1. Management of Concussion in the Community College Athlete
Nancy Resendes Chinn, Ed.D.
Monica Ohkubo, MA , ATC, EMT-B
Santa Rosa Junior College

2. What is concussion?

3. Concussion
May be caused by a direct blow to the head, face, neck or body, with a force transmitted to the head.
Does not usually result in a loss of consciousness.
Injury from concussion rarely shows up in CT scan or MRI.

4. Symptoms of Concussion
Headache
Dizziness
Loss of balance
Sensitivity to light/noise
Blurred vision
Confusion
Fatigue
Nausea
Irritability
Difficulty with concentration and memory

5. Concussions are Serious Injuries
They can affect performance in sports and create difficulties in the classroom.
Returning to play too soon after a concussion can result in permanent disabilities.

6. Challenges of Identification of Concussion in the Student-Athlete
The incident resulting in the concussion may not have been observed.
Athletes may try to hide their symptoms in order to return to play.

7. Failure to identify a concussion when it happens can result in a greater likelihood of sustaining a second more serious injury.

8. “He didn’t share his symptoms for a desire to stay in and play more
“He didn’t share his symptoms for a desire to stay in and play more...He took a hit in another game, then the symptoms were worse. This kid was bound for Arizona State on a scholarship...I saw him in physical therapy with some permanent deficits. It was a live consequence for him.” (Subject T5)
Athletic trainer who has begun using baselines talks about a time when they didn’t use objective measures in assessment.

9. The Neurometabolic Cascade (Giza and Hovda, 2001)
Identification of changes at cellular level including altered glucose metabolization, cerebral blood flow, and impaired axonal functioning.
Correlates with post-concussion cerebral vulnerability.

10. The Neurometabolic Cascade (Giza and Hovda, 2001)

11. National Athletic Training Association Standards
“Baseline testing on concussion assessment measures is recommended...The use of objective concussion assessment tools will help the certified athletic trainer in more accurately identifying deficits caused by injury, and recovery from injury.”

12. International Conference on Concussion in Sports
...all athletes, regardless of level of participation, should be managed using the same treatment and return to play paradigm...it is recommended that in all organized high-risk sports consideration be given to having this [baseline] cognitive evaluation regardless of age or level of performance.”
(McCrory et al., 2009, p.190)

13. The Community College Student-Athlete & Concussion
Developmental considerations
Cognitive demands of academics
Culture of risk in sport

14. Pressure to Return to Play: Athletes
“I take their helmet and hide it so I don’t have to worry about them going back into the game...there’s times when they get angry at me... ‘I can go back in the game I’m fine!’ and they’re still having symptoms.” (Subject T1)
A lot of these kids have no idea. They’ve heard the word concussion, but they don’t understand what it means.

15. Santa Rosa Junior College Sports Medicine Concussion Management Program: From Research to Practice

16. Concussion Management Protocol
(MONICA)

17. Santa Rosa Junior College Sports Medicine Concussion Management Program:
Physician consultation and collaboration
Coach education and collaboration
Student-Athlete concussion education
Computerized baseline testing on all contact sports
Objective assessment at the sideline
Referral to DRD for concussion management education and accommodations
Re-testing with ImPACT as part of return to play protocol

18. Student Athlete Education
Concussion quiz and concussion presentation prior to ImPACT baseline testing
Concussion Fact Sheet from CDC/NCAA distributed
Student-Athlete Concussion Statement

20. Computerized Baseline Testing (ImPACT)
Assesses memory, concentration, speed of processing, and other cognitive skills.
Re-test post-injury and compare to baseline.
Nancy and Monica are trained to administer and interpret results.
215 student-athletes during fall semester
Quiz, then after receiving education on concussion via PPT, the student athletes take a 30 minute neuro-cognitive computer test in our computer lab. After the test, they leave with a copy of the NCAA Concussion Information Sheet for Student-Athletes.

21. ImPACT Baseline Report
Cognitive Scores
Symptoms Score

22. Concussion Assessment at the Sideline

24. Identification of Concussions at SRJC
In fall of 2009, 20 concussions were identified
In fall of 2010, 24 concussions were identified
So far since Spring 2011, 24

25. Conversation on the football sideline between two student-athletes:
“Hey man, why did you have to sit out last week?” “Concussion.” “Right on.”

26. Return to the Classroom/Play following Concussion

27. Referral to Disability Resources For Education/Accommodations

28. Benefits of Meeting with DRD Concussion Specialist
Support
Concussion management education
Academic accommodations:
Note-taker
Wearing sunglasses in class
Consideration for late assignments
Taking exams in quiet room with extra time

29. ImPACT Baseline and Post Test Comparisons
Percentile Score Comparisons
Bar Graph Comparisons

31. Concussion Management Protocol
(MONICA)