refrain from physical activity until symptoms are gone. Once symptoms are gone, a physician, preferably one with experience managing concussions, should be consulted before beginning a step wise return to play process. Step 2: Light aerobic exercise. Activities such as walking or stationary cycling. The player should be supervised by someone who can help monitor for symptoms and signs. No resistance training or weight lifting. The duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day. If symptoms occur? Return to rest until symptoms have resolved. If symptoms persist, consult a physician.

Returning to Play Guidelines cont’d. Step 3: Sport specific activities. Activities such as skating or throwing can begin at step 3. There should be no body contact or other jarring motions such as high speed stops or hitting a baseball with a bat. Symptoms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. Step 4: Begin Drills without body contact. No symptoms? The time needed to progress from non-contact exercise will vary with the severity of the concussion and with the player. Proceed to Step 5 only after medical clearance. Step 5: Begin drills with body contact. Step 6: Resume playing your sport the next day.

Incident Reporting INITIAL RESPONSE – Removal from Physical Activity: An individual responsible for those who are participating in organized physical activity who believes that, following a blow to the head, face or neck, or a blow to the body that transmits a force to the head, a participant in the activity may have suffered a concussion needs to take immediate action.   For a participant who is Unconscious: Initiate emergency action plan and call 911. Contact the child/youth’s parent/guardian to inform them of the injury and that their child is being transported to the hospital. Stay with the individual until Emergency Medical Services arrives. Monitor and document any physical, emotional and/or cognitive changes. Even if consciousness is regained, he/she needs to be examined by a medical doctor or nurse practitioner. (see steps below for someone who is conscious) For a participant who is Conscious: Remove the participant from the activity immediately. If signs are observed or symptoms are reported, a concussion should be suspected. If a concussion is not suspected (i.e., signs are not observed and symptoms are not reported), the participant may resume physical activity; however, if applicable, a parent/guardian should be contacted and informed of the incident.* Contact the parent/guardian and inform them of the injury and the need to be examined by a medical doctor or nurse practitioner. Stay with the injured participant until a parent/guardian or emergency contact arrives. Remember: signs and symptoms of concussion may appear within hours or days of the injury.   With either of the above scenarios an Incident Report needs to be completed.

Incident Reporting cont’d. MEDICAL EXAMINATION: Following examination by a medical doctor or nurse practitioner and prior to the individual returning to physical activity, the coach, administrator and/or supervisor must be informed of the results (i.e. Doctors Note with Return to Play recommendations). If No Concussion is Diagnosed: the participant may return to physical activities. or If a Concussion is Diagnosed: the medically supervised gradual Return to Physical Activity Plan needs to be followed. RETURN TO PHYSICAL ACTIVITY (following a diagnosed concussion): A participant with a diagnosed concussion follows a medically supervised and individualized gradual Return to Physical Activity plan. It is critical to recovery that the individualized plan be developed through a collaborative team approach. This team should include: the concussed individual her/his parents/guardians (if applicable) his/her coach, administrator and/supervisor school staff, including teachers, coaches etc. (if applicable) a medical doctor or nurse practitioner Ongoing communication and monitoring by all members of the team will be essential to successful recovery.

Resources Additional resources for Kids and Parents: Concussions 101, a Primer for Kids and Parents http://www.youtube.com/watch?v=zCCD52Pty4A http://www.parachutecanada.org/downloads/resources/Concussion-Parents-Caregivers.pdf