Management of Concussions By: Michael Cox Technology and Assessment

1. Management of ConcussionsBy: Michael CoxTechnology and Assessment

2. What is a Concussion? Concussions are injuries that transiently impair the way your brain normally functions They can be caused by a direct blow to your head or by a force that causes your brain to shake within your skull Not all concussions include loss of consciousness

3. What to Do if There is a Suspected Concussion • If there is an athletic trainer at the location where the injury took place, call him/her for immediate evaluation • Contact your primary physician • If they are not available • Contact emergency services

4. Concussion Symptoms • Headache • Dizziness • Nausea • Ringing in the ears • Blurred vision • Dazed or confusion • Amnesia • Balance and coordination problems • Aniscoria (pupil size)

5. Evaluating A Concussion • Determine their consciousness and what symptoms the athlete is experiencing • Signs and Symptoms • Memory Testing • Determine what they remember before the injury (antrograde amnesia) and what they remember after the injury (retrograde amnesia) • SAC test • Balance Testing • Have athlete balance on both feet with their eyes closed • Then perform same test with one foot in front of the other and vies versa • Neurological Testing • Test dermatome (sensitivity to touch) and myotome (strength test) to specific nerve roots

6. Cranial Nerve Testing • Olfactory- Sense of smell • Optic- vision, reading a text at close proximity and distant proximity • Oculomotor- PEARL, pupil dilation • Trochlear- Eye trackign up and down • Trigeminal- Facial sensations • Abducens- Lateral eye tracking • Facial- facial movements • Vestibulocochlear- Balance and hearing • Glossopharyngeal- Swallowing reflex • Vagus- Gauge reflex • Accessory- Shoulder shrug • Hypoglossal- Tongue lag

7. Determining the Severity of a Concussion • Grade 1 • No loss of consciousness • Memory loss lasting < 30 minutes • Symptoms lasting < 24 hours • Grade 2 • Loss of consciousness lasting < 1 minute • Memory loss lasting 30 minutes to 24 hours, OR • Symptoms lasting > 24 hours but < 7 days • Grade 3 • Loss of consciousness lasting > 1 minute OR • Memory loss lasting > 24 hours OR • Symptoms lasting > 7 days

8. Post-concussion Symptoms • Photophobia (sensitivity to light) • Seeing stars • Difficulty concentrating • Irritability • Depression • Anxiety • Fatigue • Headache • Trouble sleeping

9. Rehabilitation • Once an athlete has been diagnosed with a concussion they are not aloud to start rehabilitation until they are symptom free • Once symptom free, a 7 day progressive rehab program can begin focusing on cardiovascular exertion, strengthening, and sport-specific activites • If at any time an athlete develops symptoms as a result of their rehab, they are to stop activity until symptoms are gone and start over

10. DAY 1 • 10 minute elliptical/bike session • Moderate intensity • Impact test- cognitive functioning • SAC test- memory • No participation during practice/game • Goal: Increase heart rate

11. DAY 2 • 20-25 minute elliptical/bike session • Higher intensity • No participation during practice/game • Goal: Increase heart rate

12. DAY 3 • 20-25 minute elliptical/bike session • Begin full-body lifting • Leg extension/curls • Chest press • Bicep curls • Triceps pull-downs • Seated rows • No participation in practice/game • Goal: Get person moving

13. DAY 4 • Warm-up on elliptical/bike 10-15 minutes • Full-body workout • Sprinting • 10-15 sprints ranging from short to long distances • No participation in practice/games • Goal: increase athletes heart rate close to max

14. DAY 5 • Warm-up on elliptical/bike 10-15 minutes • Sport specific activities • i.e- shooting, throwing, hitting, kicking • Minimal participation in practice • No participation in game • Goal: get them back to sport-specific training

15. DAY 6 • Return to practice with no contact • Goal: Return to all sports activity restraining from contact

16. DAY 7 • Full return to participation including contact • Able to play in games • Goal: Contact drills being aware of any symptoms that may return

17. Returning from a Concussion to Soon • Returning from a concussion before someone is ready can not only lead to an increase in symptoms, but it can cause further damage • Secondary Impact Syndrome • This occurs when an athlete sustains a secondary head injury while still experiencing symptoms from the first concussion • The secondary injury can be very minor • It will cause rapid swelling and disruption of the brain possibly leading to respiratory failure and possibly death

18. What to Avoid • Athletes who sustain a concussion should avoid certain behaviors until instructed otherwise. Such behaviors include: • Drinking coffee or other stimulants • Consuming alcohol • Consuming foods in excess that will upset the stomach • Weight lifting or exercise • Taking medications that contain ibuprofen such as advil or Aleve because they are blood thinners and can cause further problems

19. Some Ways to Help Treat a Concussion • There is no cure or specific medication for a concussion but there are some ways to help treat the symptoms: • REST- the most important thing a person can do is rest the body and get a good nights sleep • Taking tylenol (acetaminophen) for minor headaches • Avoid strenuous activity • Try not to watch TV or use the computer to much • If doing homework or reading is bothersome, stop doing it

20. Summary • If an athlete sustains any type of headache or “not feeling right” after being hit in the head, it is very important to have a certified health professional evaluate the injury • Do not lie about symptoms • Most important thing to do is rest the body and refrain from strenuous activity • A doctor must clear the athlete before returning to activity