Antigonish Concussion Clinic

1. March 30, 2012 David Cudmore Tara Sutherland Angela Wylie Antigonish Concussion Clinic

2. September 1996 Dr David Cudmore MD Tara Sutherland CAT(C) Varsity Athletes Sports Injuries and Concussions In January ----2009 – we added Dr Maureen Allen MD – Outpatients St Martha’s Hospital Community Athletes and General Population and Concussions The Beginning

3. A 15 year old hockey player, a 40 year old construction worker and a 35 year old woman all received a hit to the head and report to the Emergency Room. all leave with diagnosis of a concussion SO what is next for them , who and or where is the follow up .. Their family Doctor ? Time issues , specialty issues other concerns , return to play supervision. Why ??

4. Sport organizations, schools and employers are now realizing that this injury has a significant short and or long term impact on people. There is a demand for medical assessment and active management of these patients. Concussions are a hot topic!

5. What and How we work St Martha's ER DOC ‘s Concussion form Other Practitioners Referral Patient to ACC Referral Physician & AT Athletic Therapists SCAT Decision Making Next Appointment

6. The patient is usually sent home with specific instructions and a follow up appointment is booked for one or two week’s time. A handout is given if they have not yet received one . The physician will often write medical notes for modified work and or school. The ACC sees a patient regularly and continues until complete recovery whenever possible. After the Appointment

7. When the individual becomes asymptomatic and is ready to return to a sport or activity the athletic therapists will have them perform a bike test at the Athletic Therapy Clinic at STFXU. If the patient completes this bike test satisfactorily then we will have them return to activity according to the return to play guidelines set forth by McCrory et al., 2009. Follow up visits are done with the physician and the athletic therapist until an athlete returns to play, especially if they participate in contact sports. Similarly, non athletes are flowed until they resume normal activities, i.e. work, school etc Return To Play

8. Other testing • Diagnostic – xrays – CAT scans MRIs • Often head and or neck xrays are done at the outpatients on the patients orginal visit. If not and problems persist we will send them for xrays . • We do limited MRI or CT scans since imaging is usually normal as reported by McCrory et al., 2009

9. We do not refer many patients to medical specialists such as neurologists or neurosurgeons as we feel we are capable of handling most concussion cases . However if the patient is not improving and or have complicating issues such as persistent cognitive defectswe refer to the specialist. One of the most difficult parts of sending to a specialists is that they are over two hours away by car and the travelling can cause worsening of symptoms. Specialists

10. For prolonged sleep disturbances we have used amitriptyline. It helps restore a normal sleeping pattern and is useful for chronic pain. Or other sleeping aids such as >>>> Pharmacological therapy

11. Other • In addition for neck or other musculoskeletal problems we will refer to a Physiotherapist , Massage Therapy or Cranial Sacral Therapy as needed • OR • We will occasionally send patients to see a psychologist for treatment of depression or anxiety

12. STATS

13. to enable our patients to return to a normal healthy active life We consider our approach to be holistic and novel We often call ourselves concussion coaches Family doctors are kept informed of their patient’s progress through consultation letters sent by the physician Our Goal

14. Multidiscipline collaboration practice with athletic therapists and physicians It is sustainable in a medical fee for service environment, requiring no new funding Athletic therapists have the expertise in the area and can provided most of the care that the patient requires, with a small amount of medical supervision by the physician Using this model we are able to efficiently and expertly look after a large number of patients every week The Antigonish Set up

15. “The lingering aspect of this concussion is definitely the most difficult part. I sustained three concussions in a one year period, most recently 2½ months ago, and I am still not feeling 100%. I didn’t get hit by a rampaging hockey player at the speed of a train. You wouldn’t think that volleyball was a high-risk sport. All of my concussions were accidental, but they still add up nonetheless. The worst part is, I don’t know when it’s going to get better, and frankly, I’m scared of what another concussion might mean.” (Varsity University athlete) Testimonial

16. “As an athlete having a concussion is hard to explain to your coaches and teammates. There's no visible evidence that you're hurt - like there is with an ankle or knee. I felt that my coaching staff didn't take my head injury seriously and pushed me to return to play earlier that I should. Without the care of our athletic therapists and doctors I probably would have returned to play too early and done further damage.” (Varsity University athlete)

17. Questions?

18. Forms