Prevention of Prolonged Symptoms Related to Concussions in Sport

Experiences from a Community Based Perspective

Carolyn Biron, B.Sc., Ashley Brosda, B. Ed., Garnet Cummings, MD, FRCPC and Martin Mrazik, Ph.D.

• Brain Care Centre• Concussions – why get involved?• What is a concussion• The Challenges of Concussions • The Solution – prevent prolonged symptoms• The Support – Introduction to BCC’s

Concussion Client Service

Overview

Brain Care Centre

Edmonton, Alberta, Canada

Registered non-profit assisting individuals (18 and over) and families affected by brain injury in the community

• Service Coordination• Occupational Therapy• Computer and Device Training• Counseling Services• Education and Community Capacity Building• Events and Fundraising

About Brain Care Centre

VisionAs the leader for excellence in brain care, we Defy Limitations!

MissionWe will be a source of hope for those impacted by brain injury, in providing a compassionate continuum of brain care services from prevention to reintegration

Core ValuesWe provide courageous leadership through dedicated, empathetic and accountable Professionals. We treat individuals with dignity and respect. We maximize individual potential through compassionate, evidence –based and innovative program and services. We empower others to Defy Limitations!

Brain Care Centre

Concussions, Why get Involved?

Why Get Involved?Numerous calls requesting service and support for an injury that “doesn’t exist”

Brain Care Centre’s Response

• Conduct literature research and build partnerships with medical professionals

• Engage in Prevention Efforts - Prevention of PCSS (Post Concussion Syndrome Symptoms) through education and proper treatment at the time of injury

• Pilot Programming to offer Services and Support to meet the needs of those struggling with Prolonged Post Concussion Syndrome Symptoms

• Offer information to those affected by concussion via a telephone information line

Why Get Involved?

• Literature shows that those who receive treatment and education shortly after a concussion are more likely to make a full recovery

Borg et al., 2004; Comper et al., 2005; Paniak et al., 2000.

• By offering immediate and accurate information and links to medical resources, Brain Care Centre’s Concussion Public Education Program aims to play a significant role in preventing persistent symptoms and promoting the best possible recovery.

Prevention

• Engage in Prevention Efforts - Prevention of PCSS (Post Concussion Syndrome Symptoms) through education and proper treatment at the time of injury

What is a Concussion?

What is a Concussion?

“A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”

McCrory et al, CJSM, 2009

• Concussions involve a disruption of brain function rather than structural damage.

• The majority of time CT scans or MRI tests show no obvious damage.

• Can occur with our without loss of consciousness, and even without direct head trauma (whiplash)

What is a Concussion?

Typically resolves within 7 – 10 days

(Harmon et al, CJSM 2013)

So why all the fuss?

The Challenges of Concussions

The Risks

Second Impact Syndrome

• Brain swells rapidly after a second concussion sustained

• Extremely rare• Affecting those < 21 years

The Risks

Chronic Traumatic Encephalopathy

• Progressive, degenerative disease in people with a history of repetitive concussions

The Risks

Prolonged Post Concussion Syndrome / Symptoms

• Still poorly understood• Ranges from a delay in recovery to a

chronic condition• Overlap with numerous mental health

diagnoses

The Challenges of Concussions

The Challenges of Concussions

• Patients younger than 20 years old are 2.5x more likely to suffer a sports related head injury.

• Younger athletes are more prone to complex concussions than college athletes

(Iverson et al. 2006)

• 3.8 million Sport Related Concussions in US per year, estimated 50% go unreported.

(Harmon et al. 2013)

The Challenges of Concussions

• The Culture of Sport

• Failure to report

• Difficult to recognize

• Misconceptions

The Challenges of ConcussionsMrazik, Perra, Brooks & Naidu, 2013

What would you do? Total Male Female

Stop playing and tell the coach or trainer

143 (78.6) 124 (80.1) 19 (70.4)

What did you do?Total Male Female

Stopped playing and told my coach or trainer

28 (43.8) 22 (42.3) 6 (50.0)

The Challenges of Concussions in Sport

Or if an athlete has sustained a concussion

The Challenges of Concussions in Sport

The Solution

The Solution: Engage in Prevention

Research, Partnerships and a unified message

Engage in Prevention

The Process:

• Edmonton Minor Hockey Association assisted in recruiting teams

• Athletes, parents and coaches given a 30 minute presentation

• Athletes connected to professional medical concussion treatment if needed

• Athletes provided with imPACT pre-season baseline testing

• Coaches packages• Parent information sheets

Engage in Prevention

Presentation Overview

• Age Appropriate

• Concussion physiology, prevalence, and challenges

• What to do if a concussion is suspected

• Protocol when returning back to play

• ImPACT™ Assessment

Age Appropriate

Presentation Overview

• Age Appropriate

• Concussion physiology, prevalence, and challenges

• What to do if a concussion is suspected

• Protocol when returning back to play

• ImPACT™ Assessment

Concussion Physiology

Presentation Overview

• Concussion physiology, prevalence, and challenges

• What to do if a concussion is suspected

• Protocol when returning back to play

• ImPACT™ Assessment

What to do

What to do

What to do

Presentation Overview

• Concussion physiology, prevalence, and challenges

• What to do if a concussion is suspected

• Protocol when returning back to play

• ImPACT™ Assessment

Return to Play

Presentation Overview

• Concussion physiology, prevalence, and challenges

• What to do if a concussion is suspected

• Protocol when returning back to play

• SCAT and ImPACT™ Assessments

SCAT and ImPACT

Engage in Prevention

Offered to all athletes who complete the presentation:

• ImPACT testing• Referral letter to

Healthpointe Concussion Clinic

In 2012 we saw 183 athletes

Prevention Presentation Summary

Entire program takes 1.5 hours

Challenges

• Busy Athletes, busy parents• “Buy in” from teams• Attention span• Difficulty in booking appropriate

space• Technical difficulties • Athletes tend to wait until

symptoms are prolonged before seeking medical help

The Support

The SupportPost-Concussion Client Service

• Medically diagnosed with persistent symptoms of concussion

• injury occurred more than 6 months ago• exhausted all possible medical treatments.

The Support: What We Offer

• One-on-one counselling to develop coping strategies, address any co-morbid disorders, and improve quality of life

• Occupational therapy to develop compensatory strategies and increase independence.

Acknowledgements

Dr. Garnet CummingsAshley BrosdaDr. Martin MrazikDr. Dhiran NaiduStaff and colleagues at BCC Community partnersFundersAlberta Health Services and Human Services, Government of Alberta

References and Questions Borg J, Holm L, Peloso PM et al. Non-surgical intervention and cost for mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine. 2004;43:76-83.

Comper P, Bisschop SM, Carndine N, Tricco A. A systematic review of treatments for mild traumatic brain injury. Brain Injury. 2005;19:863-880.

Paniak C, Toller-Lobe G, Reynolds S et al. A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Injury. 2000;14:219-226.

Orzen, L.J, & Fernandes, M.A.. Effects of “Diagnosis Threat” on Cognitive and Affective Functioning Long After Mild Head Injury., Journal of the International Neuropsychological Society;2010: 17, 219-229.

Chong, S. Management Strategies for Post-Concussion Syndrome After Mild Head Injury: A Systematic Review. Hong Kong Journal of Occupational Therapy 2008;18(2):59 – 67.

Helmick, K. Cognitive rehabilitation for military personnel with mild traumatic brain injury and chronic post-concussional disorder: Results of April 2009 consensus conference. NeuroRehabilitation 2010;26: 239 – 255

McCrory, P. Sports Concussion and the Risk of Chronic Neurological Impairment. Clinical Journal of Sports Medicine 2011;21:6 – 12.Lange, R.T, Iverson, G.L., Rose, A. Depression Strongly Influences Postconcussion Symptom Reporting Following Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 2011;26:127 – 137.

Ferguson, R.J. & Mittenber, W., Barone, D., Schneider,B. Postconcussion Syndrome Following Sports-Related Head Injury: Expectation as Etiology. Neuropsychology 1999;13 (4) :582 – 589.

Mrazik, M., Perra, A., Brooks, B., Naidu, D. Exporing Minor Hockey Players’Knowledge and Attitudes Towards Concussions: Implications for Prevention. In Press

Harmon, K. et al. American Society for Sports Medicine Position Statement :Concussions in Sport. Clin J Sport Med 2013;23;1-18