HB 2038 Coaches Training

1. HB 2038 Coaches Training July 2012

2. Objectives • Definition • Natasha’s Law (HB 2038) • Concussion Oversight Team • Sign/Symptoms of Concussion • Return to Play • Coaching/Administration Role

4. Coaches Concussion Training • HB 2038~Natasha’s Law • Named after Natasha Helmick, a soccer player who sustained at least 5 concussions • Signed into law September 1, 2011 • Goal is to reduce injuries from second impact syndrome • Allen, TX

5. The Law • The new law applies to all interscholastic athletic activity, including practice and competition sponsored or sanctioned by the UIL • All schools are required to take a training course in the subject of concussions-must be completed no later that September 1, 2012

6. What the law does! • Concussion Management Team • Removal from Play • Waiver and Graded Protocol to Return to Play • Specific Education/Training for all HCP’s • State Wide Tracking/Logging of Concussions

7. What is the Concussion Oversight Team • The governing body of each school district and open-enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team. • Who is the COT-at least one member, a Texas licensed physician, Texas licensed athletic trainer or Texas licensed health care professional. • Steve Jones MD-Required to take additional training • Tom Lewis-Required to take additional training

8. Concussion Oversite Team Each concussion oversight team shall establish a return-to-play protocol, based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.’

9. Additional Information: Required! • Each student athlete and their parent/guardian will be required to sign, for that school year, a form acknowledging that both the student athlete and guardian have received and read written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion.

10. What do you know about concussions?

11. Concussion Quiz • You have to be knocked out to have a concussion. • True • False

12. False • Most kids who have a concussion are never knocked out.

13. What is a concussion? • A complex pathophysiological process affecting the brain, induced by traumatic biomechanical force or “An injury to the brain that effects function. • Usually no damage to brain anatomy -as far as we can tell • Disturbance in brain metabolism • Common features: • Direct blow to the head or body • Loss of consciousness not necessary • Rapid onset of symptoms (usually) • Traditional medical test usually normal (CT/MRI) • .

14. CONCUSSIONS

16. It’s a Chemical Thing!

17. It’s a Chemical Thing ! Phone Disconnect

18. You don’t have to be knocked out to get a concussion

19. Concussion Quiz • Concussions are only a problem for boys, and girls don’t need to worry about it. • True • False

20. False • Girls have concussions at least as often as boys

21. Here’s the Problem

22. The Facts • A concussion is a brain injury • All concussions are serious • Concussions can occur without loss of consciousness or other obvious signs • Concussions can occur from blows to the body as well as to the head • Concussions can occur in any sport • Recognition and proper response to concussion when they first occur can help prevent further injury or death • Athletes may not report their symptoms for fear of losing playing time • Athletes can still get a concussion even if they are wearing a helmet • Data from the NCAA injury surveillance system suggest that concussion represent 5 to 18 percent of all reported injuries, depending on the sport

23. The Facts • A concussion can occur in any sport and all concussions are serious. • 10% of all contact sports sustain concussions • 63% of all concussions occur in football. • Girls soccer report second highest # of concussions.

24. The Facts • An athlete who sustains a concussion is 4-6 times more likely to sustain a 2nd concussion. • “Bell ringers” account for 75% of all concussive injuries. • Effects of concussions are cumulative in athletes who return to play prior to complete recovery.

25. The Facts • 80% of all concussions get better in one week; 20% usually takes 3 weeks or longer to recover. • Repeat concussions can result in brain swelling, permanent brain damage, and even death.

26. Can you which kid has a concussion?

27. Does Age Matter? • Children may be less prepared for a blow to the head • Parents may be inclined to believe child is “fine” due to negative imagining and the “he looks fine to me” factor. • Other concerns may override safety issues, and often youth sports may not have a protocol in place for dealing with concussion • Children may underreport symptoms to go back to play sooner for fear of appearing weak, losing position, feeling invulnerable • Concussion MAY be 10-20 X more prevalent in children • Children are more at risk for second impact syndrome

28. Concussion Quiz • A concussion can make school work harder. • True • False

29. True • After have a concussion, kids often can’t concentrate as well and reading and doing math can cause headaches.

30. Recovery of the Young Athlete • Kids are not the same as PROS • The brain of athletes under the age of 18 heals at a slower rate than older athletes following a concussion

31. Prevention • Helmets decrease risk of skull fractures and intracranial hemorrhage. • Mouthguards decrease dental and oral trauma. • Role of protective equipment in prevention of concussion not established

32. Recovery and Return to Play-Grades and Guidelines • Are not scientifically based • Assumes standard use for gender and age groups • Poor job distinguishing “mild” concussion • Assigns too much importance in LOC • Did not provide useful prognostic information • Did no account for risk factors/individuals factors

33. Commonly Reported Symptoms • High School & College athletes – within 3 days of injury • Headache 71% • Feeling slowed down 58% • Difficulty concentrating 57% • Dizziness 55% • Fogginess 53% • Fatigue 50% • Visual blurring/double vision 49% • Light sensitivity 47% • Memory dysfunction 43% • Balance problems 43%

34. Factor Analysis, post-concussion symptom scale (Pardini et al 2004) N=327 High school and University Athletics witin 7 Days of Concussion • Emotionality • More emotional • Sadness • Nervousness • Irritability • Cognitive symptoms • Attention problems • Memory dysfunction • “fogginess” • Fatigue • Cognitive slowing Somatic Symptoms -Visual problems -Dizziness -Balance difficulties -Headaches -Light sensitivity -Nausea Sleep Disturbance -Difficulty falling asleep -Sleeping less than usual

35. Symptom Evaluation • Concussion Signs • Appears dazed • Confused about play • Moves clumsily • Answers questions slowly • Personality/behavior change • Forgets plays prior to hit • Anterograde amnesia • Loses consciousness • Concussion symptoms • Headache • Nausea • Balance problems • Double vision • Photosensitivity • Feeling sluggish • Feeling foggy • Change in sleep pattern • Cognitive changes

36. Concussion Quiz • If I feel ok right after a hit, it means I am fine and do not have a concussion • True • False

37. False • Many athletes don’t have a headache or other symptoms for hours after a concussion.

39. Later Signs of Concussion Post-Concussion Syndrome • Decreased Processing Speed • Short-term Memory Impairment • Concentration Deficit • Irritability/Depression • Fatigue/Sleep Disturbance • General Feeling of “fogginess” • Academic Difficulties

40. Relative Impacts • video

41. Second Impact Syndrome • Occurs in athletes with prior concussion following often relatively minor second impact • Athlete returns to competition before resolution of symptoms • Catastrophic increase in intracranial pressure • vasomotor paralysis, edema, massive swelling, herniation, death • Neuro-chemical processes appear to differ in developing brain

43. Second Impact • 2nd IMPACT USUALLY OCCURS WITHIN 14 DAYS OF THE FIRST CONCUSSION AND UNDER AGE 21

45. On field assessment cardSigns and symptoms evaluation • Signs observed by staff: • Appears to be dazed or stunned • Unsure of game score or opponent • Lack of coordination • Poor reaction time • Losses consciousness (even temporarily) • Shows behavior, mod or personality change • Forgets events prior to injury (retrograde) • Unequal or dilated pupils • Bleeding or clear fluid coming from nose or ears • Symptoms reported by athlete: • Headache • Nausea or vomiting • Balance problems or dizziness • Double or fuzzy vision • Sensitivity to light or noise • Feeling sluggish • Feeling foggy • Change in sleep pattern • Concentration or memory problems • Lightheadedness • Easily fatigued • confusion

46. Symptoms may worsen with exertion.Athlete should not return to play until symptom-free

47. On-field Cognitive testing • Orientation • Ask the athlete the following questions: • What stadium is this? • What city is this? • Who is the opposing team? • What month is it? • What day is it? • Anterograde amnesia • Ask the athlete to remember the following words: • Girl, dog, green • Retrograde amnesia • Ask the athlete the following questions: • What happened in the prior quarter/period? • What do you remember just prior to the hit? • What was the score of the game prior to the hit? • Concentration • Ask the athlete to do the following: • Repeat the days of the week backwards • Repeat these numbers backwards: 63 (36 is correct): 419 (914 is correct) • Word list memory • Ask the athlete to repeat the three words from earlier

48. SCAT II • SCAT II Form

49. Concussion Management • Rule out more serious intracranial pathology • CT, MRI, neurologic examination primary diagnostic test • Prevent second impact syndrome • Prevent presence of post-concussion syndrome (Home Program) • Avoid video games • Text messages • Watching tv • Playing or doing homework on computer • Long periods of reading

50. Return to Play Protocol • Exercise Progressions