Concussions in Sport

FIS Technical Delegate

Update

Outline - CoordinationOutline - Coordination•Concussion Guidelines• Dr. Morrell (CAN) – FIS • IMPACT – Best Practices •Parent / Athlete Document•Example Evaluation Tool• Scat - Card, Scat -2•Review Elements•USA Landscape• Athlete Letter• Medical Release Letter

Why InterestNote: > 90% of sport-related concussions have no L.O.C.

Any Sports – Football,Hockey, Skiing etc.There are projected tobe approx. 300,000concussions per yearin USA High School athletics alone

FIS Medical Committee Educational SeriesDr. Bob MorrellMember of the FIS Medical Committee

FIS RETURN TO SNOW SPORTS POST CONCUSSIONConcussion is a very prevalent injury in snow sports. It is defined as a disturbance in the functioning of the brain following a blow to the head or a force transmitted to the head, which may or may not cause a loss of consciousness. This typically results in the rapid onset of ashort-lived impairment of neurologic function, which resolves spontaneously. Athletes suffering from a concussion can display a wide variety of signs and symptoms, some of which can be very subtle.

concussion, as they are morevulnerable for recurrent injury, persistent post concussive symptoms, cumulative injury, andpotentially even life threatening injury, with subsequent concussive injury.Any athlete suspected of having sustained a concussion should be withdrawn from that event ortraining session, and undergo formal medical evaluation. Therefore any athlete complaining ofheadache, nausea, vision change, ringing in the ears, dizziness, or confusion after a crash ordisplaying poor coordination, poor balance, difficulty answering questions, or easy distractibility,should be brought to the attention of the team physician. It is important that these athletes not beleft alone and monitored for deterioration in the immediate post injury period.The cornerstone of concussion management is rest, until complete resolution of symptoms. Thisincludes both physical and cognitive or mental rest. Athletes should therefore have a quietenvironment and avoid exposure to stimulation such as TV or computer screens, and avoidalcohol and medications. Some analgesics and anti-inflammatories may be prescribed but itshould be recognized that these might mask some of the signs and symptoms of concussion.The return to sport progression is begun once the athlete has been off all medications andcompletely symptom free for a minimum of 24 hours. The most widely accepted return to playguideline is from the Summary and Agreement Statement of the Second InternationalSymposium on Concussion in Sport—Prague 2004. This is a step-wise process, each step beingseparated by a minimum of 24 hours. Progression to the next step only occurs if the athlete iscompletely asymptomatic at the current level. Any recurrence of symptoms should lead to theathlete dropping back to the previous asymptomatic level.Steps include1) Complete physical and mental rest until asymptomatic2) Low intensity aerobic exercise (walking, spinning on a stationary bike) but no resistancetraining3) Higher intensity aerobic exercise4) Easy free skiing/riding and light resistance training5) After medical clearance can train fully (for example, ski gates)6) After medical clearance return to full competition and racingAthletes with a simple concussion typically easily progress through these steps over 7-10 days.Athletes with complex concussion (an injury where athletes suffer persistent symptoms, specificsequelae, or prolonged cognitive impairment, or athletes who have suffered multiple concussion)may require a prolonged period of asymptomatic rest as well as more time at each of thesubsequent steps in the progression.Neurocognitive testing has become an integral part of concussion management. This can bedone as simple paper and pencil test (such as the SCAT) or using computer based tests. Allathletes should have preseason baseline neurocognitive testing done. This should be repeatedafter a concussive injury and the athlete should not return to training until back to their baselinescores. The team physician should supervise the above outlined progression and give finalclearance for return to training and competition.contact e-mail: bmorrell@telus.net

FIS Medical Committee Educational SeriesDr. Bob MorrellMember of the FIS Medical Committee

It is important to identify the athlete that has suffered a concussion, as they are more vulnerable for recurrent injury, persistent post concussive symptoms, cumulative injury, and

potentially even life threatening injury, with subsequent concussive injury.Any athlete suspected of having sustained a concussion should be withdrawn from that event ortraining session, and undergo formal medical evaluation.

Therefore any athlete complaining ofheadache, nausea, vision change, ringing in the ears, dizziness, or confusion after a crash ordisplaying poor coordination, poor balance, difficulty answering questions, or easy distractibility,should be brought to the attention of the team physician. It is important that these athletes not beleft alone and monitored for deterioration in the immediate post injury period.The cornerstone of concussion management is rest, until complete resolution of symptoms. Thisincludes both physical and cognitive or mental rest. Athletes should therefore have a quietenvironment and avoid exposure to stimulation such as TV or computer screens, and avoidalcohol and medications. Some analgesics and anti-inflammatories

FIS Medical Committee Educational SeriesDr. Bob MorrellMember of the FIS Medical Committee

Therefore any athlete complaining ofheadache, nausea, vision change, ringing in the

ears, dizziness, or confusion after a crash ordisplaying poor coordination, poor balance,

difficulty answering questions, or easy distractibility,

should be brought to the attention of the team physician. It is important that these athletes not be

left alone and monitored for deterioration in the immediate post injury period.

FIS Medical Committee Educational SeriesDr. Bob MorrellMember of the FIS Medical Committee

The cornerstone of concussion management is rest, until complete resolution of symptoms.

This includes both physical and cognitive or mental rest. Athletes should therefore have a quiet environment and avoid

exposure to stimulation such as TV or computer screens, and avoid alcohol and medications.

ImPACT– BEST PRACTICESImPACT– BEST PRACTICES Concussion Management Model for

Schools and Teams STEP 1 Pre Season Baseline Testing & Education STEP 2 Concussion is Suspected STEP 3 Post Injury Testing & Treatment Plan STEP 4 Is Athlete Ready for Non Contact Activity

ImPACT BEST PRACTICESImPACT BEST PRACTICESSTEP 5 Determining Safe Return-to-Play Educate Athletes, Parents, Coaches,

Teachers on Concussions ( Note: Canadian and USSA Focus )

Take an ImPACT Training Webinar or Workshop to Learn about Baseline Test Administration

Have a Concussion Management Protocol On-hand and Have Your Team of Key Professionals Ready to Treat Athlete .

If Concussion is Suspected – Immediate Removal from Play/ Activity

Sport Concussion Sport Concussion Assessment Tools (SCAT 1 & 2)Assessment Tools (SCAT 1 & 2)

What Is UtilizedWhat Is Utilized

• Provides an easy to use for medical responders and practitioners tools

•Standardized tool

•Combination of existing tools

Sport Concussion Sport Concussion Assessment Tool (SCAT 1)Assessment Tool (SCAT 1)

SCAT 1 – Symptom ScaleSCAT 1 – Symptom Scale

Scat 2 Assessment ToolScat 2 Assessment Tool

Review of Key Concussion Review of Key Concussion ElementsElements

Return-to-Play ManagementReturn-to-Play ManagementWhat Doctors ConsiderWhat Doctors Consider

If Concussion Is Suspected:

General medical considerations - Remove from activity and observe

If prolonged LOC or neurological concerns, C-spine precautions and hospital assessment

What is Generally PrescribedWhat is Generally Prescribed

Physical RestPhysical Rest

• No “light” exercise

• No weight training

• No physical activity

until symptom free!

• Rest - Rest - RestRest - Rest - Rest

What is Generally PrescribedWhat is Generally Prescribed

Cognitive RestCognitive Rest

• Limited - School, Computer Work,

• No !!! – Video Games

• Rest - Rest - RestRest - Rest - Rest

What is Generally PrescribedWhat is Generally Prescribed

Rest For How Long?Rest For How Long?

If rapid and full recovery, then 24-48 hours – this is not the return to

physical activity time frame.

For the same amount of time as it took to become asymptomatic ( no symptoms i.e headaches etc.)

Return-to-Play ManagementReturn-to-Play Management Neuropsychological Testing

Web-based Types: Traditional 6 hour battery programs

www.cogsport.com www.impacttest.com

USA LandscapeUSA Landscape

Presently There Are23 States + USA Congress ActionWhich Have Enacted Legislation

Concerning Concussion Management

Note: Canadian Different PerspectiveFIS Medical Guideline / Education Focus

USA LandscapeUSA LandscapePresent State Laws Were Supported By The

National Football League

Three (3) Key Elements1: Education – Coaches, Parents, Clubs

2. Removal From Activity When Appropriate3. Medical Evaluation – Before Return To PlaySee Distributed USA Parent Letter & Medical

Form

Food For ThoughtFood For Thought For FIS Jury’s With Regard For FIS Jury’s With RegardTo Potential ConcussionsTo Potential Concussions

Do Not Rush To JudgmentDo Not Rush To Judgment

When and As Deemed Appropriate When and As Deemed Appropriate

Consider All Alternatives IncludingConsider All Alternatives Including

Utilize and Rely on Medical ResourcesUtilize and Rely on Medical Resources

Keeping The Athlete Out Of CompetitionKeeping The Athlete Out Of Competition

Note FIS Medical GuidelinesNote FIS Medical Guidelines