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Introduction to Concussions: Recognition and Management of Concussion in Sport

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Introduction to Concussions: Recognition and Management of Concussion in Sport. David B. Gealt, D.O. Cooper Bone and Joint Institute Cooper University Hospital Asst Professor UMDNJ-RWJ Asst Professor UMDNJ-SOM Palmyra-Riverton Soccer Club August 24, 2011.

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Introduction to Concussions: Recognition and Management of Concussion in Sport

David B. Gealt, D.O.

Cooper Bone and Joint Institute

Cooper University Hospital

Asst Professor UMDNJ-RWJ

Asst Professor UMDNJ-SOM

Palmyra-Riverton Soccer Club

August 24, 2011

athletic trainers report
Athletic Trainers Report:
  • 5.1% of football players sustained a concussion during a season
  • 0.7% sustained a second concussion during the same season BUT……

(Guskiewicz et al.2000)


Player’s Report Symptoms of Concussion

  • 47% had at least one concussion during the season.
  • 35% had multiple concussions during the season.

(Langburt et al.2001)

athletes want to
Athletes Want to…




Education is #1

    • Healthcare Personnel
    • Certified Athletic Trainers
    • Coaches
    • Parents
    • Athletes
  • Everyone needs to be on the same page to avoid the potential dangers of repetitive concussive head injury
concussion facts
Concussion Facts
  • A direct blow to the head, face, and neck can cause a concussion
  • An indirect blow elsewhere on the body can transmit an “impulsive” force to the head, causing a concussion
  • Most concussions do NOT involve loss of consciousness
concussion facts9
Concussion Facts
  • Typically results in rapid onset of short-lived impairment of neuro function that spontaneously resolves
  • Majority of concussions resolve within 7-10 days
physical signs and symptoms

Dizzy or Lightheaded

Blurry Vision

Ringing in the Ears

Loss of Balance

Numbness or Tingling Sensations

Loss of consciousness



Difficulty Sleeping

Sensitivity to Light and Sound

Dilated Pupils

Slurred Speech

Glassy eyed/foggy

Physical Signs and Symptoms
cognitive and emotional signs symptoms

Difficulty Focusing or Concentrating

Disorientation of Time & Place

Slower Rate to Processing Information

Memory Loss*

Irritability/mood changes


Easily Saddened or Upset


Cognitive and Emotional Signs & Symptoms
consequences can affect
Consequences can Affect:
  • Academics
  • Social Relationships
  • Behavior
  • Emotions
evaluation management
  • Basic Life Support to assure ABC’s
  • Determine if LOC has occurred
  • If LOC and/or ? Cervical spine injury MUST STABILIZE and BOARD and TRANSPORT. Do not remove helmet and shoulder pads.
  • Ask teammates involved in play if LOC *
  • Once ruled out can move to sidelines
  • Sideline Assessment
    • SCAT 2
  • Reassess q 5-10 minutes
  • Remove helmet
  • Deterioration of Neuro fcn—SEND TO ED ASAP!
  • Follow up with complete eval in office
  • Computer Neuropsychological Testing-ImPACT
baseline testing a cutting edge technology impact
Baseline Testing- A Cutting Edge Technology-ImPACT

Immediate Post-Concussion Assessment and Cognitive Testing

Provides comparison based on pre and post concussion scores

Provides clinicians with a tool to help determine safe return to play

Documents an athletes concussion history

2010 nj state law
2010 NJ State Law
  • N.J.S.A 18A:40-41.3 was passed on 12/7/2010 by Gov Christie
  • Development of interscholastic athletic head injury safety training program
  • NJ Dept of Ed (NJDOE)
    • “Model Policy and Guidance for Prevention and Treatment of Sports-Related Concussions and Head Injuries”, February 28, 2011

2010 nj law
2010 NJ Law
  • Immediate removal from sports competition or practice
  • Unable to RTP: Medical Evaluation and written clearance by a physician or other licensed health care provider trained in the evaluation and management of concussion.
nj state law
NJ State Law

All coaches, school nurses, school/team physicians and ATCs must complete a Concussion Head Injury Training Program

Head Injury Fact sheet signed by each student/guardian annually before activity

Each school needs a written concussion policy implemented by 2011-2012 year

  • Acute Response (All newest literature data supports)

-Any signs/symptoms of concussion = No RTP, Out of Activity

-Not to be left alone: to ck for deterioration

-Medical evaluated ASAP

-RTP by stepwise process with trained supervision

other factors to consider
Other Factors to Consider
  • Age of the child…younger is not always better in fact may be worse (Field et al 2003)
  • Symptoms that persist for longer than 3-6 weeks (PCS)
  • Cumulative effects of multiple concussions
rtp too soon serious consequences
RTP too soon—Serious Consequences
  • Post Concussion Syndrome
  • Second Impact Syndrome
    • Loss of cerebrovascular autoregulation causing brain swelling, herniation, death
  • No Cookbook Guidelines
  • Individualized Treatment
  • Multi-Discipline Approach
    • Physicians
    • ATC
    • School Nurse
    • Neurocognitive Testing
    • Neuropsychologists/Psychologist
    • Cognitive Therapist
    • Guidance Counselors
    • Teachers
    • Family Support

In simplest terms think of a concussion as a “sprained brain”

    • Physical Rest
    • “Cognitive Rest”– limit ADLs, exertion and scholastic activities while symptomatic
  • Consider Modifications @ school during recovery
    • Extensions/Breaks/Testing/Time in School
    • Gym and athletics
rtp protocol
RTP Protocol
  • Must by ASYMPTOMATIC w/ normal neuro/cognitive fcn
  • No activity, asymptomatic for 24 hours
  • Light aerobic exercise
  • Sport specific training
  • Noncontact drills
  • Full contact
  • Game play

If become symptomatic, return to prior level

and wait 24 hours


Proper management of concussion is the best form of prevention of serious injury

  • Not worth the risk of playing with a concussion
    • Only 1 Brain: Protect It!
  • “When in Doubt - Sit Them Out!”
heads up concussion kits
Heads Up Concussion Kits

First step in fixing this epidemic

It’s Free!