1. Sports-Related Concussions

2. Video of the day Amazing Race: Watermelon

3. Concussion
Definition: an injury to the brain, as a result of shaking or jarring, that results in temporary or prolonged loss of function
Also known as mild traumatic brain injury (mTBI)

4. The Silent Epidemic
In past, as compared to other neuro disorders, received little attention
This is growing tremendously now
Many go unreported because not visible
Many signs/sx not visible
CT scans don’t reveal signs and sx
Often trivialized or missed because not well understood
“Back in my day”

5. Concussion statistics/Facts
Estimated 300,000 sport-related concussions per year (reported) [Pitt dept of Neurological Surgery]
How many go unreported?
High school football players sustain approx ¼ of sport-related concussions [Knowconcussion.org]
Secondary to motor vehicle accidents, sport-related concussion second leading cause of TBI in individuals age 15-24
Do not need to be hit in head to sustain concussion!!

6. Concussion Signs and Sx
Amnesia
Blurred vision
Dizziness
Drowsiness
Excess sleep
Easily distracted
Feeling in “a fog” or slowed down
Headache
Inappropriate emotions
Irritability
Loss of consciousness
Loss of orientation
Memory problems
Nausea
Nervousness
Personality changes
Poor balance/coordination
Poor concentration
Ringing in ears
Sadness
Seeing stars
Sensitivity to light/noise
Sleep disturbance
Vacant stare/glossy eyes
Vomiting

7. Question of the day
What are 5 signs and 5 symptoms of a concussion? What is the difference between anterograde and retrograde amnesia?
Anterograde- inability to recall events after injury; Retrograde- inability to recall events before injury

8. Concussion Signs and Sx cont.
Only 10% of concussions present with LOC
Amnesia not always present
Retrograde= inability to recall information that occurred prior to event
Anterograde= inability to recall information that occurred after the event

9. Concussion Care Monitor athlete (continuous, daily)
Remove from participation
“When in doubt, sit them out!”
Take helmet or other piece of equipment
Refer as appropriate
Post-Concussive Testing (i.e. ImPACT)
Limit exertional tasks (mental and physical)
We commonly do physical rest, but mental rest is very important

10. Video Preston Plevretes Video

11. Return to Play New CA rule= requires clearance by MD
Lystedt law (WA)- must be cleared by health care provider
Max’s law (OR)- annual training of coaches in concussion recognition
Progression of activity

12. Concussions-Immediate Referral
Any LOC
Significant Amnesia
Symptoms that progressively get worse
Vomiting
Cranial Nerve Abnormalities

13. Cranial Nerve Assessment
Olfactory- smell
Optic- vision
Oculomotor- pupil response; eye mvmnt
Trochlear- eye mvmnt

14. Cranial Nerve Assessment
Trigeminal- clench teeth; temporal sensation
Abducens- lateral eye mvmnt (abduct eye)
Facial- facial expressions (smile); sensation
Vestibulocochlear (auditory)- hearing and balance

15. Cranial Nerve Assessment
Glossopharyngeal- voice; swallow
Vagus- gag reflex
Spinal Accessory- upper trap strength
Hypoglossal- tongue movement
On Occasion Our Trusty Truck Acts Funny. Very Good Vehicle Any How!!

16. Young Athletes and Concussions
Significantly longer healing process than older individuals
Brain is still developing
Lack of awareness
Decreased presence of health care professionals
Remember, only 40% of high schools in CA have AT

17. Concussions and Gender
Literature is looking at differences in gender
Incidence of concussions in females increasing
Why?
More females playing sports
Type of sports being played
Less developed neck musculature

18. Post-Concussive Symptoms
New symptoms can show up hours after injury (may not be present at time of injury)
Symptoms indicate that brain has not healed; should not be taken lightly
Rest (mental and physical) is only tx; no way to speed this up

19. Second Impact Syndrome
Occurs more in younger athletes (<20 y.o.)
Not completely understood, but second insult to (unhealed) brain causes rapid intracranial bleeding
Medical emergency that leads to death in approx 50%; significant neural issues in survivors
What is the best way to tx second impact syndrome?
PREVENT IT FROM HAPPENING IN FIRST PLACE!!

20. Cumulative effects of Concussions
Subsequent concussions take longer to heal
May result in disqualification from sport
Once you have a had a concussion, easier to get one; lower threshold (Steve Young, Mike Matheny)
Long term effects
(later in life)
Depression
Suicide
Early onset Alzheimer’s
Cognitive impairment

21. Concussion Grading Many different grading scales (i.e. grade 1, 2, 3)
Cantu, American Academy of Neurology, Colorado Medical Society
Most based on LOC and duration of symptoms
Grading scales mostly abandoned, base it more on presence of symptoms (mild, moderate, severe)
Easier to classsify once concussion has cleared

22. Impact Testing
Immediate Post-Concussion Assessment and Cognitive Testing (from Impacttest.com)
Attention Span
Working Memory
Sustained and Selective Attention Time
Response Variability
Non-Verbal Problem Solving
Reaction Time

23. Impact continued Individual Tests within Test Word Memory
Design Memory
X’s and O’s
Symbol Matching
Color Match
Three Letter Memory
Class thoughts on each individual test?

24. Impact continued Results sent to and determined by neuropsychologist
Results based on baseline measure for individual athlete or on norms determined for age and gender
This is just another tool to use
Should be used in conjunction with other assessment strategies (current test results)
What were your thoughts on this test (overall)?

25. SAC test Not much use without baseline
Does serve as a reminder of tests that can be performed
Main goal of this is to perform something that is standardized and easily repeatable

26. SAC test continued Should take approx 15 minutes
Used to have to hold people out for at least 15 minutes to see if any symptoms showed up
Again, just another tool to have in our arsenal
Having done this test with your peers, what are your thoughts?

27. Concussion video
ddk&feature=related (10:00)

28. Bean ball video (sports science)
(approx 7 min)