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How to Recognize a Concussion?

How to Recognize a Concussion?. Chris Hummel, MS, ATC Clinical Assistant Professor/Athletic Trainer Ithaca College Department of Exercise and Sport Sciences. What is a Concussion?.

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How to Recognize a Concussion?

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  1. How to Recognize a Concussion? Chris Hummel, MS, ATC Clinical Assistant Professor/Athletic Trainer Ithaca College Department of Exercise and Sport Sciences

  2. What is a Concussion? • Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces (Zurich Consensus Statement, 2008) • In English = Brain trauma that messes up your normal brain function. • MTBI: Mild Traumatic Brain Injury • Sports Concussion

  3. The Facts- What we know… • Concussions can Occur in Any Sport • Concussions can be Life Threatening • 300,000 to 4 million Concussions/Year • Almost 9% of all injuries to High School athletes are concussions • 80-90% resolve in 7-10 days, slower in High school athletes • Professional < College < Youth • 1/5650 NFL/Youth Concussions

  4. More Concussion Facts-What we are now finding out… • Injury appears to be metabolic not structural which is why CT scan is almost always normal • Headache probably caused by increased glucose demand following injury • Magnitude of force not predictor of outcome/severity of injury • High School Facts • Rate higher in girls • 65% games/35% practices • Highest rates in football and soccer • NYS Survey (Rosenbaum, A, 2007): 26 % claim to have had concussion and not reported it!

  5. Recognition of Concussion • If you think the athlete has sustained a concussion, they probably have! • Not always a one time event. Could be a result of cumulative small traumas, not just one big one. • Having an Athletic Trainer at games and practices is key to recognition and proper early management • Only 42% of High schools nationally have any ATC access (NATA, 2010) • I think he has a concussion!

  6. Signs/Symptoms of Concussion • Headache (40%-90%) • Dizziness (40-50%) • Memory Loss • Anterograde, Retrograde • Loss of Consciousness (less than 10%) • Poor predictor of severity • Decreased Reaction Time • Vision Problems • Light Sensitive, Blurriness

  7. Assessment of Concussion • On the Field- SCAT (ICSCAT) • S/S, Memory, Balance, Cognition • Neuropsychological Testing- ImPACT • Memory, Reaction Time, Cognition • Coordination/Balance testing • Other Memory Tests

  8. Management of Concussion • Treat each athlete individually, on a case by case basis • Athlete will not return on day of injury • Complete mental and physical rest • Mental=School, texting, video games, TV, I-Pod • Referral to trained medical professional • ATC, MD • What’s different about the HS athlete? • Takes longer to recover (7-30 days) • Compared to College, NFL (7-10 days)

  9. NFHS Suggested Guidelines (2009) • No return same day • Should receive clearance from trained medical professional • RTP should follow step-wise protocol with provisions for delayed RTP based on return of any S/S. • New Rule for 2010-2011 • An official must remove anyone from competition that shows the s/s of having had a concussion • Athlete cannot return unless cleared by appropriate medical professional

  10. RTP Decision Making • Return to Play should not be considered until athlete is: • Completely S/S free for at least 24 hours! • NP Testing at/above baseline test score • Normal SCAT test • In one recent study high school football, 15.8% of athletes sustaining a concussion that resulted in LOC returned to play in < 1 day!

  11. Progressive RTP • Progressive system of return • Level 1- Rest • Level 2- Light Exercise • Level 3- Sport Specific Exercise • Level 4- Non-Contact Drills • Level 5- Full Contact • Level 6- Game • Each level should take approximately 24 hours • If s/s resume, drop back to previous level once asymptomatic • Some concussions will be progressed much slower, MD controlled

  12. Education Emphasis • What do you know/think you know about concussions? • What do your coaches, and parents know? • Who is in charge of recognizing, and managing an athlete’s concussion? • Recommend having annual meetings/seminars given by ATC/MD to coaches, parents and athletes on concussion management

  13. Where to get the best info on Concussions? • NATA.org • CDC.gov • Heads Up: Concussion in High School Sports Toolkit • Consensus Statement 3rd Int’l Conference on Concussion in Sport- Zurich 2008 • Clin J Sport Med 19(3), p.185-200

  14. Questions: • Feel free to contact me at chummel@ithaca.edu • THANK YOU!

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