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Concussions
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You only get one brain. Concussion symptoms may appear mild, but this injury can lead to significant, life-long impairment affecting a person’s ability to function: Physically Cognitively Psychologically Appropriate diagnosis, management, referral, and education can help young athletes recover and avoid these consequences
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What is a Concussion? Major health concern: 3.8 million sport related traumatic brain injuries in U.S. each year No universally accepted definition A brain injury caused by a bump or blow to the head that causes the brain to move within the skull A functional injury not a structural injury A concussion will likely not show up on an x-ray, CAT scan or MRI. Major health concern- 3.8 million sport-related TBI every year
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Wave of energy passes through brain tissue and causes neurons to dysfunction
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What does a concussion look like?
Not always going to be this obvious- can be caused by an indirect.
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Why are kids more at risk?
Child’s brain is still developing: more vulnerable Less developed cervical and shoulder musculature Less likely to use proper technique Can’t absorb the forces of collisions
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Diagnosing a Concussion
Concussions are like snowflakes- no two are exactly alike Stay away from “grading” concussions mild, moderate, and severe. Use a graded symptom scale to treat each concussion individually.
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Signs and Symptoms (S/S)
May appear immediately or hours after the injury “Evolving” injury: may feel different at 5 minutes post injury or 30 minutes post injury Some s/s overlap with other conditions These symptoms may not all present right away- may show up hours or days later.
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Signs and Symptoms: Somatic
Headache Dizziness Balance problems Nausea/vomiting Visual problems: double vision, light sensitive Noise Sensitive
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Signs and Symptoms: Cognitive
Confusion Difficulty remembering (amnesia) Difficulty concentrating Disorientation Feels foggy or slowed down Loses consciousness (Less than 10%) Vacant stare Inability to focus Delayed verbal response Slurred speech Excessive drowsiness
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Signs and Symptoms: Mood
More emotional Irritability Fatigue Anxiety Sadness
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Signs and Symptoms: Sleep
Trouble falling asleep Sleeping more than usual Sleeping less than usual
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Red Flags – Go to ER or Call 911
These could mean a more serious brain bleed is occurring– EMERGENCY!! Loss of consciousness greater than 30 seconds Headache that worsens significantly Repeated vomiting Slurred speech Increased confusion Unusual behavior Seizures Weakness/numbness in arms or legs Significant cervical pain with tenderness
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Diagnosing a Concussion: On Field Exam
Assess ABCs: airway, breathing, circulation Mental Status Neurological Deficit Cervical Spine Status
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Diagnosing a Concussion: Sideline Evaluation
More detailed physical exam and history Assess for symptoms (checklist) Evaluate orientation, memory, concentration, and balance SCAT2: Sport Concussion Assessment Tool
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Diagnosing a Concussion: Removal from Play
A player with just 1 sign or symptom must be removed from play No same day return to play! Don’t be pressured! Coaches Parents Teammates Monitor the athlete for 1-2 hours following injury and hours to look for signs of deteriorating function
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Treatment Complete physical rest
No exercise, practice, or lifting weights Complete mental/brain rest- or limit as much as possible No TV, computers, video games, phones, texting No studying, reading, or doing homework Stay home from school
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Return to Play (RTP) Requirements
No Signs or Symptoms Must have been cleared by physician Must have completed a gradual exercise progression
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Gradual Return to Play Progression
20 minutes stationary bike; light weight lifting 20 minutes jogging; moderate weight lifting 30 minutes running; Agility; Regular weight lifting Non-contact practice drills Controlled contact practice Gradual Return to Play Progression Talk about how you progress through these days- if no symptoms return next day can progress. If symptoms return- stop activity and stay at same level the next day.
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Why Concussed Players Must Sit Out
Second Impact Syndrome Can occur in people under the age of 23 Can happen with a minor blow or hit when the player is still recovering from a previous concussion Rapid swelling of the brain Almost always fatal Take a look... You can push through an ankle or a wrist but this is the athlete’s brain.
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Gfeller-Waller Concussion Awareness Act
Signed into law June 16, 2011 Major areas of focus: Education Emergency action Post concussion protocol implementation Clearance/return to play following concussion In August 2008 Matthew Gfeller (age 15) from Winston-Salem and Jaquan Waller (age 16) from Greenville died days apart after head injuries suffered during high school football games
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North Carolina leads the way for concussion research.
Using helmet sensors to learn more about concussions.
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Types of Tests Symptom Score Balance Error Scoring System (BESS)
Sport Concussion Assessment Tool (SCAT2) Neurocognitive Testing Immediate PostConcussion Assessment and Cognitive Testing (ImPACT) Concussion Vital Signs (CVS) Axon
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Symptom Score Player rates how they feel for multiple symptoms
Use a 0-6 scale: 0 = none; 6 = severe
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Balance Error Scoring System (BESS)
A player’s balance is tested in 6 positions Each position is tested for 20 seconds AT counts the # of errors or times the player moves out of position
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BESS Testing Procedure
Test all 3 positions on a hard/firm surface Test all 3 positions on a foam surface Athlete holds each position for 20 seconds Barefoot or socks – no shoes, no ankle tape Hands on iliac crest (hips) Eyes closed – time starts when athlete closes eyes
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BESS Scoring – count each time any of the following happen.
Lifting hands off of iliac crest (hips) Stepping/stumbling/falling Moving non-weight bearing hip more than 30 degrees of flexion or Abduction Opening eyes Lifting foot or heel **If more than 1 error happens at a time, only score it as 1 point **If out of position for 5 or more seconds stop test: score = 10 **Positive = 25% above baseline or above 12 if no baseline
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Neurocognitive Testing
Computer based test Not an intelligence test Measures Memory Reaction time Processing speed Symptoms ImPACT, CVS, CNSVS are examples
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Concussion Vital Signs (CVS): Demonstration Test
Athlete Test “athletetest” for username and password
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Axon: Demonstration Test
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Big Hits Broken Dreams Watch this documentary and answer the questions provided. This will be handed in for a grade at the end of class. Big Hits Broken Dreams
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