1. Concussions in Sport FIS Technical Delegate Update

2. Outline - Coordination Concussion Guidelines Dr. Morrell (CAN) – FIS IMPACT – Best Practices Parent / Athlete Document Example Evaluation Tool Scat - Card, Scat -2 Review Elements USA Landscape Athlete Letter Medical Release Letter

3. Why Interest Note: > 90% of sport-related concussions have no L.O.C. Any Sports – Football, Hockey, Skiing etc. There are projected to be approx. 300,000 concussions per year in USA High School athletics alone

4. FIS Medical Committee Educational Series Dr. Bob Morrell Member of the FIS Medical Committee FIS RETURN TO SNOW SPORTS POST CONCUSSION Concussion is a very prevalent injury in snow sports. It is defined as a disturbance in the functioning of the brain following a blow to the head or a force transmitted to the head, which may or may not cause a loss of consciousness. This typically results in the rapid onset of a short-lived impairment of neurologic function, which resolves spontaneously. Athletes suffering from a concussion can display a wide variety of signs and symptoms, some of which can be very subtle. concussion, as they are more vulnerable for recurrent injury, persistent post concussive symptoms, cumulative injury, and potentially even life threatening injury, with subsequent concussive injury. Any athlete suspected of having sustained a concussion should be withdrawn from that event or training session, and undergo formal medical evaluation. Therefore any athlete complaining of headache, nausea, vision change, ringing in the ears, dizziness, or confusion after a crash or displaying poor coordination, poor balance, difficulty answering questions, or easy distractibility, should be brought to the attention of the team physician. It is important that these athletes not be left alone and monitored for deterioration in the immediate post injury period. The cornerstone of concussion management is rest, until complete resolution of symptoms. This includes both physical and cognitive or mental rest. Athletes should therefore have a quiet environment and avoid exposure to stimulation such as TV or computer screens, and avoid alcohol and medications. Some analgesics and anti- inflammatories may be prescribed but it should be recognized that these might mask some of the signs and symptoms of concussion. The return to sport progression is begun once the athlete has been off all medications and completely symptom free for a minimum of 24 hours. The most widely accepted return to play guideline is from the Summary and Agreement Statement of the Second International Symposium on Concussion in SportPrague 2004. This is a step-wise process, each step being separated by a minimum of 24 hours. Progression to the next step only occurs if the athlete is completely asymptomatic at the current level. Any recurrence of symptoms should lead to the athlete dropping back to the previous asymptomatic level. Steps include 1) Complete physical and mental rest until asymptomatic 2) Low intensity aerobic exercise (walking, spinning on a stationary bike) but no resistance training 3) Higher intensity aerobic exercise 4) Easy free skiing/riding and light resistance training 5) After medical clearance can train fully (for example, ski gates) 6) After medical clearance return to full competition and racing Athletes with a simple concussion typically easily progress through these steps over 7-10 days. Athletes with complex concussion (an injury where athletes suffer persistent symptoms, specific sequelae, or prolonged cognitive impairment, or athletes who have suffered multiple concussion) may require a prolonged period of asymptomatic rest as well as more time at each of the subsequent steps in the progression. Neurocognitive testing has become an integral part of concussion management. This can be done as simple paper and pencil test (such as the SCAT) or using computer based tests. All athletes should have preseason baseline neurocognitive testing done. This should be repeated after a concussive injury and the athlete should not return to training until back to their baseline scores. The team physician should supervise the above outlined progression and give final clearance for return to training and competition. contact e-mail: bmorrell@telus.net

5. FIS Medical Committee Educational Series Dr. Bob Morrell Member of the FIS Medical Committee It is important to identify the athlete that has suffered a concussion, as they are more vulnerable for recurrent injury, persistent post concussive symptoms, cumulative injury, and potentially even life threatening injury, with subsequent concussive injury. Any athlete suspected of having sustained a concussion should be withdrawn from that event or training session, and undergo formal medical evaluation. Therefore any athlete complaining of headache, nausea, vision change, ringing in the ears, dizziness, or confusion after a crash or displaying poor coordination, poor balance, difficulty answering questions, or easy distractibility, should be brought to the attention of the team physician. It is important that these athletes not be left alone and monitored for deterioration in the immediate post injury period. The cornerstone of concussion management is rest, until complete resolution of symptoms. This includes both physical and cognitive or mental rest. Athletes should therefore have a quiet environment and avoid exposure to stimulation such as TV or computer screens, and avoid alcohol and medications. Some analgesics and anti- inflammatories

6. FIS Medical Committee Educational Series Dr. Bob Morrell Member of the FIS Medical Committee Therefore any athlete complaining of headache, nausea, vision change, ringing in the ears, dizziness, or confusion after a crash or displaying poor coordination, poor balance, difficulty answering questions, or easy distractibility, should be brought to the attention of the team physician. It is important that these athletes not be left alone and monitored for deterioration in the immediate post injury period.

7. FIS Medical Committee Educational Series Dr. Bob Morrell Member of the FIS Medical Committee The cornerstone of concussion management is rest, until complete resolution of symptoms. This includes both physical and cognitive or mental rest. Athletes should therefore have a quiet environment and avoid exposure to stimulation such as TV or computer screens, and avoid alcohol and medications.

9. ImPACT– BEST PRACTICES Concussion Management Model for Schools and Teams STEP 1 Pre Season Baseline Testing & Education STEP 2 Concussion is Suspected STEP 3 Post Injury Testing & Treatment Plan STEP 4 Is Athlete Ready for Non Contact Activity

10. ImPACT BEST PRACTICES STEP 5 Determining Safe Return-to-Play Educate Athletes, Parents, Coaches, Teachers on Concussions ( Note: Canadian and USSA Focus ) Take an ImPACT Training Webinar or Workshop to Learn about Baseline Test Administration Have a Concussion Management Protocol On-hand and Have Your Team of Key Professionals Ready to Treat Athlete. If Concussion is Suspected – Immediate Removal from Play/ Activity

12. Sport Concussion Assessment Tools (SCAT 1 & 2) What Is Utilized Provides an easy to use for medical responders and practitioners tools Standardized tool Combination of existing tools

13. Sport Concussion Assessment Tool (SCAT 1)

14. SCAT 1 – Symptom Scale

15. Scat 2 Assessment Tool

16. Review of Key Concussion Elements Return-to-Play Management What Doctors Consider If Concussion Is Suspected: General medical considerations - Remove from activity and observe If prolonged LOC or neurological concerns, C-spine precautions and hospital assessment

17. What is Generally Prescribed Physical Rest Physical Rest No light exercise No weight training No physical activity until symptom free! Rest - Rest - Rest Rest - Rest - Rest

18. What is Generally Prescribed Cognitive Rest Cognitive Rest Limited - School, Computer Work, No !!! – Video Games Rest - Rest - Rest Rest - Rest - Rest

19. What is Generally Prescribed Rest For How Long? If rapid and full recovery, then 24-48 hours – this is not the return to physical activity time frame. For the same amount of time as it took to become asymptomatic ( no symptoms i.e headaches etc.)

20. Return-to-Play Management Neuropsychological Testing Web-based Types: Traditional 6 hour battery programs www.cogsport.com www.impacttest.com

21. USA Landscape Presently There Are 23 States + USA Congress Action Which Have Enacted Legislation Concerning Concussion Management Note: Canadian Different Perspective FIS Medical Guideline / Education Focus

22. USA Landscape Present State Laws Were Supported By The National Football League Three (3) Key Elements 1: Education – Coaches, Parents, Clubs 2. Removal From Activity When Appropriate 3. Medical Evaluation – Before Return To Play See Distributed USA Parent Letter & Medical Form

23. Food For Thought For FIS Jurys With Regard To Potential Concussions Do Not Rush To Judgment When and As Deemed Appropriate Consider All Alternatives Including Utilize and Rely on Medical Resources Keeping The Athlete Out Of Competition Note FIS Medical Guidelines