“A headache is part of the game.”

Unless knocked unconscious it was not

considered a concussion.

“He just got his bell rung”

If unconscious less than 10 seconds could

go back in the game if symptoms cleared.

Ammonia Inhalants & smelling salts

If you could stand and know what the play

was they would keep you in.

3 Grades Grade 1- No loss of consciousness

Mild Dizziness

Mild Balance problem

Slight memory loss

Grade 2- LOC Up to 5 min

Slight confusion

Mild Memory loss

Grade 3-LOC Over 5 min

Prolonged Memory loss

Severe Dizziness

Monitor symptoms. As soon as symptoms went away we would double the time.

If they had continued symptoms we would send them home with a room mate or parent. › Wake up every 2 hours through the night

› Watch for personality change

› Level of consciousness

Athlete consistently getting head injuries should be restricted from sport?

First described in 1973

Second head injury before recovery of 1st

May be minor trauma

Brain loses blood autoregulation ability

Blood vessel engorgement

Mueller, Catastrophic Head Injuries in High School and Collegiate Sports, J Ath Train, July-Sept, 2001.

Cantu, Second Impact Syndrome: A Risk in Any Contact Sport, The Physician and Sportsmedicine,

June 1995.

Intracranial Pressure – rapid respiratory failure, coma, possible death

1984-1992: 4 cases

1992-1995: 17 cases

Approximately 100 cases over past 25 years* › Nearly all have occurred to those < 18 yo*

Cantu, Second Impact Syndrome: A Risk in Any Contact Sport, The

Physician and Sportsmedicine, June 1995.

*Personal communication, Kevin Guskiewicz

HS athletes may

take longer to recover than older athletes

Residual effects on memory and reaction time may persist longer in HS athletes

Pellman et al, Concussion in Professional Football: Recovery of NFL and

High School Athletes Assessed by Computerized Neuropsychological

Testing, J Neurosurgery, Feb 2006.

Signs

Appears dazed

Confused,

forgets plays

Moves clumsily

Answers

questions slowly

Can’t recall

events prior to or

after the hit

Symptoms

Headache

Dizziness

Fogginess or feeling “slowed down”

Concentration probs

Light or noise

sensitivity

Vision probs

Ringing in ears

Misunderstood by

parents, athletes

and even some

medical

professionals

› Only 10% athletic-

related involve

LOC

Guskiewicz et al, National Athletic Trainers’ Association Position Statement:

Management of Sport-Related Concussion. J Ath Train, 2004; 39(3).

Prague Consensus Statement

Simple Concussion

Resolves in 7-10 days

Complex Concussion

No RTP same day as injury, stepwise progression

Summary and Agreement Statement of the Second International Conference

on Concussion in Sport, Prague 2004. The Physician and Sports Medicine,

April 2005

Zurich Consensus Statement

Removed simple, complex defs

No RTP same day as injury for most

Stepwise progression

Some adults may RTP same day

Consensus Statement on Concussion in Sport: The 3rd International

Conference on Concussion in Sport Held in Zurich, November 2008. Journal of

Ath Trn, July-Aug 2009

25 minute computer test or other forms of testing

Measures memory, reaction time, processing speed, etc

Post-injury test compared to baseline to determine recovery

Sports Legacy Institute and Boston University Center for the Study of CTE

Dr. Ann McKee (Boston University), 23 years studying brains

18 brains studied of retired NFL and college football players

All the brains studied had Chronic Traumatic Encephalopathy

“Has not seen this unique pattern of change to this severity”

Abnormal protein found in the brain that

eats away at the brain cells.

Found that it is triggered by trauma in

youth

Normal 65 yrs Grimsley 45yrs Boxer 73 yrs.

Dementia

Depression

Memory Impairment

Emotional Instability

Average age of the onset of symptoms is 43yrs.

MYTHS: › 1. Normal CT Scans rule out concussion

› 2. Unconsciousness is indicator of severity

› 3. Males more than females

› 4. The harder the hit , the worse the concussion

› 5. No pain, no gain

› 6. Adult HI is the same as adolescent HI

› 7. Helmets prevent concussion

› 8. Sleep is dangerous.

Officially took effect 1/1/2012

REQUIRES Coaches, volunteer coaches

that are contracted, formally engaged

or employed to complete a concussion

recognition education course.

REQUIRES REMOVAL and REFERRAL to

Health Care Provider

NO RETURN until CLEARED IN WRITING BY

THAT Health Care Provider

Who is a health care provider: › M. D. Medical Doctor

› D.O. Doctor of Osteopathic Medicine

› L.N.P – Licensed Nurse Practitioner

› P.A - Physician Assistant

› PhD – Neuropsychologist with specific Training

› ATC, ATC-R Certified Athletic Trainer may supervise return to play program But MAY NOT medically clear athlete.

1. One concussion increases the

chances of more

2. Concussion treatment should be

individualized

Return to Play programs essential.

3. When in Doubt, Sit them out.

1. Times have changed Better Science, Better Medicine

2. Contact Sports DO NOT equal headaches

3. Investigate the cause of the problem and take it seriously! Get medical help if un-sure

4. DO NOT give any medications until the cause of the headache is UNDERSTOOD.

5. Form a partnership with the coaches and medical staff. Communication benefits everyone.

6. Verify training of coaches.

7. Athlete must complete a RTP Program

7. WHEN IN DOUBT, SIT THEM OUT !!!

• Athletes should not return to play until: – Completely symptom free for 24-48 hours

• Normal medical exam • May begin gradual return to activity program

1) Light aerobic exercise (e.g. exercise bike) 2) Sport-specific training (e.g. running, agilities, skating, lifting) 3) Non-contact drills 4) Full-contact drills 5) Game play

• The athletes must be, and remain symptom free in order to progress from step to step and there must be 24 hours between steps.

• Athlete must stop activity immediately if symptoms return – Re-evaluate the following day

• Closely monitor for any return of concussion symptoms

– ALWAYS respect the brain and the time it needs to heal

mailto:ddimanna@jeffco.k12.co.us