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Concussions

Concussions. By: Steve Korsan and Kele Mangus. What is a Concussion?. Concussions are brain injuries. They are caused by a bump, blow, or jolt to the head. They can range from mild to severe and can disrupt the way the brain normally functions.

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Concussions

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  1. Concussions By: Steve Korsan and Kele Mangus

  2. What is a Concussion? • Concussions are brain injuries. • They are caused by a bump, blow, or jolt to the head. • They can range from mild to severe and can disrupt the way the brain normally functions. • Quite often signs of a head injury do not appear immediately after trauma but hours after the initial injury which is know as post-concussion syndrome.

  3. Signs and Symptoms an Athlete or Individual Should be Aware of: Nausea (feeling that you might vomit) Balance problems or dizziness Double of fuzzy vision Sensitivity to light or noise Severe headache Feeling sluggish Feeling foggy or groggy or just out of it Concentration or memory problems Confusion

  4. Signs and Symptoms a Guardian or Loved one Should be Aware of: • Appears dazed or stunned • Is confused about assignment or position • Forget an instruction • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows behavior or personality changes • Can’t recall events prior to hit or fall • Can’t recall events after hit or fall

  5. Myths By: Dr. Robert Cantu- chief of Neurosurgery and director of sports medicine at Emerson Hospital in Boston and a professor at North Carolina Concussions must be a blow to the head Concussion involves losing consciousness (less then 10% of concussions black out) The next concussion is always more serious then the last (multiple concussions are reason for concern, and their effect can be cumulative, but every concussion is unique. Dr. Cantu is the Co director of Boston University’s Center for the Study of Chronic Traumatic Encephalopathy) Three concussions and individual career in collision sports is over (there isn’t a magic number) Concussions determine risk of chronic traumatic Encephalopathy (CTE causes the early onset- dementia from repeated trauma ) NFL players are at higher risk of CTE because of higher risks of being in the sport majority of their lives Boys suffer concussions more then girls(2007-08 journal of athletic training reported that women were more likely to sustain concussions then men in soccer)

  6. Myths continued… • Mouth guards prevent concussions (Dr. Cantu says there is “no scientific basis”) • Concussion symptoms are obvious immediately (Symptoms may not occur until days afterwards)

  7. Second Impact Syndrome(SIS) • An individual who receives a second concussion before symptoms from a previous one has healed may be at risk of developing a rare but deadly condition called SIS • Brain swells catastrophically after even a mild blow can cause the debilitating or deadly results • Zachary Lystedt suffered head injury in an eighth grade football game, returned to the field and finished game then collapsed on the field NOW DISABLED • Preston Pleverete suffered SIS November 2005 playing football for LaSalle University. He received settlement for 7.5 million dollars, but currently struggles to walk and talk.

  8. How is Second Impact Syndrome Diagnosed? CT Scan (computed tomography) to detect acute intracranial bleeding

  9. Who Gets Second Impact Syndrome? • Any athlete who returns to a sports competition while still experiencing concussion-like symptoms is at risk • Between 1.6 and 3.8 million sports related concussions occur every year. Injury rate per 1 thousand exposures Football (2.34) Mens Ice Hockey(1.47) Womens Soccer(1.42) Wrestling (1.27) Cycling even greater than football

  10. Prevention of Second Impact Syndrome SIS has a higher mortality rate in young athletes. The key to preventing SIS is to ensure that athletes do no return to sport with any post-concussion symptoms. Legislation is trying to mandate that athletes do not return to sport on the same day that they are concussed and they do not return to sport unless they have been cleared by a sports medicine professional. Education regarding the proper diagnosis and management of a concussion needs to occur throughout all communities. As the population becomes more aware of the dangers of the Second Impact Syndrome the incidence of SIS should begin to decrease.

  11. A Little Research… • Retired NFL Players • Neurodegenerative mortality is 3x higher • Alzheimer disease and Amyotrophic Lateral Sclerosis (ALS) is 4x higher • Posture Control and Motor Functions • People with a history of concussions can have changes in their cerebral functioning that affects postural control LONG after the injury • College FB players displayed persistent alterations in posture and primary motor cortex intracortical inhibition (9months AFTER injury)

  12. What is Chronic Traumatic Encephalopathy? • CTE is a progressive neurodegenerative disease caused by repeated trauma to the head and characterized by the build up of a toxic protein called Tau. • The abnormal protein (Tau) impairs normal functioning and eventually kills brain cells according to Dr. Cantu and Dr. Ann McKee. • Those suffering from CTE display symptoms such as: Memory Impairment Depression Emotional Instability Problems with impulse control Erratic Behavior Progresses to full grown dementia

  13. CTE continued… CTE in the brain can be confirmed only after death According to Dr. McKee the build of Tau is an unique pattern not found in any other brain disease except in CTE. Tau accumulations, which are also involved in Alzheimer’s Disease, prevent nerve cells from making normal connections with other cells, eventually killing them. Previously referred to as dementia pugilistica or boxer syndrome New research has found sirt 1 enzyme has been shown to reduce the build up of Tau. Which may help the CTE patients and Alzheimer patients in the future.

  14. New Research and Statistics for Concussions • A 2007 study that post-concussion symptoms resolved in three days or less and more then 50% of high school athletes. • 50% of these high school athletes return to play in nine days or less. • ALARMING 30-80% of those athletes still had post-concussion symptoms three months after being injured. • 1/7 were still symptomatic after one year

  15. New Research and Statistics Continued The 2011 study of U.S high schools with athletic trainers reveal that approximately 75-80% of all concussed athletes symptoms have resolved within one week. 18-20% resolve between one week and one month 2-3% resolve in more then one month Two studies were released in 2011 both found that 11% of concussions in high school sports were repeat concussions. (At LaSalle-Peru High School this year we have had 39 athletes sustain a concussion or concussion like symptoms. Three of those concussions were repeat concussions. 26/39 were football players.)

  16. Once an athlete has suffered an initial concussion, his or her chances of a second one is 3 to 6 times greater than an athlete who has never sustained a concussion. • Athletes who suffer 3 or more concussions have 8 times greater risk of losing consciousness.

  17. It’s About Time! Denis Williams performed the study called electro-encephalogram in Chronic Post Traumatic head injuries in 1941. He recognized that cerebral dysfunction may continue long after all clinical signs have subsided. We now have cerebral testing to help verify when the athletes brain is functioning at its full capacity. (At L-P High School we use a computerized system called Impact Testing.) This was developed in the 1990’s by Dr. Mark Lovell, Dr. Joseph Maroon and Dr. Micky Collins. 50 years after Denis Williams identified an issue, cognitive standardized cerebral testing was developed.

  18. Impact Testing • The Impact Test assists qualified practitioners in making sound return to play decisions following concussions. • In the test there are five cognitive categories and one category on self-reporting of symptoms. • There are times when the concussed athlete scores very well on the Impact Test, but is still experiencing symptoms. If this occurs we don’t send athlete to competition until symptom free for one week and is able to remain symptom free after graded exercise. • Impact Testing remains as a tool to the practitioner. • Impact Testing is not the final criteria to return to competition.

  19. Body Blows According to Steven Broglio (the director of the Neurotrauma Research Laboratory at University of Michigan) has stated that the biggest worry of high school athletes may be the accumulation of body blows that jolt the head shaking the brain like a bowl of jello, and traumatizing fragile brain tissue and nerves. Damage may occur under the sight of impact or on the side opposite of the impact called Coup and Countrecoup.

  20. Left doesn’t have a concussion and the right with a concussion, the red areas indicate electrical activity during a memory test.

  21. Body Blows Continued… • At Purdue University researcher and professor Larry Leverenz states that there is a lot of changes in the brain even if the individual doesn’t have symptoms after playing football. In the two seasons study there were 6 players with concussions but 17 that showed brain changes even though they didn’t report concussion symptoms.

  22. Brain scans of Lafayette high school football player show the differences in brain activity over the course of a season. The scans were taken while the player was performing memory loss.

  23. Safety and Preventions • We as a country need to develop mandatory education for all players and coaches in order to prevent Second Impact Syndrome. (SIS) • Rule changes have been implemented. • Better equipment has been developed and is being tested. • In 2012 Virgina Tech researches have researched 15 different football helmets, ranking them into 5 classes. • Helmets that have not qualified a 4/5 rating have gone out of business and has stopped being manufactured. • Costume mouth guards • New proper tackling videos have been made available to parents and coaches throughout the country.

  24. Recommendations for Coaches(By Dr. Jeff Radel at KU Medical Center) • When and doubt, sit them out • Insist your school to do neurocognitive testing • Use standard sideline decisions-if athlete is showing concussion-like symptoms-safety first do not return athlete to competition • Create a team culture that emphasizes these student athletes good health • Discourage plays with direct head contact • Make a point of obtaining yearly concussion waivers and making sure they are filed along with the students school records

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