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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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slide1

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)

slide5

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…

STAY IN THE

GAME!!

slide7

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
Headaches

Dizzy or Lightheaded

Blurry Vision

Ringing in the Ears

Loss of Balance

Numbness or Tingling Sensations

Loss of consciousness

Nausea/Vomiting

Fatigue,Exhaustion

Difficulty Sleeping

Sensitivity to Light and Sound

Dilated Pupils

Slurred Speech

Glassy eyed/foggy

Physical Signs and Symptoms
cognitive and emotional signs symptoms
Confusion

Difficulty Focusing or Concentrating

Disorientation of Time & Place

Slower Rate to Processing Information

Memory Loss*

Irritability/mood changes

Anxiety

Easily Saddened or Upset

Sadness,Depression

Cognitive and Emotional Signs & Symptoms
consequences can affect
Consequences can Affect:
  • Academics
  • Social Relationships
  • Behavior
  • Emotions
  • GOES BEYOND THE PLAYING FIELD!
evaluation management
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
evaluation
Evaluation
  • 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”

http://www.njleg.state.nj.us/legislativepub/ldoa/ldoa.pdf, 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

management
Management
  • 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
management23
Management
  • No Cookbook Guidelines
  • Individualized Treatment
  • Multi-Discipline Approach
    • Physicians
    • ATC
    • School Nurse
    • Neurocognitive Testing
    • Neuropsychologists/Psychologist
    • Cognitive Therapist
    • Guidance Counselors
    • Teachers
    • Family Support
slide24

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

    • Physical Rest
    • “Cognitive Rest”– limit ADLs, exertion and scholastic activities while symptomatic
      • (INCLUDING VIDEO GAMES, TEXTING, FACEBOOK, INTERNET, ETC.)
management25
Management
  • 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

slide27

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

http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm

http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm

First step in fixing this epidemic

It’s Free!