What is a Concussion?

1. What is a Concussion? A concussion is a mild traumatic brain injury that interferes with normal function of the brain Evolving knowledge “dings” and “bell ringers” are serious brain injuries Do not have to have loss of conciousness Young athletes are at increased risk for serious problems

2. Coup and Contracoup

3. The Problems in the Medical Field There is much variation in the knowledge of health care providers managing concussed athletes Physicians (MD/DO) Physician assistants Nurse practitioners Chiropractors Athletic trainers School nurses New and emerging research and technologies will lead to a continuing evolution of care

4. Problems for Athletes-Post-Concussion Syndrome 85-90% of concussed young athletes will recover within 1 to 2 weeks The remainder may have symptoms lasting from weeks to months interfering with school and daily life Subtle deficits may persist a lifetime

5. Problems for Administrators: Just a few mouse clicks away…… “At Burg, Simpson, Eldredge, Hersh, & Jardine, P.C., our brain injury lawyers represent brain injury victims caused during high school sports in Colorado, Wyoming and nationwide. We have the resources and experience with complex brain injury lawsuits to fully assess your injuries and take your case to a jury. If you or your loved one has suffered a brain injury while playing high school sports, please email or call us today.”

6. Extent of the Problem Professional athletes get a great deal of attention 1600 NFL players Much more common in high school than any other level- due to large number of participants HS Sports Participants Football- 1.14 million Boys Soccer- 384,000 Girls Soccer- 345,000 Boys Hoops- 545,000 Girls Hoops- 444,000 NFHS 2008-09

7. Extent of the Problem 19.3% of all FB injuries in 2009!!! Likely at least 100,000 concussions in HS athletes yearly based on CDC estimates

8. Not Just a Football Problem Injury rate per 100,000 player games in high school athletes Football 47 Girls soccer 36 Boys soccer 22 Girls basketball 21 Wrestling 18 Boys basketball 7 Softball 7 Data from HS RIO JAT, 2007

9. What has happened to make this such a big deal? • Increasing awareness and incidence • Number of high profile athletes over the past 20 years • Steve Young, Troy Aikman, Eric Lindros, etc • Bigger and faster kids, increased opportunities

10. What has happened to make this such a big deal? • High profile cases • Second Impact Syndrome • Death or devastating brain damage when having a second injury when not healed from the first • Long-term effects • Possible long-term effects- dementia, depression

11. Chronic Traumatic Encephalopathy • CTE- progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma • Tau protein • Examples- • Normal brain • 45 yo former NFL player • 73 yo boxer

12. Chronic Traumatic Encephalopathy • 18 yo HS athlete • 2 documented concussions in football • Multi-sport athlete • Early CTE changes on autopsy • Isolated case or harbinger of huge ramifications for contact sports?

13. NFL making changes • Commissioner before Congressional Sub-committee in Oct • NFL’s response since that time: • Resignation of concussion committee co-chairs • Hiring of “independent” neurologists to make RTP decision • No RTP same game in most cases

14. NCAA Follows NFL lead • December 2009 • NCAA now making changes in response to what NFL has done • No return to play same day of concussion

15. Sea Change? • November 2009 • 2 Super Bowl QBs report that they cannot play in upcoming games due to persistent headaches and/or not feeling that they had recovered from most recent concussion. • How important is that upcoming HS game this week??

16. What has the NFHS SMAC done? • Rulebook • Language change • Education!! • Suggested management • Concussion Brochure • No RTP same day- Fall 2008 • Dissemination of information • Where does that information come from?

17. 2010 – 2011 NFHS Rule Book Changes on Concussion • Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional. (Please see NFHS Suggested Guidelines for Management of Concussion). • Approved by NFHS Sports Medicine Advisory Committee – October 2009 • Approved by the NFHS Board of Directors – October 2009

18. Concussion Management- The Basics Coach Education Awareness and Recognition When in doubt, sit ‘em out!! Policies No return to activity on the same day of a concussion No return to activity if having symptoms of a concussion

19. Staying Ahead of the Issue • Need to take initiative • State SMACs (form one if you don’t have one!!) • Education for coaches • No same day return to play • State laws in WA and OR in 2009 • What’s happening in your state? • Keep your ear to the ground

20. The Oregon Experience- 2008 Any athlete…with a concussion…shall not be permitted to return… on that same day. No return until… “no longer experiencing post-concussive symptoms, and a medical release form signed by an appropriate healthcare professional”

21. The Oregon Experience- 2009 • Oregon BIA sponsors “Helmet Law” in honor of young Second Impact Syndrome victim • Mandatory football coach education • Mandatory helmet “re-conditioning” yearly • Mandatory helmet retirement after 10 years • OSAA finds out just before the first public hearing • Testimony by OSAA execs and SMAC Chair • Result is a significantly better law

22. “Max’s Law”- The final product • Mandatory coach education • Player must be removed from play if “exhibits signs, symptoms, or behaviors consistent with a concussion” • Cannot return to play that day • Cannot return to play until asymptomatic and cleared to return by a “health care professional”

23. Washington- “Zach’s Law” • Zach Lystedt- suffered devastating brain injury playing with concussion symptoms • Similar to Oregon Law with additions: • Applies to youth sports • Parents and athlete read and sign information sheet which details signs, symptoms, and effects of a concussion • Outstanding press state-wide and nationally • FB player from Spokane died in September

24. Beyond Education and Policy • Rules making and enforcement • Leading with helmet • Rough play • Limiting contact in practice? • Can we prevent concussions? • Should there be a “mandatory retirement” rule? • What if they just say, “I’m fine?”

25. Neuropsychologic Testing Computerized programs Easily accessed Can be done quickly with immediate results Can obtain “baseline” data on all athletes Can assess reaction times and processing speed

26. Prevention • “Concussion prevention” has become the “holy grail” for sports equipment marketers • Soccer head gear • Girl’s Lacrosse head gear/helmets • Pole vaulting helmet • New football helmets, soccer head pads, mouth guards- NO PROVEN PROTECTION FROM CONCUSSION!! • Multiple flaws in a study looking at “Riddell Revolution” helmet • Neurosurgery, 2006

27. Conclusions Educate Everyone dealing with young athletes must be aware of the signs, symptoms, and ramifications of concussions Mandate or Legislate? Concussion management policies must be in place at every level If you don’t do it, someone will do it for you

28. THANK YOU!!!!!! Thad Stanford, MD, JD- Salem Bill Bowers- Executive Director, OADA Tom Welter- Executive Director, OSAA Mickey Collins, PhD- Pittsburgh Ron Savage, EdD- New Jersey Brian Rieger, PhD- New York Ann Glang, PhD- Eugene http://www.backlinker.com/brain-injury/mild-traumatic-brain-injury-powerpoint