1. Presented by: Matt Brennan, ATC/AT-L

3. “….just got their bell rung”  300,000 sports concussions per year  1.6 to 2.3 million sports concussions per year (CDC 2006)  16 deaths in youth sports since August 2008, 6 head injury related  36 concussions in SHS athletics during the 2008-2009 school year

4. What is a concussion?  A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.  Caused by a blow or jolt to the head that disrupts the function of the brain.  In concussions acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. (Zurich Consensus Statement 2009)

5. What is a concussion?  Complex --- no “easy” concussion  Pathophysiological--- not structural!  Trauma Induced--- impact to the head  Less than 10% of all concussions involve a loss of consciousness.

6. Pathophysiology  In a concussion, certain chemical levels are altered at the cellular level  Blood supply to the brain decreases  The brain’s demand for glucose increases The result is a metabolic imbalance referred to as an “energy crisis” The supply/demand mismatch can last days. (Giza, Hovda J Athl Training 2001)

7. If your brain is a computer…. Then a concussion is a software issue, not a hardware problem  Imaging (X-ray, CT, MR, etc) shows structure not function  Imaging will be normal in most cases  Normal Imaging ≠ Normal Function!  Most concussions have Normal Imaging!

8. Concussions- Not Just a Football Problem….  Concussion rate per 1000 athlete-exposures Football0.47 Girls Soccer0.36 Boys Soccer0.22 Girls Basketball0.21 Boys Basketball0.07 Most injuries occur in football players due to the large number of participants Gessel LM et al. “Concussions Among United States High School and Collegiate Athletes” Journal of Athletic Training 2007; 42:495-503 60% Higher 300% Higher

9. Signs and Symptoms COGNITIVESOMATICAFFECTIVESLEEP Confusion Post-Traumatic Amnesia (PTA) Retrograde Amnesia (RGA) Loss of Consciousness (LOC) Disorientation Feeling “in a fog”, “zoned out” Vacant Stare Inability to focus Delayed verbal and motor responses Slurred/incoherent speech Excessive drowsiness Headache Fatigue Disequilibrium, dizziness Nausea/Vomiting Visual disturbances (photophobia, blurry/double vision) Phonophobia Emotional liability Irritability Sleeping more than usual Sleeping less than usual Trouble falling asleep Drowsiness

10. Recognizing a Concussion Signs observed by coach, parent, teammates  Appears dazed or stunned  Is confused about assignment  Forgets plays  Is unsure of game, opponent, or score  Moves clumsily  Answers questions slowly  Shows behavior or personality changes  Loss of consciousness  Can’t recall events prior to the hit  Can’t recall events after the hit Symptoms reported by the athlete  Headache  Nausea  Balance problems or dizziness  Double or fuzzy vision  Sensitivity to light or noise  Feeling sluggish  Feeling foggy  Concentration and/or memory problems  Confusion

12. The Law… EHB 1824---Zackery Lystedt Law Signed May 14, 2009

13. Zackery Lystedt Law, EHB 1824  Parents and athletes must sign an information sheet about head injuries prior to beginning participation in athletics each year  Requires that any youth athlete suspected of having a concussion be removed from practice or play  Any athlete suspected of suffering a concussion is removed from play until they receive written medical clearance from a licensed health-care provider trained in the evaluation and management of concussions. http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1824&year=2009

14. When a concussion is suspected  Remove the athlete from practice or play IMMEDIATELY!  If there is a school approved licensed health care provider trained in the management and evaluation of a concussion available they should provide care for the athlete

15. When a concussion is suspected  If there is no school approved licensed health care provider available it is the coaches job to continually evaluate and reassess the athlete  Never leave the athlete unsupervised by a member of the coaching staff  Inform the athletes parent/guardian of the suspected injury  If the athlete worsens, call 911  If the athlete is stable, release them to their parent/guardian

16. When can an athlete return to play?  Youth athletes should not be returned to play on the same day as injury The younger the athlete the more conservative the treatment  REST is BEST! This is both physical and cognitive rest  Every athlete is different and there is no set timeline for their return to activity  Athletes will follow a gradual multi-stage return to play protocol once they are symptom free and all of their exams have returned to normal

17. Catastrophic Head Injuries in High School and College Football Players  National Center for Catastrophic Sports Injury Research data from 1989-2002  94 cases  92 cases were in high school players  59% of athletes had a previous history of concussion(s): 71% of those injuries occurred in the same season as the catastrophic injury  39% of the athletes at time of catastrophic injury were playing with residual symptoms from a previous concussion Boden et al. AJSM 2007; 35: 1075 - 1081

18. Risk of Early Return to Play  Intracranial Bleeding----can lead to death  Second Impact Syndrome---can cause death  Multiple Concussions  Longer Recovery Period  Post-Concussion Syndrome  Permanent Brain Damage

19. Gradual Return to Play  The athlete should be completely symptom free to begin this process  There should be 24 hours between each stage  The athlete must be asymptomatic in each stage  If symptoms return at any time, they must stop and rest for a minimum of 24 hours and be symptom free before restarting return to play protocol back at stage 1

20. Gradual Return to Play  Steps: No activity Light aerobic activity Sport-specific activity Non-contact training drills Full contact practice Full return to play  This process takes at least 1 week to return an athlete to play

21. SHS/MS Head Injury Protocol  ImPACT baseline testing  If a head injury occurs: No same day return to play Evaluation will be done by AT/L and the athlete will be evaluated by a physician Athlete will re-test using ImPact 24-48 hours after the injury Athlete will begin the return to play protocol when they are symptom free and have returned to baseline on all testing

22. SHS/MS Head Injury Protocol  If a head injury occurs: If the AT is not present do not leave the athlete unsupervised If they are stable contact their parents and have them pick them up and take them for further evaluation If they are not stable, call 911 Contact the AT to notify of the injury so that it can be followed up on the next day

23. Is This Practice/Game More Important Than:  The rest of the season?  The rest of the athlete’s career?  The rest of the athlete’s life?

24. Finally Do not let an athlete suspected of having a concussion back into practice or games until they have been evaluated and cleared in writing by a Licensed Health Care Provider trained in the management and evaluation of concussions. That is not only the LAW; It Is the Right Thing To Do!

25. Resources  Heads up kit: www.cdc.gov/concussioninYouthSports/ www.cdc.gov/concussioninYouthSports/  www.biawa.org www.biawa.org  www.nata.org www.nata.org  www.seattlechildrens.org www.seattlechildrens.org  www.wiaa.com www.wiaa.com