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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 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 • 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
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
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
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.
Movement of the Brain Rotational and Angular Linear
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)
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
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.
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.
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.
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
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