Introduction to Concussions: Recognition and Management of Concussion in Sport

1. 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

3. Estimates:Concussions in New Jersey

4. 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)

5. 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)

6. Athletes Want to… STAY IN THE GAME!!

7. 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

8. 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

9. 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

10. 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

11. 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

12. Consequences can Affect: • Academics • Social Relationships • Behavior • Emotions • GOES BEYOND THE PLAYING FIELD!

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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

19. How to manage concussions?

20. 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

21. 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

22. RTP too soon—Serious Consequences • Post Concussion Syndrome • Second Impact Syndrome • Loss of cerebrovascular autoregulation causing brain swelling, herniation, death

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

24. 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.)

25. Management • Consider Modifications @ school during recovery • Extensions/Breaks/Testing/Time in School • Gym and athletics

26. 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

27. 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!”

28. 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!

29. Thank You