Concussionsby

Katherine Rice Frey, BSRN, MAEd, LSN

with contributions from

Bea Benda, BSRN, MSN, Licensed School NurseJessica Findell, BSRN, Licensed School Nurse

Karen Thill, BSRN, Licensed School Nurse

Minneapolis Public Schools

Dedicated to Scott Sacco, Coaches Bob Bancroft and John Deehan

Whitman-Hanson Regional High School, Whitman, Massachusetts

Coach and Hero Bob Bancroft Coach and Hero John Deehan

Scott SaccoClass of ‘80

Scott’s StoryScott Sacco, a 6’2” 225 pound defensive and offensiveend was tackled during a football game. Hit in theshoulder, Scott’s head rotated so violently he sustained a concussion. For the next 2 weeks Scott’s coaches noted his complaints of headaches. Scott’s parentswere unaware of the seriousness of this. CoachesBancroft and Deehan took Scott to the EmergencyRoom where a CAT Scan was performed. The CT revealed a subdural hematoma, (brain bleed). Scotthad emergency surgery to relieve the pressure on hisbrain. The doctors told Scott that his coaches saved hislife. Coaches Bob Bancroft and John Deehan are heroes.

“Concussions can trigger a chemical chain reaction in brain neurons that leaves an athlete disoriented, unconscious or dead. They can also impair learning over a period of years.”

OutlineI. Introduction and GoalsII. Definition of Concussions, Signs and SymptomsIII. Management of ConcussionsIV. Guidelines for Return to PlayV. Recovery ConsiderationsV. Prevention and Prevalence VI. Results of Studies and Case StudiesVIII. Resources and Works Consulted

IntroductionSince a concussion can be an immediate life-threatening condi-tion with potential long-term effects, a working knowledge of this

injury is essential for physical education teachers, coaches, and anyone who works with athletes.

Goals Understand concussions, recognize signs

and symptoms

Understand management, be aware of possible life threatening/changing complications

Incorporate preventative and safety measures into your program

Implement an ACTION PLAN for a suspected concussion

Know when it is safe to return to play

Know which sport and positions are most susceptible

II. Concussions Defined

A concussion canhappen anytime there is a blow to

aperson that

causes the brain to moverapidly inside theskull.

Concussion:Head trauma which causes an

alteration in mental status which may or may not include LOC (loss of consciousness)

Alters how the cells in the brain workThree grades of concussion, 1,2,and 3Treatment varies based on the severity

of the injuryCan be fatal if the head is hit several

successive times in a short time span

Three Categories of Concussions

LOC= Loss of Consciousness

Grade 1transient confusion, no LOC,

mental status abnormalities for < 15 minutes

Grade 2transient confusion, no LOC,

mental status changes for > 15 minutes

Grade 3ANY LOC,

brief or prolonged, seconds, minutes or longer

Recognizing a Concussion

Watch for the following two things among your athletes:

A forceful blow to the head OR BODYthat results in rapid movement of the

head

Any change in an athlete’s behavior, thinking, or physical functioning

Signs reported by athlete:Headache or “pressure” in headNausea or vomitingBalance problems or dizzinessDouble or blurry visionSensitivity to lightSensitivity to noiseFeeling sluggish, hazy or foggyConcentration or memory problemsConfusionDoes not “feel right”

Signs observed by others:Appears dazed or stunnedIs confused about what to doForgets playsMoves clumsilyAnswers questions slowlyLoses consciousness (even briefly)Shows behavior changesCannot recall events prior to injuryCannot recall events after injury

Management of Concussions The AAP (American Academy of Pediatrics)

recommends calling the physician for anything more than a light bump on the head.

A doctor or health care professional can determine if a concussion occurred.

A second head injury during the recovery phase of the initial injury can be catastrophic or fatal. Follow physician activity restrictions and recommendations CLOSELY.

Management (cont.) No one should return to play or vigorous activity while signs or symptoms of a concussion are present. If signs or symptoms last 15 minutes or longer or include loss of consciousness or amnesia, according to the Mayo Clinic physicians, it is not safe to return to play for at least one week. Mayo Clinic, 3/09.

An Action Plan for Suspected Concussion

1. Remove athlete from play, look for signs and symptoms of a concussion

2. Have athlete evaluated by physician3. Report cause of injury and force of blow

Any loss of consciousness Any memory loss Any seizure activity after injury Number of previous concussions (if any)

4. Inform parents of possible concussion, give concussion fact sheet (see end of PowerPoint)

5. Allow athlete to return to play with physician permission

Return to Play Guidelines

The American College of Sports Medicine, (ACSM), The Colorado Medical Society and the American Academy of Neurology have achieved consensus on the following guidelines. Thesehave been adopted by the NCAA (National Collegiate Athletic Association).

Return to PlayLOC= Loss of Consciousness; PTA= Post Traumatic

Amnesia

Athletes should NOT return to play whilesymptoms of concussion are present.Grade 1: Symptoms < 15 minutes,

(“Bellringer” or “Ding”), no LOC or PTA, then return to play after 15-20 minutes

Grade 2: Symptoms > 15 minutes, or any PTA, then remove from play for 1 week

Grade 3: Any LOC, remove from play for 1 week, see physician

Communication is CriticalRE: Recovery and Return to Play

Communication between the athlete, parents,teachers, coaches, school nurses, athletic trainer, and the athlete’s physician is critical for recovery from a concussion.

If teachers, coaches, or school nurses see or hear students struggling in school or complaining of symptoms after a concussion , let the parents, athletic trainer and coaches know! 

The Athlete Needs:

To rest completely from everything that strains the brain including studying, watching tv, reading

To be honest and not hide his/her symptoms 

To GRADUALLY return to play with light activity (such as biking) first before any contact and high intensity drills are allowed

To report if any symptoms return (they must stop activity and return to rest) 

However,

There is a lack of agreement about how to manage second or third concussionsin the same athlete. In addition, noguidelines are offered for themanagement of serial concussions ofdifferent grades.

"When in doubt, sit them out."

Considerations/Complications during Recovery

Second Impact Syndrome (SIS)

Post Concussion Syndrome (PCS)

Epidural or Subdural Hematoma (brain bleed)

Second Impact Syndrome (SIS)

If a 2nd concussion occurs before the brain has fully recovered fromthe first one, even if the first one ismild, it can be catastrophic or fatal.SIS can trigger vascular

congestion,swelling and cause widespread,permanent damage.

Post Concussion Syndrome (PCS)

A complex disorder in which acombination of symptoms suchas headaches and dizziness lastfor weeks and sometimes months after the con-cussion. Learning can beimpaired.

Post Concussion SymptomsFatigue and HeadachesDizziness Irritability Anxiety Insomnia Loss of concentration and memory Noise and light sensitivity Memory, mood and attention deficits Intellectual dullnessPersonality changes

Subdural or EpiduralHematoma (brain bleed)

Hematoma- collection of bloodDura- membrane covering the brainSub- below Epi- on top of

After a blow to the head or a violent shakingmotion, a blood vessel may rupture on top of 0r beneath the dura. The blood (hematoma)compresses brain tissue, which is LIFETHREATENING. Treatment is often timessurgery .

PreventionFollow the rules for safety and of the sportPractice good sportsmanship at all timesWear the right protective equipment

(helmets, mouth and eye guards, padding, shin guards)

Fit protective equipment properly, maintain equipment and wear consistently

Learn the signs and symptoms of a concussion

Mouth Guards and HelmetsA proper fitting helmet and mouth guard

canminimize or prevent concussions.

Studies indicate that the triple layered, vacuum fitted mouth guards may lead to a decrease in concussions (Shock Doctor, Brain Pad, etc.).

Studies show a 10 % reduction in concussions with improved high

tech helmets.

The Evolution of the Helmet

Fabricated vacuum fitted mouth guards are the most effective mouth guards for preventing concussions (Shock Doctor, Brain Pad, Power Gel) etc.

High Tech Mouth Guards

Prevalence of ConcussionsIn a study conducted comparing the 3 sports with thehighest rate of concussions, (hockey, soccer and football), it was determined that football players had the highest incidence of concussions. The mechanismof injury is head-to-head contact.

According to this study, the defensive backs had the high-

est rate of concussions due to their smaller size

combined

with multiple high impact collisions.

What do Studies Show?Concussions are underreported in high schoolAthletes, adults and some coaches think that a

concussion requires a loss of consciousnessAthletic trainers report 5 percent of high school

players suffer a concussion per seasonSurveys of players STRONGLY suggest that

number is much higherAnonymous questionnaires show 15% of football

players had at least one concussion per seasonWhen the word “concussion” is omitted and a

description of symptoms provided, nearly 50 percent of players say they had one, with 35 percent reporting two or more concussions per season

Final thoughts:It is critical that coaches, players and

parents understand the medical issues involved in concussion.

Athletes are more likely to follow recommendations and seek medical attention if they know that premature return to play could result in death.

It is helpful when players understand that not every concussion results in automatic removal from athletic participation.

Case StudiesJohn is tripped outside at recess. He falls and lands

on his head. In the health office, he complains of nausea and dizziness which does not abate after 1 hour. Physician confirmed diagnosis? Concussion. Treatment? No activity for 7 days (avoid SIS).

Will falls playing football at recess hitting his head. He comes to the health office for first aid. During the nurse’s assessment, she notes he’s unusually sleepy and mentally groggy. He went to bed at the normal hour the night before. Physician confirmed diagnosis? Concussion. No activity for 7 days.

Inside the athlete’s brain (NFL outstanding video, works when PowerPoint is in the slide show mode)

Free Fact Sheets, Coaches Toolkit and other Resources (

Gillette Children’s Brain Injury Department

)http://www.cdc.gov/ncipc/tbi/CGToolKit/CoachGuide.pdfhttp://www.cdc.gov/concussion/pdf/coaches_Engl.pdfhttp://www.cdc.gov/concussion/pdf/poster_Eng.pdfhttp://www.cdc.gov/concussion/pdf/

parents_Eng.pdfhttp://www.cdc.gov/concussion/pdf/

parents_Span.pdf

Works Consultedhttp://www.nytimes.com/2010/01/31/sports/31concussions.html

Orr, M., and Schwartz, A. High School Football’s Hidden Glory, 2007

CDC- Concussionshttp://www.healthsystem.virginia.edu/internet/neurogram/

neurogram1_4_concussion.cfmhttp://www.headinjury.com/sports.htm http://www.mayoclinic.com/health/post-concussion-syndrome/DS01020

http://beyondthesideline.com/Documents/Microsoft%20Word%20-%20ATR%20490%20Concussions%20Paper.pdf

http://www.aafp.org/afp/990901ap/887.html

http://www.aan.com/professionals/practice/guidelines/pda/Concussionsports.pdf

http://www.nytimes.com/2007/09/15/sports/football/15concussions.html?pagewanted=1&_r=3

http://www.cnn.com/2009/HEALTH/01/26/athlete.brains/index.html#cnnSTCVideo

McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus Statement on Concussion inSport 3rd International Conference on Concussion in Sport . Clinical Journal of Sport Medicine, 19, 185-195.

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