Transcript Document
MSYSA
Annual General Meeting
January 19, 2008
Management and Treatment of Concussions
Heat Related Illness
MSYSA Annual Workshop
January 19, 2008
1
Concussion
Concussion of the brain, is a traumatic injury to
the brain as a result of a violent blow, shaking,
or spinning.
Ref: American Medical Association
MSYSA Annual Workshop
January 19, 2008
2
Concussions in Sports
Complex “pathophysiological” process affecting the
brain that disrupts brain activity.
Disruption is “Functional” rather than
“Structural”
Ref: First International Conference In Concussion in Sport, British Journal of Sports Medicine (2002), 15(2):48-55
MSYSA Annual Workshop
January 19, 2008
3
Comparison of Annual Incidence
Traumatic Brain Injuries
Breast Cancer
HIV/AIDS
Spinal cord injuries
Multiple Sclerosis
1,500,000
176,300
43,681
11,000
10,400
Soccer concussions are increasing but is it a real increase in
numbers OR awareness.
Ref: Brain Injury Association of America, Centers for Disease Control and Prevention, American Cancer Society,
National Multiple Sclerosis Society
MSYSA Annual Workshop
January 19, 2008
4
Incidence of Concussions are
“Under-Reported” by Athletes
Athlete did not believe injury was serious
Not wanting to leave game / practice
Not knowing injury was a concussion
“macho” attitude
MSYSA Annual Workshop
January 19, 2008
5
Signs Observed by Staff
Appears dazed or stunned
Confused
Unsure of game, score, or opponent
Disoriented, clumsy
Answers questions slowly
Loses consciousness (even temporarily)
Behavior or personality change
Forgets events prior to injury (retrograde)
Forgets events after injury (anterograde)
Ref:www..impacttest.com
MSYSA Annual Workshop
January 19, 2008
6
Symptoms reported by athlete
Headache
Nausea
Balance problems / dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling sluggish
Feeling “foggy”
Change in sleep pattern
Concentration or memory problems
MSYSA Annual Workshop
January 19, 2008
7
On-Field Cognitive Testing
Orientation
What field are we on?
Who is the opposing team?
What month is it?
What day is it?
Anterograde Amnesia
Ask athlete to repeat following words:
Girl, dog, green
MSYSA Annual Workshop
January 19, 2008
8
On-Field Cognitive Testing II.
Retrograde Amnesia
What happened before your injury?
What was the score of the game before injury?
Do you remember how you were injured?
Concentration
Repeat the days of the week backwards
Repeat these numbers backward
63 (36 correct); 419 (914 correct)
MSYSA Annual Workshop
January 19, 2008
9
On Field Cognitive Testing III
Ask the athlete to repeat the three words from
earlier
MSYSA Annual Workshop
January 19, 2008
10
Word List Memory Test
Girl
Dog
Green
Ref: Impact Test, Impact Applications, Inc. Hilton Head SC.
MSYSA Annual Workshop
January 19, 2008
11
Coaches ACTION Plan
Remove athlete from PLAY
Ensure that athletes receive professional medical
care
Inform parents or guardians about the
concussion
Allow RTP (Return to Play) with permission
from medical practitioner
Ref: Bollinger Sports Forum, Dr. Vito A. Periello, Jr. MD
MSYSA Annual Workshop
January 19, 2008
12
Risk Assessment of Concussions
Each concussion reduces the person’s resistance
to additional concussions. (Unlike structural
injuries, e.g. broken bones, etc.)
athlete has 4 times greater chance
2nd concussion, 3rd, 4th,……..
of suffering
RTP before complete recovery:
“Second Impact Syndrome” –
Catastrophic Damage
Ref: Bollinger Sports Forum, Dr. Vito A. Periello, Jr. MD
MSYSA Annual Workshop
January 19, 2008
13
New Data concerning CONCUSSIONS
Children and Females are more vulnerable and
take longer to recover.
Exercise and stress can exacerbate symptoms if
the brain does not fully recover
RTP before medical clearance increases risk of
“second impact syndrome” and catastrophic
consequences
Ref: Bollinger Sports Forum, Dr. Vito A. Periello, Jr. MD
MSYSA Annual Workshop
January 19, 2008
14
US Soccer Federation
Statement on Use of Padded Headgear
Fifa laws of the game, Law 4, “Players
Equipment” does not include headbands.
“Safety” clause: “players who opt to use padded
headgear should be permitted to do so as long as the
referee confirms that equipment is not dangerous to the
player or another player”.
Ref: U.S. Soccer Federation Statement on Use of Padded Headgear, 8/25/2005
MSYSA Annual Workshop
January 19, 2008
15
US Soccer Federation
Statement on Use of Padded Headgear
It is not permissible for a USSF member or affiliate to require use
of headgear by players.
FIFA’s sports medicine committee concluded that headgear provides
no measurable benefit in head to ball impacts.
There is “measurable benefit” in subconcussive head to head
impacts.
Headgear is not a substitute for proper medical evaluation and
treatment of concussions.
Headgear may create a false sense of security causing players to play
more aggressively
Ref: U.S. Soccer Federation Statement on Use of Padded Headgear, 8/25/2005
MSYSA Annual Workshop
January 19, 2008
16
MSYSA Annual General
Meeting
May 20, 2007
Heat Related Syndromes
MSYSA Annual Workshop
January 19, 2008
17
Risk Management
Heat Related Syndromes
Heat Stroke is DEADLY and
it’s Preventable
MSYSA Annual Workshop
January 19, 2008
18
Heat Related Syndromes
Recognition
of risk factors
Recognition of symptoms
Emergency care plan
Primary Care
Secondary Care
MSYSA Annual Workshop
January 19, 2008
19
Risk Factors
Clothing (light colored / light weight
Age (extremes of age – young / old)
Hydration – Pre game / Post game
High Body Fat
Poor Acclimatization / Fitness Level
MSYSA Annual Workshop
January 19, 2008
20
Additional Risk Factors
Febrile
Illness
Medications
Sickle cell Trait
MSYSA Annual Workshop
January 19, 2008
21
Symptoms of Heat Illness
Muscle spasms / cramps
Skin is flushed or cool and pale
Headache
Dizziness
Rapid Pulse, nausea, weakness
MSYSA Annual Workshop
January 19, 2008
22
Symptoms of Heat Illness
(continued)
Disoriented,
confusion
Cessation of sweating
Red, Dry Skin
Shallow breathing
MSYSA Annual Workshop
January 19, 2008
23
Heat Illness –
WHAT HAPPENS?
Core body temperature rises because:
The
body cannot perspire –
Removal
of excess heat evaporating thru the pores
When perspiration stops
– body temp. rises !!
----- HEAT ILLNESS
MSYSA Annual Workshop
January 19, 2008
24
Environmental Factors Contributing To
Heat Illnesses
Heat and Humidity
Temp
90 F
90 F
90 F
95 F
Humidity
40%
55%
70%
55%
MSYSA Annual Workshop
January 19, 2008
App. Temp
93 F
98 F
106 F
110 F
25
Health Alert Categories
Temperature / Humidity
Category
App TempEffect
Ext. Danger
>= 130F
Heat Stroke
Danger
105-130 F
Heat Exhaustion
Ext. Caution 90-105 F
Heat Cramps
Caution
Fatigue
80-90 F
MSYSA Annual Workshop
January 19, 2008
26
Heat Illness Prevention Techniques
Acclimatization – A child needs 8-10 days (45-60
minutes /day) to acclimate before beginning intense
practice and game situations.
During this period – drink adequate amounts of
fluid to build the body’s fluid volumes.
Wear light colored / lightweight clothing to facilitate
evaporation of sweat.
Allow more water breaks and encourage fluid intake
Ref: U.S. Soccer Federation: 2006 Youth Soccer Heat and HydrationGuidelines.
MSYSA Annual Workshop
January 19, 2008
27
Fluid Guidelines
U.S. Soccer Federation
Before prolonged physical activity, the child should be
well hydrated.
During the activity periodic drinking should be enforced.
Each 15-20 minutes the child or adolescent should
consume:
- 5 oz. of fluid (90 lbs. or less)
- 9 oz. of fluid (more than 90 lbs.)
Ref: U.S. Soccer Feferation; 2006 Youth Soccer Heat and Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
28
Fluid Guidelines
U.S. Soccer Federation
To ensure proper hydration – child should drink
12-16 oz. of fluid approximately 30 minutes
before getting on the field.
After the activity players should drink water or a
sports drink every 15 – 20 minutes for the first
hour.
Ref:Ref: U.S. Soccer Feferation; 2006 Youth Soccer Heat and Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
29
Risk Management Strategies
Schedule practice at the coolest times of
the day
Allow for water breaks
Referees
may allow water breaks (5 minute
break in the middle of each half)
Quick recognition of any athlete who
shows signs of heat illness
MSYSA Annual Workshop
January 19, 2008
30
Plan to prevent Heat illness
Pre-hydration
– fluid intake prior to
practice / game
Clothing
– light material that
efficiently dissipates heat
RECOGNITION
of Risk Factors
MSYSA Annual Workshop
January 19, 2008
31
Dehydration
Loss of 2% of body weight during exercise in heat
Symptoms
Noticeable thirst
Irritability
Decreased performance
Fatigue
Weakness
Nausea
Headache
Muscle cramping
Dark yellow urine
Lightheaded / dizzy
Ref:
Treatment
Rest the player in a cool place
Provide a sports drink containing
electrolytes (no caffeine)
Prevent dehydration by insuring player
consume fluids before, during and
after activity.
U.S. Soccer Federation; 2006 Youth Soccer Heat and Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
32
Muscle Cramping
Symptoms
Muscle spasms
“knotting” of muscles and
pain
Treatment
Drink fluids with electrolytes
(no caffeine).
Gently stretch and massage
cramped muscles
Rest in cool, shaded area
Excessive sweat loss
Apply ice to the cramped
area
Excessive dehydration
Consider additional sodium
in palatable food source, like
pretzels, etc.
Ref:
U.S. Soccer Federation; 2006 Youth Soccer Heat and
Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
33
Heat Exhaustion
Symptoms
Feeling chilly
Rapid Pulse
Ref:
Treatment
Rest the child in a cool, shaded
place
Drink a sports drink that contains
electrolytes
Have child lie down with legs
elevated to promote circulation
Athlete should begin to feel better
soon, if not, assume heat stroke.
U.S. Soccer Federation; 2006 Youth Soccer Heat and Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
34
Heat Stroke
Medical Emergency
Symptoms
Treatment
Very high core temperature
Ice packs over as much
of the body as possible
Altered CNS function
(confusion, extreme lethargy,
etc.)
Cool, wet towels
Cool shower
Athlete may collapse during
intense exercise in the heat.
Water spray
Do not provide fluids
(vomiting is common)
Ref:
U.S. Soccer Federation; 2006 Youth Soccer Heat and Hydration Guidelines
MSYSA Annual Workshop
January 19, 2008
35
Energy Drinks
Health Related Issues
Loaded with caffeine, sugar,
ginseng, taurine, guarana, and Bvitamins
Adverse Effects
“Red Bull” – is marketed as
increasing “physical endurance,
reaction speed, mental alertness,
and stamina”.
Other brands: 180, Adrenalin Rush,
Atomic Energy, Blue Ox, Whoop
Ass, etc.
Dehydration
Insomnia
Headaches
Nervousness
Vomiting
Seizure
Heart arrhythmia
Death
Ref: Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention.
InfoFacts Resources. www.higherdcenter.org
MSYSA Annual Workshop
January 19, 2008
36
Banning Energy Drinks
Sweden: banned in some restaurants
Norway: sold only in pharmacies
France: banned Red Bull
Denmark: banned Red Bull
European Union: In 2004, requiring Red Bull and other energy drinks to carry
a health warning about their “high caffeine content”
Virginia: One county has banned energy drinks from High schools
Ref: Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention. InfoFacts
Resources. www.higherdcenter.org
MSYSA Annual Workshop
January 19, 2008
37
What is Risk Management?
Why is it important?
The safety and well being of our players
is our FIRST PRIORITY.
Education and being aware of the risks
associated with playing soccer will
minimize our risk.
MSYSA Annual Workshop
January 19, 2008
38
MSYSA Annual Workshop
January 19, 2008
Goal Post Safety
MSYSA Annual Workshop
January 19, 2008
39