Introduction to Concussions: Recognition and Management of

Concussion in Sport

David B. Gealt, D.O.Cooper Bone and Joint Institute

Cooper University HospitalAsst Professor UMDNJ-RWJAsst Professor UMDNJ-SOM

Palmyra-Riverton Soccer ClubAugust 24, 2011

Estimates:Concussions in New Jersey

10,000 sports and recreation-related Traumatic Brain Injuries every year

25,000 to 75,000 unidentified sports-related concussions every year

CDC estimates up to 1.6 million total sports related concussions in the U.S.

(CDC Estimates based on similar proportions to national estimates)

The Scope of the Problem

Athletic Trainers Report:

5.1% of football players sustained a concussion during a season

0.7% sustained a second concussion during the

same season BUT……

(Guskiewicz et al.2000)

47% had at least one concussion during the season.

35% had multiple concussions during the season.(Langburt et al.2001)

Player’s Report Symptoms of Concussion

Athletes Want to…

STAY IN THE GAME!!

• Education is #1 – Healthcare Personnel– Certified Athletic Trainers– Coaches– Parents– Athletes

• Everyone needs to be on the same page to avoid the potential dangers of repetitive concussive head injury

Concussion Facts

A direct blow to the head, face, and neck can cause a concussion

An indirect blow elsewhere on the body can transmit an “impulsive” force to the head, causing a concussion

Most concussions do NOT involve loss of consciousness

Concussion Facts

• Typically results in rapid onset of short-lived impairment of neuro function that spontaneously resolves

• Majority of concussions resolve within 7-10 days

Physical Signs and Symptoms

Headaches

Dizzy or Lightheaded

Blurry Vision

Ringing in the Ears

Loss of Balance

Numbness or Tingling Sensations

Loss of consciousness

Nausea/Vomiting

Fatigue,Exhaustion

Difficulty Sleeping

Sensitivity to Light and Sound

Dilated Pupils

Slurred SpeechGlassy eyed/foggy

Cognitive and Emotional Signs & Symptoms

Confusion

Difficulty Focusing or Concentrating

Disorientation of Time & Place

Slower Rate to Processing Information

Memory Loss*

Irritability/mood changes

Anxiety

Easily Saddened or Upset

Sadness,Depression

Consequences can Affect:

Academics

Social Relationships

Behavior

Emotions

GOES BEYOND THE PLAYING FIELD!

Evaluation/Management

• Basic Life Support to assure ABC’s

• Determine if LOC has occurred

• If LOC and/or ? Cervical spine injury MUST STABILIZE and BOARD and TRANSPORT. Do not remove helmet and shoulder pads.

• Ask teammates involved in play if LOC *

• Once ruled out can move to sidelines

Evaluation

• Sideline Assessment– SCAT 2

• Reassess q 5-10 minutes• Remove helmet• Deterioration of Neuro fcn—SEND TO ED

ASAP!• Follow up with complete eval in office• Computer Neuropsychological Testing-ImPACT

Baseline Testing- A Cutting Edge Technology-ImPACT

Immediate Post-Concussion Assessment and Cognitive Testing

Provides comparison based on pre and post concussion scores

Provides clinicians with a tool to help determine safe return to play

Documents an athletes concussion history

2010 NJ State Law

• N.J.S.A 18A:40-41.3 was passed on 12/7/2010 by Gov Christie

• Development of interscholastic athletic head injury safety training program

• NJ Dept of Ed (NJDOE)– “Model Policy and Guidance for Prevention and

Treatment of Sports-Related Concussions and Head Injuries”

http://www.njleg.state.nj.us/legislativepub/ldoa/ldoa.pdf, February 28, 2011

2010 NJ Law

• Immediate removal from sports competition or practice

• Unable to RTP: Medical Evaluation and written clearance by a physician or other licensed health care provider trained in the evaluation and management of concussion.

NJ State Law

• All coaches, school nurses, school/team physicians and ATCs must complete a Concussion Head Injury Training Program

• Head Injury Fact sheet signed by each student/guardian annually before activity

• Each school needs a written concussion policy implemented by 2011-2012 year

How to manage concussions?

Management

• Acute Response (All newest literature data supports)

-Any signs/symptoms of concussion = No RTP, Out of Activity

-Not to be left alone: to ck for deterioration

-Medical evaluated ASAP

-RTP by stepwise process with trained supervision

Other Factors to Consider

Age of the child…younger is not always better in fact may be worse (Field et al 2003)

Symptoms that persist for longer than 3-6 weeks (PCS)

Cumulative effects of multiple concussions

RTP too soon—Serious Consequences

• Post Concussion Syndrome

• Second Impact Syndrome– Loss of cerebrovascular autoregulation

causing brain swelling, herniation, death

Management• No Cookbook Guidelines• Individualized Treatment• Multi-Discipline Approach

– Physicians– ATC– School Nurse– Neurocognitive Testing– Neuropsychologists/Psychologist– Cognitive Therapist– Guidance Counselors– Teachers– Family Support

• In simplest terms think of a concussion as a “sprained brain”

– Physical Rest– “Cognitive Rest”– limit ADLs, exertion and

scholastic activities while symptomatic• (INCLUDING VIDEO GAMES, TEXTING,

FACEBOOK, INTERNET, ETC.)

Management

• Consider Modifications @ school during recovery– Extensions/Breaks/Testing/Time in School– Gym and athletics

RTP Protocol

• Must by ASYMPTOMATIC w/ normal neuro/cognitive fcn

I. No activity, asymptomatic for 24 hoursII. Light aerobic exerciseIII. Sport specific trainingIV. Noncontact drillsV. Full contactVI. Game play

If become symptomatic, return to prior leveland wait 24 hours

• Proper management of concussion is the best form of prevention of serious injury

• Not worth the risk of playing with a concussion• Only 1 Brain: Protect It!

• “When in Doubt - Sit Them Out!”

Heads Up Concussion Kitshttp://

www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm

http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm

First step in fixing this epidemic

It’s Free!

Thank You