Concussions

Long Term Memory Evaluation

Day of Week What did you eat for lunch

Evaluation: Balance testing procedures?

Double Leg Stance Single Leg Stance Tandem or Heel to Toe

Short Term Memory Evaluation

How injury occurred 3 word memory

Evaluations: what Decisions should be made when: physician not present? concussion is suspected? if completely asymptomatic? if asymptomatic still?

If Team Physician NOT present Remove from all activities If a concussion is suspected, do not return them that day!!! Observe for minimum of 15 minutes Athletic Trainer reevaluates If athlete is: COMPLETELY asymptomatic Normal neurological exam including balance testing Perform Functional Testing (Explained on next slide) Still symptomatic Athlete does not return that day and remains in observation Arrange for physician evaluation

What does a physician evaluation include?

Immediate Concussion Treatment Tylenol only for pain (when physician says to) Daily Follow-up Symptom Score Determine athletes best interest depending on symptoms and academic demands Refer to nutritionist to be placed on DHA Omega 3 ◦ Has been shown to aid the brain tissue

Functional testing includes:

Running Up/Downs Bear Crawls Observe for Symptoms "Do you feel like normal _________ (name)?" ◦ If Yes, allow return ◦ If No, hold them Diagnosed Concussion Physician Evaluation ASAP

Processing Functions

Subtract from 100 by 7's Months of Year Backwards

What should be done is symptoms score is less than 10?

An IMPACT test must be set up

What symptoms are worse than others?

Fogginess is worse than dizziness

Symptoms

Headache Irritable Nausea Sadness Vomiting Nervousness Balance Problems Numbness or Tingling Dizziness Feeling "foggy" Fatigue Difficulty in concentration Drowsiness Visual Problems Sensitivity to light Sensitivity to noise

What health care providers handle concussed athletes? What two things are they responsible for determining?

Team Physician and Athletic Trainer 1. Have unchallengeable authority to determine and manage the treatment and the return to play of any ill or injured athlete. 2. Return to play following a concussion will be made by the team physician or his/her designate.

IMPACT testing

a computer program in which symptoms checklist, concussion history and neuropsychological testing

By the end of 2014:

all states have enacted concussion related laws

What sports are tested for baseline testing? (8)

baseball, basketball, diving, equestrian, football, pole vaulting, soccer, and softball

What is a typical recovery for a complex concussion?

weeks to years

What factors determine final clearance?

◦ Athlete is Completely Asymptomatic ◦ Athlete Returns to Baseline on IMPACT ◦ Athlete can accomplish all Return-to-Play activities with NO ONSET of SYMPTOMS ◦ Athlete is referred by to physician for final clearance. ◦ Ultimate Return-to-Play ◦ Upon Medical Clearance: Athlete is released to coaches for normal training exercises including contact drills if appropriate to restore athletes confidence and to determine if athletes is ready to participate.

Education: What are the three things the coach (1) and the players (2) must be knowledgeable of when handling concussions?

◦ Coaches must acknowledge that have been educated and they understand the concussion management plan. They are presented education and they answer basic questions. ◦ Athletes must receive documentation and sign an acknowledgement form. ◦ Athletes must agree to report if they feel they have an injury or suspect someone else.

Graduated return to play includes? (3) What is the goal of each?

◦ Light Aerobic Exercise - Goal= Increase Heart Rate Walking, Stationary Bike, Swimming -70% max ◦ Sport Specific Exercise- Goal= Add Movement Running Drills, jogging to sprinting ◦ Training Drills- Goal= Add Coordination and Cognitive Function Up/Downs, Bear Crawls, Pass Catching,

When first diagnosed with a concussion, a physician might suggest to refrain from what activities?

◦ Physical Activity ◦ Texting and Emailing ◦ Playing video games ◦ Watching TV, Video ◦ Consider excusing from all academics

Concussion Management: (RRRR)

◦ RECOGNIZE Train athletes, coaches, parents, school staff ◦REMOVE Develop and implement a sound concussion management policy ◦REFER Athlete must be seen by a physician* ◦RETURN Stepwise progression (Prague Guidelines and NATA position statement)

What is the NCAA Policy? (6 Policies)

◦ Required concussion management plan on file ◦ Student-athletes must sign a statement agreeing to report all injuries and illnesses ◦ Student-athletes should be presented with educational material on concussions ◦ All student-athletes with suspected head injuries must be removed and evaluated ◦ Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day ◦ Medical clearance determined by team physician

When do they become active?

◦At or near NO Symptoms ◦At or near Return to Baseline on IMPACT

House Bill 2038 (Natasha's Law): When was it signed? What are the 4 requirements?

-signed into law May 17, 2011 - Every school district that competes in interscholastic athletic activity must establish a concussion oversight team (COT) All suspected head injuries must be evaluated by a physician A 5-step return-to-play (RTP) protocol Must obtain a written release by a physician or health care provider prior to an athlete's RTP

Evaluations include: (3)

1. Short term memory evaluation 2. long term memory evaluation 3. processing functions

Progressive Functional Testing includes: (3)

1. walk 2. jog 3. sprint

Concussion report for 2012

3,800,000 concussions reported in 2012, double what was reported in 2002

October 24, 2011

33 states have enacted youth sports concussion-related laws

What percentage of concussions occur at practice

33% of all sports concussions happen at practice

What percentage of high school athletes report two or more within the same year?

33% of high school athletes who have a sports concussion report two or more in the same year

How many concussions occur annually and within what population do these numbers rise?

4 to 5 million concussions occur annually, with rising numbers among middle school athletes

What is a typical recovery for a simple concussion?

5-7days

Concussions and unconsciousness

90%-diagnosed concussions do not lose consciousness