2012 Concussion Training Course
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Transcript 2012 Concussion Training Course
Epidemiology/Definitions
Mechanism of Injury
Brain physiology
Who is at risk
Signs and symptoms of
concussion
Sideline evaluation
“A complex pathophysiological process
affecting the brain caused by traumatic
physical force or impact to the head or body
which may include temporary or prolonged
altered brain function resulting in physical,
cognitive, or emotional symptoms, or altered
sleep patterns and may involve loss of
consciousness.”
NFL
Depression
Alzheimer’s disease
Problems with memory
and concentration
Led to congressional
hearings on the issue
Players lawsuit
UIL implementation of
guidelines/laws
Natasha Helmick
TX soccer player
Multiple concussions
Headaches, memory
loss, anxiety, and
depression
Advocate of
concussion education
1.6-3.8 million/yr (cdc)
80-90% “mild”
“Ding”
“Bell rung”
Many likely
unrecognized/underreported
Direct or indirect blow
to the head or body
causing impulsive
forces transmitted to
the brain
Functional problem
(“software”)
Change in ion flux in
brain cells
No structural
(“hardware”) damage
No skull fracture,
intracranial bleed, brain
lesion
No MRI or CT changes
are observed
Brain Energy Demand
Brain Blood Flow
As mismatch corrects, symptoms improve
Many different guidelines
and classification systems
in the past.
There has been nearly one
new guideline every year
for the past 20 years.
As of the most recent
International Symposia on
Concussion in Sport,
concussion is no longer
graded or classified.
Gender
Females increased risk
Different symptoms
reported
▪ Females: drowsiness, noise
sensitivity
▪ Males: amnesia, confusion
Learning disabilities
Prolonged recovery
Repeat concussions
Risk increases with prior
concussion
Sport specific risks
Which child has a concussion?
•
•
•
•
•
Headache
Fatigue
Dizziness
Balance problems
Light/noise
sensitivity
• Nausea
• Irritability
• Sadness
• Nervousness
Physical
Emotional
Sleep
•Memory
•
• Poor concentration
• “Slowed down”
• “Foggy
• Sleeping less or more
• Trouble falling asleep
Drowsy
Home
Difficulty completing tasks at home
Reduced activity
Irritability with challenges
School
Concentration
Remembering directions
Disorganized
Completing assignments
Fatigue
Fall behind, fail tests, reduced grades
If concussion suspected, remove from play
immediately
Coach
Trainer
Physician
Parent/legal guardian
If in doubt, do not allow return to play
Initial assessment
ABCs
C-spine precautions
Neurologic evaluation
▪
▪
▪
▪
Cranial nerves
Strength/sensation
Balance testing
SCAT card
Cranial nerves
Strength
Sensation
Balance
Reflexes
Red Flags (Emergency Room)
Confusion > 30 minutes
Loss of consciousness on field
Focal neurologic deficit
Deteriorating level of consciousness
Severe, persistent headache (“the worst headache
of my life”)
Persistent nausea/vomiting
Seizure
NEVER ALLOW RETURN
TO PLAY THE SAME DAY
Medical referral
Following injury, the athlete MUST be evaluated
by a physician
Does not have to be the Concussion Oversight
Team’s physician
Timing: prior to beginning phase 1 of RTP
protocol
“The cornerstone of concussion management
is physical and cognitive rest until symptoms
resolve and then a graded program of
exertion prior to medical clearance and return
to play.” - Zurich consensus guidelines
Complete rest until asymptomatic x 24h
Athletic
Academic
Daily activities
Requires education
Coaches
Teachers
Parents
Athlete
Physical Rest=
No sports
No jogging
No weightlifting
Cognitive Rest=
No prolonged concentration
No prolonged homework
No prolonged classes
No prolonged days
Many recover in 1-2 weeks
Delayed recovery: Post-concussion
syndrome
Persistent symptoms: HAs, dizziness, fatigue,
irritability, impaired cognition
10% to 20% of athletes with concussion
May last weeks to months...unrelated to severity
of injury.
Second brain injury which occurs before symptoms
associated with the first have fully cleared
Death usually follows rapidly (2-5 minutes) due to brainstem
herniation
Disordered cerebral autoregulation of cerebral blood flow
vascular engorgementincreased ICPBrainstem
herniation
50% mortality
~100% morbidity rate
E:60 Preston Plevretes: videoE:60 Second Impact -YouTube
RTP protocol
Required RTP
documentation
Educational
considerations
Prevention strategies
Questions
1. Evaluation by physician
2. Completion of Return to Play Protocol
3. Written statement by physician clearing
athlete
4. Parent must consent (written) for player to
return to play
Determined by the COT for the applicable ISD
Step-wise return to activity
No activity, complete rest until asymptomatic x 24h
Light aerobic exercise (walking)
Sport-specific training
Non-contact training drills
Full contact training
Game play
If athlete becomes symptomatic at any level, drops
back to previous level
To begin the protocol
Athlete must be completely asymptomatic
▪ No headache
▪ Normal concentration/cognitive skills
▪ Normal balance
If time to reach asymptomatic state is > 7 days
revisit physician; possible referral to pediatric
neurologist
Asymptomatic completion of each step of the
protocol must be documented
Athletic trainer
Coach
▪ Superintendent or his/her designee supervises
Physician note
After completing the RTP progression, the athlete
must be evaluated/cleared by the treating
physician
Treating physician can be the:
▪ COT physician
▪ PCP
▪ Pediatric neurologist
Parent/Guardian Consent Form
The athlete’s parent/guardian must sign the
consent for return to play form, which indicates
the parent/guardian:
▪ Understands of the risks of returning to play
▪ Consents to disclosure of medical information
pertaining to concussion
▪ Understands the immunity provisions
Signed RTP progression form
Each step initialed by trainer, supervising
administrator, or nurse
Parent signature
Collect all forms WITH signatures (including
parent) before student returns to play
Minimize risk secondary to lack of
documentation
Athlete should stay home if:
Able to concentrate < 20 minutes
Headache/other symptoms with attempted
concentration
Bedrest or light mental activity only
Return to school once able to concentrate 2030 min without symptoms
May require return for half days initially
Equipment
Headgear
▪ Do not eliminate risk of concussion, but likely decrease risk
Mouthpiece
▪ No decreased risk of concussion
▪ Prevention of maxillofacial injuries
Teach Proper Technique
Education!!
Athlete education---athlete must be honest about
symptoms
Parent/Teacher/Coach education
Education (cont)
UIL required documentation of concussion
education
▪ Athlete/Parent
▪ Acknowledgment form must be signed by athlete and parent
stating that they have received and read written information that
explains concussion prevention, symptoms, treatment, and
oversight
▪ Must be signed every year of athletic participation
Coaches must complete concussion training every
2 years
Wade Krause
Cell: 210-264-1776
Office: 830-393-0235
Dr. Sheldon Gross (Pediatric Neurologist)
Office: 210-614-3737
UIL
512-471-5883
Billy Marshall
830-743-6839
[email protected]
Athletes who have had a concussion are at no
higher risk of a second concussion?
False
Second impact syndrome is a deadly
complication after concussion which can be
avoided by allowing the athlete to completely
recover before returning to play
True
1.
2.
3.
4.
5.
Unequal pupils
Severe headache
Seizure
Increasing confusion
None of the above
Answer: 5
Concussions can be detected on CT and MRI?
Answer: False
Answer: sleep
Texas licensed physician
One or more of the following:
Athletic trainer
Nurse
Neuropsychologist
PA
No
No
Must be seen by a physician of the
parents/guardians choosing
No
The treating physician must provide a written
statement that in his/her judgment it is safe
for the athlete to return to play
Physician clearance form
Completed RTP protocol form
Each step must be initialed by supervising school
official
Signed by parent
Consent form signed by parent
Yes
But…the superintendent or his/her designee
has supervisory responsibilities of the coach
Every 2 yrs
Yes, every 2 yrs
Athlete safety #1 priority
If in doubt, sit them out
Follow the protocol…this is now LAW
Make sure you have ALL documentation
before the athlete returns
Get the required signatures from the parents
Questions?