Coaches Understanding Sports-Related Concussion

1. Coaches Understanding Sports-Related Concussion Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center Washington, DC

2. USA Hockey Foundation Project Goal of Project: Maximize safety of youth hockey players, specifically as it relates to the prevention and management of concussion.

3. USA Hockey Foundation Project • Completed with support from USA Hockey Foundation (Heads Up Hockey) • In collaboration with Gardens Ice House and Montgomery Youth Hockey Association • Modeled after NHL Concussion Program • Education, Baseline Testing, Post-Concussion Evaluation & Gradual Return-To-Play

4. 1997 • NHL REQUIRES BASELINE • TESTING FOR ALL ATHLETES • Over 3800 athletes tested • 800 concussion evaluations • Player and league supported • Post-Concussion Evaluation • Gradual Return-To-Play Eric Lindros (8 reported concussions)

5. Four-Part Concussion Education & Management Program • Education: Increase knowledge of signs, symptoms, and risks associated with concussion • Baseline: Establish pre-season baseline levels of concussion symptoms • Early ID of concussion: Promote effective, early identification of concussions • Return to play: Implement safe return-to-play (RTP) protocol

6. Key Starting Points • Concussions can occur in any sport • Ice hockey is a safe sport • Concussions are relatively infrequent • Concussions vary with the level, skill & intensity of the play. • Individual’s likely vary in their susceptibility to concussion. • Proper management of a suspected concussion significantly reduces the chances of a bad outcome.

7. Four-Part Concussion Education & Management Program • Education: Increase knowledge of signs, symptoms, and risks associated with concussion • Baseline: Establish pre-season baseline levels of concussion symptoms • Early ID of concussion: Promote effective, early identification of concussions • Return to play: Implement safe return-to-play (RTP) protocol

8. What is a Concussion? A concussion is an injury to the brain that: • Is caused by a bump, blow or jolt to the head. • Can change the way the brain normally works. • Can range from mild to severe. • Can occur during practices or games in any sport.

9. What are the Symptoms of a Concussion? 3 symptom types • Physical: Headache, nausea, balance problems, double/fuzzy vision, sensitivity to light or noise, feel sluggish, dizziness • Thinking: Poor concentration, memory, trouble following conversation, fogginess, confusion • Emotions: irritable, more emotional, sadness

10. Do you need to lose consciousness with a concussion? NO! • You may or may not have a loss of consciousness • Only a small % do (approx 10)! • Can happen even if you haven’t been knocked out. • Can be serious even if you’ve just been “dinged” or had your “bell rung.”

11. Incidence • Traumatic brain injury (TBI) is among the most common injuries in children • Annually, more than one million children sustain a TBI; 80-90% “ mild” • Concussion = Mild TBI • Estimated 300,000 sports-related concussions per year (likely an underestimate by 3-8x)

12. How do you know if a player has had a Concussion? • After a blow, something seems different. • You might notice some symptoms right away (confusion, loss of balance, fogginess, memory). • Player is not following the game or the plays. • BUT - Other symptoms may take hours, days, or weeks (headache, irritability, poor concentration). • Later on, difficulties with schoolwork, completing everyday tasks, irritability.

13. What Parents/ Coaches/ Teammates See (Signs) • Appears dazed, stunned, glassy • Confused about tasks, game assignment • Forgetful, repeating same questions • Unsure of game, score, opponent • Moves clumsily • Answers questions slowly • Shows behavior or personality changes • Can’t recall events before hit or after hit • Loses consciousness

14. Symptoms The Player May Report • Headache • Nausea • Balance problems, dizziness • Double or fuzzy vision • Sensitivity to light or noise • Feeling sluggish or slowed down • Feeling foggy or groggy • Concentration or memory problems • Confusion

15. What to do if your player has a Concussion • Initial Assessment - Do NOT ignore a blow or jolt to the head. Observe the player for signs and symptoms. • If a Concussion is suspected, implement the ACTION PLAN. • When in doubt, sit them out.

16. Basic Assessment • Observe player for signs & symptoms • Check Concussion Card or clipboard • Questions to Ask: • Score of game, Who playing, Last Play, Current Period • What happened right before hit • What happened right after hit • Symptom list (card/ clipboard) • Questions Not to Ask (not useful) • Name of self or others • Day, date, time, where they are (orientation) • How many fingers

17. ACTION PLAN • Do NOT allow the player to play with symptoms. • Remove the player from the game/ practice. • Inform the parents. • Encourage a medical checkup. Obtain a proper evaluation by sports concussion expert. • Allow return to play only with permission from an appropriate health care professional.

18. What if I Have Questions about a possible Concussion? If Coach, Parent, or Player has any question: • Call the SCORE Information Hotline to discuss with a Concussion consultant • SCORE Hotline #: 240-426-8057 • SCORE Hotline Hours: • Mon-Fri 8am-9pm • Sat-Sun 10am-9pm

19. Treatment of a Concussion • Give yourself time to recover. REST! • Your brain needs to heal. • If not healed, your brain is more likely to be injured again - and worse. • Recovery can take several days or weeks. • Manage physicial (e.g., running, weightlifting) and cognitive (e.g., schoolwork, homework) exertion

20. What could happen if nothing is done? • Player is more likely to be re-injured. • Second/ third... injuries: • are more likely to be more severe • could cause permanent brain damage • can take longer to recover from. • The player is put in greater danger. • The player is not helping their team or teammates. • Teammates must help their fellow teammates!

21. After a Concussion, When Can the Player Return to Play? • No longer have symptoms • No longer need medicine to control symptoms. • Cognitive/ thinking skills back to “normal.” • Cleared by medical professional.

22. After a ConcussionGradual Return to Play Protocol After rest and gradual activity (exertion) • Light aerobic exercise such as walking or stationary cycling. • Sport specific training. • Non-contact training drills. • Full contact training. • Game play.

23. How Can Concussions be Prevented? • Follow the sport’s safety rules (especially checking, rough play). • Good sportsmanship. • Use proper equipment. • Right equipment for the sport and position. • Use equipment properly. • Properly fitted. • Use it every time you play. • Do not ignore a blow or jolt to the head.

24. Key Ending Points • Know what a concussion is and its symptoms. • Dings and bell-ringers count! • 3 types of symptoms: physical, thinking, emotional • Don’t Ignore. Observe the players, tell parents. • Encourage teammates to watch out for their friends. • When in doubt, consult with SCORE. • Give TIME to recover. REST! • Follow the sports’ rules safely. • Use the equipment properly. Play Hard! Play Safe! Play Smart!

25. It’s better to miss a game or two than the whole season or a career!

26. Four-Part Concussion Education and Management Program • Education: Increase knowledge of signs, symptoms, and risks associated with concussion • Baseline: Establish pre-season baseline levels of concussion symptoms • Early ID of concussion: Promote effective, early identification of concussions • Return to play: Implement safe return-to-play (RTP) protocol

27. Pre-Season Symptom Baseline • Assess presence of any “symptoms” prior to any injury • Allows for comparison following an injury • Identify number and degree of symptoms • After an injury, symptoms are monitored until return to pre-injury levels • Assist in guiding a safe return to play

28. Pre-Season Symptom Baseline • With parental permission, complete baseline assessment by both parent and athlete • Copies of baseline assessments collected by SCORE staff; will be returned to parents for their records • Letter to pediatrician indicating that baseline has been completed, should a concussion occur

29. 0= Not a problem 2= Moderate problem 4= Severe problem

31. Four-Part Concussion Education and Management Program • Education: Increase knowledge of signs, symptoms, and risks associated with concussion • Baseline: Establish pre-season baseline levels of concussion symptoms • Early ID of concussion: Promote effective, early identification of concussions • Return to play: Implement safe return-to-play (RTP) protocol

32. Concussion Identification and Return to Play • Implement the ACTION PLAN • Should an injury occur, SCORE staff can provide consultation and evaluation, in collaboration with athlete’s physician • Return to Play: Ideally, conducted by certified athletic trainer.

34. Safe Concussion Outcome, Recovery, and Education (SCORE) Program • Staff includes neuropsychologists, sports medicine physician, and athletic trainer • Symptom monitoring and concussion-specific neuropsychological testing • Computerized testing (ImPACT) assessing attention, memory, and processing speed/ reaction time

35. Safe Concussion Outcome, Recovery, and Education (SCORE) Program • Provide consultation to coaches and trainers regarding safe return to play • Provide consultation to schools regarding academic issues

36. SCORE Hotline If Coach, Parent, or Player has any question: • Call the SCORE Hotline to discuss with a Concussion consultant • SCORE Hotline #: 240-426-8057 • SCORE Hotline Hours: • Mon-Fri 8am-9pm • Sat-Sun 10am-9pm