Concussion: How to Return to Work, School, & Sports Safely

1. Concussion: How to Return to Work, School, & Sports Safely Anthony Marra, MS, ATC Staff Clinical Athletic Trainer NYU Winthrop Hospital St. Dominic's High School Anthony.Marra@nyulangone.org

2. Anatomy of the Brain

3. Location and Function of the Brain

4. Definition of a Concussion What is a concussion? • A reaction by the brain as a result of a bump, blow, or jolt to the head How can it occur? • May occur from a fall or blow to the body that causes the head to move rapidly back and forth.

5. How are concussions Diagnosed? • Thorough Evaluation • Neurological examination • Vision, Hearing, strength, sensation, balance, coordination, reflexes • Cognitive Testing • Memory, concentration, ability to recall information • Observation • Imaging Tests (Differential Diagnose) • Skull fractures, brain bleeding

6. Why do we want to do imagining? • Rule out: • Skull Fracture • Epidural, Subdural Hematomas

7. Definition of Second Impact Syndrome • A potential catastrophic medical emergency where a 2nd concussion is sustained while symptomatic from the initial concussion. • Both injuries can occur within a same event! • Most cases have occurred in young athletes. • As a result may create massive pressure to the brain which can lead to brain damage and or death.

8. Post-Traumatic Concussion Syndrome • Persistent post-concussion symptoms lasting weeks, months or even years after a concussion. • Headache • Dizziness • Nausea • Blurred vision • Sensitivity to light/noise • Ringing in the ears • Trouble Sleeping • Pressure in head • Balance Problems • Feeling like “in a fog” • Difficulty concentrating and remembering • Emotional Behavior

9. How Concussions May Occur in a School Setting • Classroom- Desk(top or bottom), door, trip/fall and or collision with another person or object. Hallway- “Kids will be kids” • PE Class- Collision with another student or non-moving object (wall), moving objects such as basketball or soccer balls. • Recess- Outdoor equipment which will include swings, slides, monkey bars, rings and climbing ropes. • Athletic Competition/Practices- Collision (body to body, head to ground/stationary object), moving objects (ball, puck, discus, etc.)

10. How Concussions May Occur in a WorkSetting “Approximately 1 in 4 mild traumatic brain injuries (MTBIs) in adults occur at work” (Terry et. Al., 2018) • Slip and Fall-Environmental, tripping hazards (cords, clutter, etc.) • Falling Objects-Materials and tools • Accidents- Motor Vehicle, faulty equipment (i.e. Fork lift, air pressure hoses, safety belts/nets, hard hat areas, etc.) • Assault-Arguments with physical violence • Military-Trauma caused IED’s on ground and under water.

11. Signs and Symptoms Signs observed others: • Appears dazed or stunned • Is confused about events • Answers questions slowly • Repeats questions • Lethargic • Can’t recall events after hit, bump or fall • Loses consciousness (even briefly)

12. Signs and Symptoms (cont.) Symptoms reported by Co-worker/Student Athlete • Thinking/Remembering • Difficulty thinking clearly • Difficulty concentrating or remembering • Feeling sluggish, foggy or groggy • Physical • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Fatigue or feeling tired • Blurry or double vision • Sensitivity to light or noise

13. Emergency Procedures • Observe body position of the individual: • Face up/down • Sitting • Standing unbalanced • Contact Medical Personnel immediately. • School: School Nurse, Athletic Trainer • Work: 911 • Do not move or have anyone else move individual if unconscious. (Immediate 911 call)

14. Responsibilities of Parent, Spouse, Partner dealing with a concussed Child/Adult Parent / Spouse / Partner • Observe daily individual behavior • Observe sleeping/eating behaviors and physical symptoms (dizziness and headaches) • Limit the use of all electronic devices (TV, computer, IPAD/gaming devices and cell phone usage) • Observe emotional behavior (irritability, sadness/crying and nervousness)

15. Responsibilities of School Staff/Co-worker dealing with a concussed Child/Adult School Staff/Co-workers • Observe academic/work performance (difficulty concentrating, remembering or thinking clearly) • Observe light and noise sensitivity, headaches and dizziness. • Observe emotional behavior (irritability, sadness/crying and nervousness) “SEE SOMETHING, SAY SOMETHING” Speak to Individual (individual safety) Speak to Administrators (class/team safety) Follow chain of command in work-setting

16. New York State Concussion Management and Awareness Act • Originally Published 2012 • Revised 2018 • Purpose: • Provide school district personnel, parent/guardian, students, and healthcare providers with information on concussion management in school settings. • Return a child back to academic and physical activity in a controlled symptom free environment.

17. Return to Play/Work Protocol (RTPP & RTWP) • In the event an individual is concussed, they may not return to physical activities (for students including Physical Education/Sports) until a 6-Stage Return to Play/Work Protocol is administered and completed by a healthcare professional

18. Return to Play/Work Protocol

19. Most Concussions involve a loss of Consciousness.

20. Second Impact Syndrome can occur when an athlete sustains a second below to the head before their symptoms disappear.

21. Headache, Dizziness, and Nausea, are all symptoms of a concussion. This can happen to anyone!

22. Thank you!