Management of ConcussionFor Administratorsin High School Athletics Michele C. Benz, ATC, LAT, CSCS, HFS
What Do I Need To Know? 1. What are the new guidelines on treatment and management of concussion 2. how can we develop a second impact syndrome prevention program? Treatment, Management & Prevention of SIS Helmet Fitting Performed by ATC Viewing of Concussion Video Prior to Play Baseline Testing (ImPACT) Use Concussion Evaluation Form (SCAT/SAC) Return To Play Guidelines, Zurich 2008
What Is A Concussion? Complex pathophysiological process that affects the brain, induced by traumatic biomechanical forces. -Zurich Concussion Conference, 2008 Blow to the head resulting in Concussion=BRAIN DAMAGE!!!
Facts About Concussion 1.2 Million Youth Concussions Per Year 50% FB Players Have Sustained A Concussion 35% Suffered Multiple Concussions 80% Symptoms Worsen Over Weeks 50% Return To Play Too Soon 70% Would RTP Concussed 41% Would Not Leave A Game 50 H.S. Football Players Have Died Since 97 “It’s not dangerous to play with a concussion,” said Kelby Jasmon, a senior two-way player for his high school in Springfield, Ill., who has had three concussions. “You’ve got to sacrifice for the sake of the team. The only way I come out is on a stretcher.”
Recognizing A Concussion • Know the cognitive level of the student • Learn to recognize the signs and symptoms • Signs: • Athlete stumbles after play • Shakes head in attempt to “shake it off” • Goes to wrong huddle or in wrong direction • Takes a knee/bent over • Runs the wrong play • Eyes don’t focus/follow • Symptoms • Headache • Nausea • Sensitivity to Light • Lethargic • Personality Changes
Online 20 minute test Inexpensive Printed test score Tests Reaction time Working & Design memory Attention span Non-verbal problem solving Visual processing speed Impulse control Response inhibition Heads Up CDC/NFHS Youth Concussion ESPN’s E:60 (5.4.10) Outside The Lines (11.4.07) Baseline Testing and Videos Testing Videos
Treatment National Federation of State High Schools: February, 2010 • Removal from participation, even if symptoms clear within 15 minutes. • In absence of medical staffing, officials now charged with removal from participation without LOC. • SCAT evaluation • Parental/guardian contact • Dialogue with coach/athlete • Referral/Diagnostic testing* • Post-Injury ImPACT test • Graduated RTP • Head Injury Reporting Form *Referral based upon results of evaluation. Diagnostic testing diagnoses structural abnormality, not concussion.
Return To Play New guidelines (Zurich Conference, 2008) recommend a graduated RTP “Step-Wise Return to Play Protocol” Complete physical and cognitive rest Light aerobic activity Sport specific exercise Non-contact training drills Full contact practice Return to game play Athletes should also be back to baseline and depending on grade of concussion, be cleared by a neurologist and/or neuropsychologist. The NFL changed their RTP guidelines on Dec. 3rd, 2009 stating: “Any player suffering signs/symptoms of a concussion should not return to play the same day and should be checked out by proper medical staff.”
Non-Athletic Injured Students • Physical Education Classes • Fighting or other accident *Have a plan in place prior to the school year* Do not move the student Have an administrator decide whether or not EMS is needed Contact the parent or guardian If transport is not necessary-advise the parent to have the student checked out by their doctor. Fill out accident report
Second Impact Syndrome (SIS) • Second concussion before previous concussion has completely resolved • Metabolic volcano within the brain • Athletes under 23 at greatest risk • Catastrophic brain injury or Death Second Impact Syndrome is PREVENTABLE
Prevention Miami Palmetto SIS Prevention Program • Coaches are on board with program • Baseline testing-ImPACT • Concussion awareness videos • Parent/Athlete Information Sheet • Equipment fit by ATC • Use of Sideline Evaluation Test • Responsibility Clause –Physical form • Referral for diagnostic testing via Sports Medicine team. SIS is PREVENTABLE