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Prevention of Prolonged Symptoms Related to Concussions in Sport

Prevention of Prolonged Symptoms Related to Concussions in Sport. Experiences from a Community B ased P erspective. Carolyn Biron , B.Sc., Ashley Brosda, B. Ed., Garnet Cummings, MD, FRCPC and Martin Mrazik , Ph.D. . Overview . Brain Care Centre Concussions – why get involved?

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Prevention of Prolonged Symptoms Related to Concussions in Sport

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  1. Prevention of Prolonged Symptoms Related to Concussions in Sport Experiences from a Community Based Perspective Carolyn Biron, B.Sc., Ashley Brosda, B. Ed., Garnet Cummings, MD, FRCPC and Martin Mrazik, Ph.D.

  2. Overview • Brain Care Centre • Concussions – why get involved? • What is a concussion • The Challenges of Concussions • The Solution – prevent prolonged symptoms • The Support – Introduction to BCC’s Concussion Client Service

  3. Brain Care Centre

  4. Edmonton, Alberta, Canada

  5. About Brain Care Centre • Registered non-profit assisting individuals (18 and over) and families affected by brain injury in the community • Service Coordination • Occupational Therapy • Computer and Device Training • Counseling Services • Education and Community Capacity Building • Events and Fundraising

  6. Brain Care Centre Vision As the leader for excellence in brain care, we Defy Limitations! Mission We will be a source of hope for those impacted by brain injury, in providing a compassionate continuum of brain care services from prevention to reintegration Core Values We provide courageous leadership through dedicated, empathetic and accountable Professionals. We treat individuals with dignity and respect. We maximize individual potential through compassionate, evidence –based and innovative program and services. We empower others to Defy Limitations!

  7. Concussions, Why get Involved?

  8. Why Get Involved? • Numerous calls requesting service and support for an injury that “doesn’t exist” • Brain Care Centre’s Response • Conduct literature research and build partnerships with medical professionals • Engage in Prevention Efforts - Prevention of PCSS (Post Concussion Syndrome Symptoms) through education and proper treatment at the time of injury • Pilot Programming to offer Services and Support to meet the needs of those struggling with Prolonged Post Concussion Syndrome Symptoms • Offer information to those affected by concussion via a telephone information line

  9. Why Get Involved? •  Literature shows that those who receive treatment and education shortly after a concussion are more likely to make a full recovery • Borg et al., 2004; Comper et al., 2005; Paniak et al., 2000. • By offering immediate and accurate information and links to medical resources, Brain Care Centre’s Concussion Public Education Program aims to play a significant role in preventing persistent symptoms and promoting the best possible recovery.

  10. Prevention • Engage in Prevention Efforts - Prevention of PCSS (Post Concussion Syndrome Symptoms) through education and proper treatment at the time of injury

  11. What is a Concussion?

  12. What is a Concussion? “A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” McCrory et al, CJSM, 2009 • Concussions involve a disruption of brain function rather than structural damage. • The majority of time CT scans or MRI tests show no obvious damage. • Can occur with our without loss of consciousness, and even without direct head trauma (whiplash)

  13. What is a Concussion? Typically resolves within 7 – 10 days (Harmon et al, CJSM 2013) So why all the fuss?

  14. The Challenges of Concussions

  15. The Risks • Second Impact Syndrome • Brain swells rapidly after a second concussion sustained • Extremely rare • Affecting those < 21 years

  16. The Risks • Chronic Traumatic Encephalopathy • Progressive, degenerative disease in people with a history of repetitive concussions

  17. The Risks • Prolonged Post Concussion Syndrome / Symptoms • Still poorly understood • Ranges from a delay in recovery to a chronic condition • Overlap with numerous mental health diagnoses

  18. The Challenges of Concussions

  19. The Challenges of Concussions • Patients younger than 20 years old are 2.5x more likely to suffer a sports related head injury. • Younger athletes are more prone to complex concussions than college athletes • (Iverson et al. 2006) • 3.8 million Sport Related Concussions in US per year, estimated 50% go unreported. • (Harmon et al. 2013)

  20. The Challenges of Concussions • The Culture of Sport • Failure to report • Difficult to recognize • Misconceptions

  21. The Challenges of Concussions Mrazik, Perra, Brooks & Naidu, 2013

  22. The Challenges of Concussions in Sport Or if an athlete has sustained a concussion

  23. The Challenges of Concussions in Sport

  24. The Solution

  25. The Solution: Engage in Prevention Research, Partnerships and a unified message

  26. Engage in Prevention • The Process: • Edmonton Minor Hockey Association assisted in recruiting teams • Athletes, parents and coaches given a 30 minute presentation • Athletes connected to professional medical concussion treatment if needed • Athletes provided with imPACT pre-season baseline testing • Coaches packages • Parent information sheets

  27. Engage in Prevention

  28. Presentation Overview • Age Appropriate • Concussion physiology, prevalence, and challenges • What to do if a concussion is suspected • Protocol when returning back to play • ImPACT™ Assessment

  29. Age Appropriate

  30. Presentation Overview • Age Appropriate • Concussion physiology, prevalence, and challenges • What to do if a concussion is suspected • Protocol when returning back to play • ImPACT™ Assessment

  31. Concussion Physiology

  32. Presentation Overview • Concussion physiology, prevalence, and challenges • What to do if a concussion is suspected • Protocol when returning back to play • ImPACT™ Assessment

  33. What to do

  34. What to do

  35. What to do

  36. Presentation Overview • Concussion physiology, prevalence, and challenges • What to do if a concussion is suspected • Protocol when returning back to play • ImPACT™ Assessment

  37. Return to Play

  38. Presentation Overview • Concussion physiology, prevalence, and challenges • What to do if a concussion is suspected • Protocol when returning back to play • SCAT and ImPACT™ Assessments

  39. SCAT and ImPACT

  40. Engage in Prevention • Offered to all athletes who complete the presentation: • ImPACT testing • Referral letter to Healthpointe Concussion Clinic • In 2012 we saw 183 athletes

  41. Prevention Presentation Summary • Entire program takes 1.5 hours • Challenges • Busy Athletes, busy parents • “Buy in” from teams • Attention span • Difficulty in booking appropriate space • Technical difficulties • Athletes tend to wait until symptoms are prolonged before seeking medical help

  42. The Support

  43. The Support • Post-Concussion Client Service • Medically diagnosed with persistent symptoms of concussion • injury occurred more than 6 months ago • exhausted all possible medical treatments.

  44. The Support: What We Offer One-on-one counsellingto develop coping strategies, address any co-morbid disorders, and improve quality of life Occupational therapy to develop compensatory strategies and increase independence.

  45. Acknowledgements Dr. Garnet Cummings Ashley Brosda Dr. Martin Mrazik Dr. Dhiran Naidu Staff and colleagues at BCC Community partners Funders Alberta Health Services and Human Services, Government of Alberta

  46. References and Questions Borg J, Holm L, Peloso PM et al. Non-surgical intervention and cost for mild traumatic brain injury: Results of the WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine. 2004;43:76-83. ComperP, Bisschop SM, Carndine N, Tricco A. A systematic review of treatments for mild traumatic brain injury. Brain Injury. 2005;19:863-880. PaniakC, Toller-Lobe G, Reynolds S et al. A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Injury. 2000;14:219-226. Orzen, L.J, & Fernandes, M.A.. Effects of “Diagnosis Threat” on Cognitive and Affective Functioning Long After Mild Head Injury.,Journal of the International Neuropsychological Society;2010:17, 219-229. Chong, S. Management Strategies for Post-Concussion Syndrome After Mild Head Injury: A Systematic Review. Hong Kong Journal of Occupational Therapy 2008;18(2):59 – 67. Helmick, K. Cognitive rehabilitation for military personnel with mild traumatic brain injury and chronic post-concussional disorder: Results of April 2009 consensus conference. NeuroRehabilitation 2010;26:239 – 255 McCrory, P. Sports Concussion and the Risk of Chronic Neurological Impairment. Clinical Journal of Sports Medicine 2011;21:6 – 12. Lange, R.T, Iverson, G.L., Rose, A. Depression Strongly Influences Postconcussion Symptom Reporting Following Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 2011;26:127 – 137. Ferguson, R.J. & Mittenber, W., Barone, D., Schneider,B. Postconcussion Syndrome Following Sports-Related Head Injury: Expectation as Etiology. Neuropsychology 1999;13 (4) :582 – 589. Mrazik, M., Perra, A., Brooks, B., Naidu, D. Exporing Minor Hockey Players’Knowledge and Attitudes Towards Concussions: Implications for Prevention. In Press Harmon, K. et al. American Society for Sports Medicine Position Statement :Concussions in Sport. Clin J Sport Med 2013;23;1-18

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