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Concussions

Concussions. Information, Statistics, Issues and Next Steps. International Concussion Summit – Presenters. Dr. Scott Delaney Assistant Professor of Sports Medicine, McGill University, and Montreal Alouettes team Physician

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Concussions

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  1. Concussions Information, Statistics, Issues and Next Steps

  2. International Concussion Summit – Presenters • Dr. Scott Delaney Assistant Professor of Sports Medicine, McGill University, and Montreal Alouettes team Physician • Dr. Blaine HoshizakiNeurotrauma Impact Research Laboratory, University of Ottawa • Dr. Charles TatorChair of Neurosurgery, at the University of Toronto • Dr. Michael Hutchison Director, Concussion Program, University of Toronto • Chris NowinskiSports Legacy Institute (SLI) • Dr James Carson Assistant Professor, Department of Family and Community Medicine and the Department of Surgery at the University of Toronto • OBIA, OPHEA, Brock University, Sunnybrook Health Sciences Centre

  3. Simple facts of Concussions • Immediate and temporary alteration of mental functioning due to trauma • Not necessarily caused by direct impact to the head, but due to whiplash effect on the brain • Want to avoid the term mTBI - as Concussion issues are not so mild • Exact mechanism is still unknown • Continuous concussions cause brain degeneration

  4. Canadian Statistics • 25% of Hockey, 50% of Football players with average age 18yrs concussed each year. • 20% School aged children concussed in 12mth period, 6/10 suffer a ABI • 1/2 of all trauma deaths due to TBI, 30% pediatric injuries - ABI • 500 000 people in Ontario living with a brain injury • Brain injury #1 cause of death and disability <45yrs • Incidence of Brain Injury 15x more prevalent than Breast Cancer • Costs $19.8 Billion/year

  5. Global Stats • 85% direct trauma to the head • <5-7% include LOC • 15-20% Pre/Post Amnesia • TBI – kills >5mill a year, 9% of global mortality • Sport injuries statistically small, yet on the rise and the focus has been one of acceptance.

  6. Movement of the Brain Rotational and Angular Linear

  7. Mechanism of Injury • Tends to vary for females and males (female – ice, boards, balls. Male – elbows, fists, shoulders • 15msec impact can cause 100-190 G’s of force. Longer the impact, more effect on brain (puck vs soccer ball)

  8. What we are dealing with.

  9. Falls create the biggest Linear impact

  10. Punches lead to the biggest angular impacts

  11. Issues and Recovery Blue – Professional Athletes Red – College Athletes Green – High School Students Recovery rates amongst teens is much greater than those more physically developed First Concussion Adult 7-14 days Child up to 1 month

  12. Issues and Recovery Showing longer healing rates in females than males. Some evidence to indicate susceptibility and effects have a genetic link 5-15% symptoms >6mths. C a novel experience and don’t have skills to deal with it. Rest is a foreign concept, hard to get students to rest. Delay of treatment can greatly effect recovery times.

  13. Issues we are facing • Hiding concussions – Individuals and Staff • WWE Trainers reported 5%, Survey shows 50% • CT/MRI DO NOT show any indicators of concussions • Continued impacts are causing degenerative brain conditions – CTE Chronic traumatic encephalopathy • Frontal and Medial Temporal lobe inhibition (path of destruction for CTE – reasoning and memory) • Doctor’s not up to scratch with current and evolving information.

  14. Issues in the school • Heavy focus on R2P, need more focus on R2L • NO universal R2P, R2L protocol • Need “Point Person” in each school • Resentment and lack of success implementing strategies in IEP’s for recovery (ABI brain has changed, LD is a brain that has always been that way) • ABI/TBI symptoms can overlap with existing LD conditions • Baseline testing flawed – easy to misinterpret • Concerns that no Dr. signature required on C3 forms • Doctors charging up to $80 for a concussion assessment.

  15. What can be implemented in the class for sufferers? • ID ABI/TBI in the classroom (BC/NFLD only provinces) • Avoid the labeling of behaviour • Treat as ABI, not LD even if they present the same • Target organization/planning problems. • Focus on initiation for “lazy” aspect • Structure and Routine • Monitor learning on their capabilities NOW, not from before • Allow opportunities for success • Provide alternatives for frustration. • Time to talk

  16. Recommended R2L Procedures

  17. Recommended R2P Procedures

  18. RDSB Schools

  19. Where do we go now? • Continual implementation of “Prevention” and removing “accidents” • Comprehensive and consistent message to all stakeholders • Point Person + Time to manage • Academic Support needs a bigger focus during recovery • Procedure to monitor progression and development of ILP • Annual concussion education for staff and students • WILLINGNESS TO CHANGE

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