Concussions in High School Athletes

1. Concussions in High School Athletes By Dr. Leyen Vu Resident Physician, St. Peter Hospital Sept. 28, 2010

2. Definition: Concussion • Change in mental status caused by a traumatic episode with or without loss of consciousness. • May be caused by blow to the head or anywhere else on the body with an impulsive force on head • Most commonly no loss of consciousness

3. How Often Do Concussions Occur in Sports? • 300,000 sports related concussions each year • Most common sports: football, ice hockey, soccer, boxing, rugby. • 10% of college and 20% of high school football players suffer head injuries each season • Only 4-5% of players report symptoms. • 63.4% football • 10.5% wrestling • 6.2% girls basketball • 14% had repeat concussion during same season

4. Who Gets More Concussions? • Males more likely than females • 2-3 times more likely

6. The Science

7. The Science

8. The Science • Children have weaker neck and shoulder muscles compared to adults • More of the impact is absorbed by the head and less by the upper body. • Most brain scans are still normal

9. Signs of a Concussion

10. Signs of a Concussion • Immediate • Confusion • Double vision, seeing stars • Not feeling right • Amnesia • Can’t remember the play, quarter, score • Later on • Headache • dizziness • Change in mood

11. Signs of a Concussion • Vacant Stare • Slower to answer questions • Can’t focus • Disorientation (walking in wrong direction) • Poor coordination • Poor memory • LOSS OF CONSCIOUSNESS

12. Sideline Detection of Concussion • Suspected concussions need evaluation • May be unrecognized by non medical personnel • More than 80% of people with a previous concussion did not recognize it as such • Just asking time and date not adequate • “When in doubt, sit them out”

14. Standard Assessment of Concussion (SAC) • Test at beginning of season and immediately after injury • Decline in 1 point 76-94% accurate in detecting concussion

15. Other Tools • Brief Questionairre • What is your name? • What is the name of this place? • Why are you here? • What month are we in? • What year are we in? • In what town/suburb are you in? • How old are you? • What is your date of birth? • What time of day is it? (morning, afternoon, evening) • Three pictures are presented for subsequent recall

16. Other Tools • 1 wrong answer suggests concussion

17. Management • Any athlete with suspected concussion MUST be removed from game/event • Cannot return to play on same day • Does not matter how mild concussion symptoms are!!!

18. Management • When to go to Hospital • Loss of consciousness • Suspected broken skull • Black eyes, bruising behind ears • Ear drainage • 2 or more episodes of vomiting • Significant neurologic impairment

19. Complications of Concussions • Bleeding in the brain • Second Impact Syndrome • Occurs when a second head injury occurs before 1st concussion can fully heal • Causes brain swelling • Can be deadly • Rare

20. Management • General Principles: • A player should not return to play until symptoms have resolved completely, both at rest and during activity • Younger athletes have longer recovery time and a more conservative approach should be taken • All suspected concussions should have medical evaluation by physician before returning to play

21. Management • Athlete should not be left alone after concussion • Need to monitor for worsening condition

22. How To Return to Play Stepwise return to play (Vienna, 2001) Day 1 - No activity and rest until no symptoms (i.e. headache dizziness, etc.)Day 2 – May start light aerobic exercise if no symptoms Day 3 - Sport-specific training Day 4 - Noncontact drills Day 5 - Full-contact drills Day 6 - Game play

23. How To Return to Play • Day 1: complete brain rest (i.e. no reading, video games) • If you have symptoms at any level, you have to go back to the level where you have no symptoms .

24. IMPACT Testing • Neuropsychological test • Measures: • Attention span • Memory • Reaction Time • Non verbal problem solving • Considered a “cornerstone of concussion management” • Can be given by coach, trainer, anyone who is trained to administer test

25. IMPACT Testing • May be able to detect subtle signs of a concussion • Can follow the accumulative effects of multiple concussions over time • Need Baseline test prior to injury to compare • Still being researched • Cannot alone determine return to play.

26. Long Term Consequences of Multiple Concussions • Alzheimers Disease • Parkinsons • Depression • Permanent memory problems • Long term brain damage • Vertigo

27. Long Term Consequences of Multiple Concussions

28. Chris Henry, Cincinnati Bengals • Chronic Brain Injury • Did not suffer any “documented” concussions in college or NFL

29. ZackeryLystedt Law • Passed May 14, 2009 • Requires all school districts to work with the WIAA to develop guidelines to educate coaches, youth athletes, and parents of the nature and risk of concussion and head injury • Requires an informed consent must be signed by parents and youth athletes recognizing risk of concussions • Requires that a youth athlete who is suspected of sustaining a concussion or head injury be removed from play. “When in doubt, sit them out” • Requires a written clearance from licensed health care provider prior to returning to play. • http://www.king5.com/sports/high-school/Sports-Head-Injuries-83303332.html

30. Prevention • Specialized helmets or mouthpieces- no clear benefit • May be more harmful • Athlete has false sense of security and changes behavior of play.

31. Summary • Concussions are much more common than previously believed • Players with concussions (even mild) should be removed from play • Stepwise approach to return to play • Must be seen by a medical professional and preferably get IMPACT testing prior to return • Long term mental effects of repeated concussions • New laws in place in Washington

32. THANK YOU!