Introduction to Introduction to ConcussionsConcussions

NPR Story – March 2007NPR Story – March 2007 Billy’s storyBilly’s story

http://www.npr.org/templates/story/story.php?storyId=9002473

Newspaper pieceNewspaper piece http://laxbuzz.wordpress.com/2008/11/09/concussions-in-lacrosse-athletic-directors-and-coaches-must-be-held-accountable-for-enforcing-no-play-or-practice-rules/

Listen to this later – 30 minute pieceListen to this later – 30 minute piece http://www.npr.org/templates/story/story.php?storyId=9158658

StatisticsStatistics 300,000 a year in sports 300,000 a year in sports 19% or 1 in 5 chance that you can get a 19% or 1 in 5 chance that you can get a concussion in a contact/collision sportconcussion in a contact/collision sport

Collegiate Stats (2002-2003 season, per 1,000 Collegiate Stats (2002-2003 season, per 1,000 athletes)athletes) Football: Football: 3.523.52 per game/practice; Ice Hockey: per game/practice; Ice Hockey: 22 per game/practice; Men’s Soccer: per game/practice; Men’s Soccer: 1.131.13 per per game/practice; Women’s Soccer: game/practice; Women’s Soccer: 1.81.8 per per game/practicegame/practice

1.3-1.5 million youth will suffer a concussion 1.3-1.5 million youth will suffer a concussion during football playduring football play

After 1After 1stst concussion concussion 4X more likely to receive a 24X more likely to receive a 2ndnd one one Takes less of a blow to the headTakes less of a blow to the head

VideosVideos

http://videos.espn.com/m/video/21244042/outside_the_lines_second_impact_syndrome.htm

http://videos.espn.com/m/video/21964180/otl_heading_for_trouble.htm

AnatomyAnatomy

ScalpScalp SkullSkull CerebrumCerebrum CerebellumCerebellum DiencephalonDiencephalon

ThalamusThalamus HypthalamusHypthalamus

Brain StemBrain Stem

AnatomyAnatomy

Meninges and SpacesMeninges and Spaces Dura mater Dura mater – “hard – “hard

mother”mother”

Meningeal arteriesMeningeal arteries Subdural spaceSubdural space

Venous drainageVenous drainage Arachnoid materArachnoid mater Subarachnoid spaceSubarachnoid space

CSF fluidCSF fluid Pia materPia mater– “tender – “tender

mother”mother”

Check out the Meningeal Layers in a REAL brain!

Image from http://faculty.une.edu/com/fwillard/Meninges/outreach.mcb.harvard.edu/teachers/Summer05/JenniferJunkins/

Brain_sportsconcussion.ppt

Head Injury TerminologyHead Injury Terminology

Mild Traumatic Brain Injury Mild Traumatic Brain Injury (MTBI)(MTBI) ConcussionsConcussions

Subdural hematomaSubdural hematoma Epidural hematomaEpidural hematoma Brain EdemaBrain Edema Post-concussion SyndromePost-concussion Syndrome Second Impact SyndromeSecond Impact Syndrome

ConcussionsConcussions A clinical syndrome characterized by A clinical syndrome characterized by immediate and transientimmediate and transient post-traumatic post-traumatic impairment of neural functions.impairment of neural functions. = contusion to the brain which messes up your = contusion to the brain which messes up your normal brain functionnormal brain function

Concussions occur as a result of a direct Concussions occur as a result of a direct blow, or sudden snapping of the head blow, or sudden snapping of the head forward, backward, or rotating to the forward, backward, or rotating to the sideside

May or may not result in result in loss of loss of consciousnessconsciousness, , disorientation or amnesiadisorientation or amnesia; ; motor coordination or balance deficits motor coordination or balance deficits and cognitive deficitsand cognitive deficits

Neurometabolic CascadeNeurometabolic Cascade

Giza and Hovda, JAT, 2001

http://discovermagazine.com/2004/dec/lights-out/article_view?b_start:int=1&-C=

Mechanisms

…and we cannot tape up a damaged brain……and we cannot tape up a damaged brain…

Clinical EvaluationClinical Evaluation Signs and SymptomsSigns and Symptoms are your are your clues…clues………but they are not always but they are not always obviousobvious

Be aware of the…Be aware of the…easily seen signseasily seen signs the self-reported (subtle) the self-reported (subtle) symptomssymptoms

and the delayed symptomsand the delayed symptoms Need a timeline to record Need a timeline to record symptomssymptoms

Signs observed Signs observed Appears to be dazed Appears to be dazed Is confused about Is confused about assignment assignment

Forgets plays Forgets plays Is unsure of game, Is unsure of game, score, or opponent score, or opponent

Moves clumsily Moves clumsily Answers questions slowly Answers questions slowly Loses consciousness Loses consciousness (even temporarily) (even temporarily)

Shows behavior or Shows behavior or personality change personality change

Forgets events prior to Forgets events prior to hit (retrograde amnesia) hit (retrograde amnesia)

Forgets events after hit Forgets events after hit (anterograde amnesia) (anterograde amnesia)

Symptoms reported by Symptoms reported by athlete athlete

Headache Headache Nausea Nausea Balance problems or Balance problems or dizziness dizziness

Double or fuzzy vision Double or fuzzy vision Sensitivity to light Sensitivity to light or noise or noise

Feeling sluggish Feeling sluggish Feeling "foggy" Feeling "foggy" Change in sleep Change in sleep pattern pattern

Concentration or Concentration or memory problems memory problems

http://www.impacttest.com/concussionresource.php

Signs and SymptomsSigns and Symptoms

• Are there any signs and Are there any signs and symptoms that are more symptoms that are more important?important?

• What signs or symptoms seem What signs or symptoms seem to matter most?to matter most?

Sign and SymptomsSign and Symptoms

Take home message:Take home message: Athlete doesn’t have to have any Athlete doesn’t have to have any certain number of signs and certain number of signs and symptomssymptomsDefinition of concussion:Definition of concussion:

1 or more of S/S1 or more of S/S Recent evidence suggests that Neuropsychological testing plus symptom scoring is the gold standard

Allows for post concussion assessment - CHANGES

ImPACT Testing

What can an athletic What can an athletic trainer do to prevent and trainer do to prevent and

treat concussions?treat concussions? Understand mechanisms of injuryUnderstand mechanisms of injury Monitor equipment and techniqueMonitor equipment and technique Be thorough in your evaluationBe thorough in your evaluation

Use team physicianUse team physician Recognize injury severity Recognize injury severity Collaborate with physician on return Collaborate with physician on return to play decisionsto play decisions

Use concussion assessment toolsUse concussion assessment tools Understand the potential negative Understand the potential negative consequences of concussionsconsequences of concussions

Concussions and Athletic Concussions and Athletic TrainersTrainers

Recognition and TreatmentRecognition and Treatment 50% of all those who suffer permanent 50% of all those who suffer permanent neurological consequences from head neurological consequences from head trauma are the result of trauma are the result of inappropriate inappropriate first aid, NOT the actual injuryfirst aid, NOT the actual injury

Often catastrophic head injuries have few Often catastrophic head injuries have few outward signs and symptoms.outward signs and symptoms.

Work as a sports medicine teamWork as a sports medicine team Athletic trainer, physician, and athleteAthletic trainer, physician, and athlete

Athlete should understand consequencesAthlete should understand consequences

The ability to identify and properly The ability to identify and properly manage patients with head injuries may manage patients with head injuries may determine life, death, or disability.determine life, death, or disability.

Equipment IssuesEquipment Issues Protective Equipment and Proper TechniqueProtective Equipment and Proper Technique

Helmets/FacemasksHelmets/Facemasks Properly fitted and maintainedProperly fitted and maintained

Will not prevent all head injuries but may Will not prevent all head injuries but may reduce riskreduce risk

National Operating Committee on Standards for National Operating Committee on Standards for Athletic Equipment (NOCSAE) or American Society Athletic Equipment (NOCSAE) or American Society for Testing and Materials (ASTM)for Testing and Materials (ASTM)

MouthguardsMouthguards No concrete evidence that reduces head injury but No concrete evidence that reduces head injury but provides protection of mouthprovides protection of mouth

No spearing or butt blocking – Heads Up No spearing or butt blocking – Heads Up VideoVideo

Reduction of full contact practicesReduction of full contact practices

Be thorough in your Be thorough in your evaluationevaluation

BE COMPLETEBE COMPLETE History – i.e., previous injuryHistory – i.e., previous injury Observation – i.e., response of Observation – i.e., response of the eyes, balance, symptoms over the eyes, balance, symptoms over timetime

Palpation – i.e., rule out C-spine Palpation – i.e., rule out C-spine and Skull Fractureand Skull Fracture

Special Tests – i.e., memory and Special Tests – i.e., memory and concentrationconcentration