Chris Hummel MS ATC Clinical Assistant ProfessorAthletic Trainer Ithaca College Department of Exercise and Sport Sciences What is a Concussion Complex pathophysiological process affecting the brain induced by traumatic biomechanical forces Zurich Consensus Statement 2008 ID: 570345
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How to Recognize a Concussion?
Chris Hummel, MS, ATCClinical Assistant Professor/Athletic TrainerIthaca CollegeDepartment of Exercise and Sport SciencesSlide2
What is a Concussion?
Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces (Zurich Consensus Statement, 2008)In English = Brain trauma that messes up your normal brain function.
MTBI: Mild Traumatic Brain InjurySports ConcussionSlide3
The Facts- What we know…
Concussions can Occur in Any SportConcussions can be Life Threatening300,000 to 4 million Concussions/YearAlmost 9% of all injuries to High School athletes are concussions
80-90% resolve in 7-10 days, slower in High school athletesProfessional < College < Youth
1/5650 NFL/Youth ConcussionsSlide4
More Concussion Facts-What we are now finding out…
Injury appears to be metabolic not structural which is why CT scan is almost always normal
Headache probably caused by increased glucose demand following injuryMagnitude of force not predictor of outcome/severity of injury
High School Facts
Rate higher in girls
65% games/35% practices
Highest rates in football and soccer
NYS Survey (Rosenbaum, A, 2007): 26 % claim to have had concussion and not reported it!Slide5
Recognition of Concussion
If you think the athlete has sustained a concussion, they probably have!Not always a one time event. Could be a result of cumulative small traumas, not just one big one.Having an Athletic Trainer at games and practices is key to recognition and proper early managementOnly 42% of High schools nationally have any ATC access (NATA, 2010)
I think he has a concussion!Slide6
Signs/Symptoms of Concussion
Headache (40%-90%)Dizziness (40-50%)Memory LossAnterograde, RetrogradeLoss of Consciousness (less than 10%)Poor predictor of severityDecreased Reaction Time
Vision ProblemsLight Sensitive, BlurrinessSlide7
Assessment of Concussion
On the Field- SCAT (ICSCAT)S/S, Memory, Balance, CognitionNeuropsychological Testing- ImPACTMemory, Reaction Time, CognitionCoordination/Balance testingOther Memory TestsSlide8
Management of Concussion
Treat each athlete individually, on a case by case basisAthlete will not return on day of injuryComplete mental and physical restMental=School, texting, video games, TV, I-PodReferral to trained medical professionalATC, MD
What’s different about the HS athlete?Takes longer to recover (7-30 days)Compared to College, NFL (7-10 days)Slide9
NFHS Suggested Guidelines (2009)
No return same dayShould receive clearance from trained medical professionalRTP should follow step-wise protocol with provisions for delayed RTP based on return of any S/S.New Rule for 2010-2011An official must remove anyone from competition that shows the s/s of having had a concussion
Athlete cannot return unless cleared by appropriate medical professionalSlide10
RTP Decision Making
Return to Play should not be considered until athlete is:Completely S/S free for at least 24 hours!NP Testing at/above baseline test scoreNormal SCAT testIn one recent study high school football, 15.8% of athletes sustaining a concussion that resulted in LOC returned to play in < 1 day!Slide11
Progressive RTP
Progressive system of returnLevel 1- RestLevel 2- Light ExerciseLevel 3- Sport Specific ExerciseLevel 4- Non-Contact DrillsLevel 5- Full ContactLevel 6- Game
Each level should take approximately 24 hoursIf s/s resume, drop back to previous level once asymptomaticSome concussions will be progressed much slower, MD controlledSlide12
Education Emphasis
What do you know/think you know about concussions?What do your coaches, and parents know?Who is in charge of recognizing, and managing an athlete’s concussion?Recommend having annual meetings/seminars given by ATC/MD to coaches, parents and athletes on concussion management Slide13
Where to get the best info on Concussions?
NATA.orgCDC.govHeads Up: Concussion in High School Sports ToolkitConsensus Statement 3rd Int’l Conference on Concussion in Sport- Zurich 2008Clin J Sport Med 19(3), p.185-200Slide14
Questions:
Feel free to contact me at chummel@ithaca.eduTHANK YOU!