Should Richie play football Christina Smith Paul MD FAQSM Primary Care amp Sports Medicine Student Health Service University of Pennsylvania Concussions are not a new phenomenon but they certainly have been getting a lot of attention in the news in the past few years High profile pro ID: 245131
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Concussions:Should Richie play football?
Christina Smith Paul MD, FAQSMPrimary Care & Sports MedicineStudent Health ServiceUniversity of PennsylvaniaSlide2
Concussions are not a new phenomenon, but they certainly have been getting a lot of attention in the news in the past few years. High profile professional athletes and former athletes have started to come forward and speak about their experiences with this injury and its (sometimes) prolonged and profound effect on their respective futures. The heightened awareness about this important injury has led to a boom in marketing efforts: both from an injury prevention standpoint and a diagnosis standpoint, with inconsistent evidence that these efforts are successful. Education about the injury remains the most important tool in preventing bad outcomes. Come learn a bit more about concussion, help clarify some myths, and hear how we take care of our concussed students here at PennSlide3
Concussions in the News: ESPN, NYTimes
“SEC concerned about concussions”“New concussion law suit filed by 100 ex-players”“Concussions affecting women more often than men”“More retired players sue NFL over concussion effects”
“Trying to Reduce
H
ead
I
njuries, Youth
F
ootball
L
imits
P
ractices”Slide4
Overview
DefinitionsDiagnosis Cognitive tests TreatmentPreventionReturn to school, return to athletics/clearanceOngoing research
Systems at PennSlide5
Headgames
http://vimeo.com/headgames/trailerSlide6
Concussion
Concussion = Traumatic Brain InjuryLoss of consciousness = Rare (and not predictive)Causes: blow to head or body http://www.youtube.com/watch?feature=player_detailpage&v=fY7J7bccNoUSymptoms vary
Grading systems obsolete
Simple
vs
Complex (Prague, abandoned Zurich)
Avoid slang terms as well (“bell rung” etc.)Slide7
Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008Slide8
What we knowNumbers are increasing
More so in femalesEach subsequent concussion seems to require less forceBalance testing is an objective measure (BESS: Balance Error Scoring System)Is a functional, not
structural
issueSlide9
What we knowEquipment does not PREVENT concussion
“Absence of Proof is not Proof of Absence”
www.
sportsdentristy.comSlide10
What we don’t know (but are working on)
How to predict duration of recoveryWhy some people are more susceptiblehttp://www.youtube.com/watch?v=O8R1x6Co6OY&feature=player_detailpageHow many is “too many”
How to speed recovery
Supplements
Medications
Physical therapySlide11
Concussion Symptoms
HeadacheNauseaDizzinessBlurry visionSensitivity to light or noiseFeeling sluggish, foggy, “out of it”ConfusionDifficulty with concentration, memorySlide12Slide13
Concussion Facts
High risk activities: Bicycling, Football, Playground Activities, Basketball, SoccerNumbers and rates are highest in:football (55,007; 0.47 per 1000 athlete exposures) girl’s soccer (29,167; 0.36 per 1000 athlete exposures
)
ED visits:
1.37 million per year (790k male/575k female)Slide14
Concussion Diagnosis
You can’t SEE itSings/symptoms usually follow the injury but there can be a delayAwareness/education of coaches, parents, athletes is VITALhttp://www.nfl.com/videos/nfl-network-around-the-league/09000d5d814d2543/Concussion-safetySlide15
Concussion Treatment
Initial Treatment: Do I need to take Richie to the ED?Should Richie get a head CT?COGNITIVE AND PHYSICAL RESTSlide16
Treatment, continuedOngoing:
Do I need to wake Richie up at night?Can Richie go to school?Can Richie do homework, watch TV, email?Can Richie play in his game tomorrow?Can Richie take ibuprofen?
Role of
meds or physical
therapy?Slide17
Concussion InvestigationsNeuroimaging
CT scanMRI (structural and functional: studies emerging)Objective balance assessment (BESS)Neuropsychological assessmentSlide18
Neurocognitive Testing
Computer-basedImPACT, CogSport, HeadMinderAdded tool for use in return-to-play decisions
Avoidance of returning an athlete too soon
Baseline testing
Timing of testing
Pros/cons of testing
Formal “paper and pencil” testing
Several hours
Comprehensive
Reserved for chronic/difficult casesSlide19
Return To School Guidelines (CHOP)
Step 1Complete cognitive rest: No TV, computer, text, etc. Step 2Light cognitive activity, 5-15 min increments, frequent breaks, stop if symptomaticStep 3Schoolwork at home, 30 min increments
Step 4
if tolerating 1-2
hrs
at home, can go half day
*advance to next step if symptom-free x 24
hrsSlide20
Graded Return to Play
Rehab Stage
Functional Exercises
Objective at each stage
1. No activity
Physical
and Cognitive Rest
Recovery
2. Light aerobic
exercises
Walking, swimming, stationary bike; intensity <70% maximum HR
Increase HR
3. Sport-specific exercises
Skating drills, running drills
etc.
No head impact.
Add movement
4. Non-contact
training drills
Progression
to more complex training (passing, etc.); May start resistance training
Exercise, coordination, and cognitive load
5. Full contact practice
Following medical clearance
participate in n
ormal
training/practice
Restore confidence
and assess functional skills
6. Return
to play
Normal game playSlide21
Recurrent ConcussionsSecond impact syndrome:
Brain swells rapidly, death near certainrepeat injury w/o proper healing timeYoung people more vulnerableFew casesPost concussive syndromeChronic Traumatic EncephalopathySlide22
Sports Legacy InstituteChris
NowinskiSlide23
Concussions and mental health:In the news
Chronic Traumatic Encephalopathy (Tau Protein) Slide24
Prevention?
GearHead gearHelmetOther head gearMouth guardsSofter balls (soccer)Exercises:
Strengthen neck
Learn proper techniques
Tackle
techniques
Heading techniquesSlide25
Prevention
Rule Changes:NFL and College FootballKickoffs moved up to 35 yd line (from 30 yd line)Pop Warner Football
No hitting in 2/3 of practice
Additional
precautions (3 yards or less,
etc
)
USA Hockey
Raise checking age (11 to 13)
Education (coaches, trainers, athletes, parents)Slide26
What we are doing at Penn
Concussion policy (NCAA requires)All varsity and club athletes must be evaluated and cleared by SHS physicianBaseline ImPACT testing done on all Varsity athletes involved in contact sportReferral resources:Neurology and Neuropsychiatry
Weingarten
CAPS
Physical Therapy (Vestibular Rehabilitation)Slide27
SHS visits for concussionsSlide28
2010 SHS DataSlide29
2010 SHS DataSlide30
2010 SHS DataSlide31
summary
http://www.youtube.com/watch?v=yyRBlSAfb_k&feature=player_detailpageSlide32
Should Richie play football?Should Finley play Soccer??Slide33
References
www.cdc.gov/concussion/sportsMcCrory P, Meeuwisse W, Johnston K, et al.
Consensus
Statement on Concussion in Sport: the 3
rd
International Conference on Concussion in Sport, Zurich 2008.
Br J Sports Med
2009;
43
:i76-i84.
New York Times, June 13 2012
Internet resources
(ESPN,
Youtube
,
Vimeo
,
google,etc
.)Slide34
More video, if time… Sudden Impact Syndrome
http://www.youtube.com/watch?v=dqlDOH45xWM&feature=relmfu