By Dr. Leyen Vu Resident Physician, St. Peter Hospital Sept. 28, 2010

Change in mental status caused by a traumatic episode with or without loss of consciousness. May be caused by blow to the head or anywhere else on the body with an impulsive force on head Most commonly no loss of consciousness

300,000 sports related concussions each year Most common sports: football, ice hockey, soccer, boxing, rugby. 10% of college and 20% of high school football players suffer head injuries each season Only 4-5% of players report symptoms. 63.4% football 10.5% wrestling 6.2% girls basketball 14% had repeat concussion during same season

Males more likely than females 2-3 times more likely

Children have weaker neck and shoulder muscles compared to adults More of the impact is absorbed by the head and less by the upper body. Most brain scans are still normal

Immediate Confusion Double vision, seeing stars Not feeling right Amnesia Can’t remember the play, quarter, score Later on Headache dizziness Change in mood

Vacant Stare Slower to answer questions Can’t focus Disorientation (walking in wrong direction) Poor coordination Poor memory LOSS OF CONSCIOUSNESS

Suspected concussions need evaluation May be unrecognized by non medical personnel More than 80% of people with a previous concussion did not recognize it as such Just asking time and date not adequate “When in doubt, sit them out”

Test at beginning of season and immediately after injury Decline in 1 point 76-94% accurate in detecting concussion

Brief Questionairre What is your name? What is the name of this place? Why are you here? What month are we in? What year are we in? In what town/suburb are you in? How old are you? What is your date of birth? What time of day is it? (morning, afternoon, evening) Three pictures are presented for subsequent recall

1 wrong answer suggests concussion

Any athlete with suspected concussion MUST be removed from game/event Cannot return to play on same day Does not matter how mild concussion symptoms are!!!

When to go to Hospital Loss of consciousness Suspected broken skull Black eyes, bruising behind ears Ear drainage 2 or more episodes of vomiting Significant neurologic impairment

Bleeding in the brain Second Impact Syndrome Occurs when a second head injury occurs before 1 st concussion can fully heal Causes brain swelling Can be deadly Rare

General Principles: A player should not return to play until symptoms have resolved completely, both at rest and during activity Younger athletes have longer recovery time and a more conservative approach should be taken All suspected concussions should have medical evaluation by physician before returning to play

Athlete should not be left alone after concussion Need to monitor for worsening condition

Stepwise return to play (Vienna, 2001) Day 1 - No activity and rest until no symptoms (i.e. headache dizziness, etc.) Day 2 – May start light aerobic exercise if no symptoms Day 3 - Sport-specific training Day 4 - Noncontact drills Day 5 - Full-contact drills Day 6 - Game play

Day 1: complete brain rest (i.e. no reading, video games) If you have symptoms at any level, you have to go back to the level where you have no symptoms.

Neuropsychological test Measures: Attention span Memory Reaction Time Non verbal problem solving Considered a “cornerstone of concussion management” Can be given by coach, trainer, anyone who is trained to administer test

May be able to detect subtle signs of a concussion Can follow the accumulative effects of multiple concussions over time Need Baseline test prior to injury to compare Still being researched Cannot alone determine return to play.

Alzheimers Disease Parkinsons Depression Permanent memory problems Long term brain damage Vertigo

Chronic Brain Injury Did not suffer any “documented” concussions in college or NFL

Passed May 14, 2009 Requires all school districts to work with the WIAA to develop guidelines to educate coaches, youth athletes, and parents of the nature and risk of concussion and head injury Requires an informed consent must be signed by parents and youth athletes recognizing risk of concussions Requires that a youth athlete who is suspected of sustaining a concussion or head injury be removed from play. “When in doubt, sit them out” Requires a written clearance from licensed health care provider prior to returning to play. Injuries html

Specialized helmets or mouthpieces- no clear benefit May be more harmful Athlete has false sense of security and changes behavior of play.

Concussions are much more common than previously believed Players with concussions (even mild) should be removed from play Stepwise approach to return to play Must be seen by a medical professional and preferably get IMPACT testing prior to return Long term mental effects of repeated concussions New laws in place in Washington