CONCUSSION
Latin concutere = “to shake violently”
concussus = “action of striking together”
Dr Stephen Kara
Blues Team Doctor
Definition
Consensus Statement of Concussion in Sport, Zurich 2008
Concussion is defined as a complex pathophysiological process affecting
the brain, induced by traumatic biomechanical forces. Several common
features that incorporate clinical, pathologic and biomechanical injury
constructs that may be utilized in defining the nature of a concussive
head injury include:
1. Concussion may be caused either by a direct blow to the head, face,
neck or elsewhere on the body with an ‘‘impulsive’’ force transmitted
to the head.
2. Concussion typically results in the rapid onset of short-lived impairment
of neurological function that resolves spontaneously.
3. Concussion may result in neuropathological changes but the acute
clinical symptoms largely reflect a functional disturbance rather than a
structural injury.
4. Concussion results in a graded set of clinical symptoms that may or may
not involve loss of consciousness. Resolution of the clinical and
cognitive symptoms typically follows a sequential course; however it is
important to note that in a small percentage of cases however, postconcussive symptoms may be prolonged.
5. No abnormality on standard structural neuro-imaging studies is seen in
concussion.
Definition
Consensus Statement of Concussion Most Parents,
Auckland 2012
Concussion is a brain injury from a blow to the
head causing me or my child to have a loss
of consciousness
Concussion can cause me or my child to have
a lot of brain symptoms especially
headaches and sleep problems
Concussion can cause me or my child to have
lasting effects
Tests need to be done to make sure me or my
child does not have brain damage
Definition
Consensus Statement of Concussion Simplified
Concussion is a traumatic brain injury
causing an alteration in function
producing a wide range of symptoms
that generally get better by
themselves over a 10 day period
Do not have to have LOC
Imaging investigations generally are not
indicated
Important Concussion Facts
1.
80-90% of concussions resolve over 7 – 10 days
2.
Symptoms of concussion may take several hours to appear and
may not be evident at the time of the injury
3.
Symptoms can be varied from:
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physical (headache, nausea, vomiting, dizziness, poor balance)
emotional (sad, depressed, irritable)
cognitive (poor memory, confusion, poor concentration)
sleep disturbance (more, less, difficult to go to sleep)
4.
Debate over genetic markers and sports concussion
5.
Recurrent concussion (defined as 3 or more):
increased risk of lifetime depression
3 x increase risk of mild memory impairment in the future
5 x increase risk of mild cognitive impairment in the future
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Rugby Facts in Concussion
1.
14% of all rugby players will sustain a concussion in
a season (Hollis et al. 2011 BJSM)
2.
Concussion is the 3rd highest match-related injury
3.
Lower levels of competition lower risk
4.
Tackles and collisions are the events most likely
associated with a concussion
5.
Midfield backs at higher risk
Chris Lowrey this year
Canes
Is This a Concussion?
Brumbies guy who stumbles
around
On Field Management
Consensus Statement of Concussion in Sport, Zurich 2008
2.2b The appropriate disposition of the player must be
determined by the treating healthcare provider in a
timely manner. If no healthcare provider is available,
the player should be safely removed from practice or
play and urgent referral to a physician arranged.
2.2e A player with diagnosed concussion should not be
allowed to return to play on the day of injury.
Occasionally in adult athletes, there may be return to
play on the same day as the injury. See Section 4.2.
On Field Management
Practical Advice 2012
1.
2.
3.
4.
You are the ref and have the power to
remove any player from the field if you feel
the player is not medically safe to continue
Maddock’s Questions – standard
orientation questions (time, place, person)
have been shown to be unreliable
LOC = concussed
General look and behaviour of the player
(eyes, movement, speech)
Maddock’s Questions
Which field are we at?
Which team are we playing today?
Who is your opponent at present?
Which half are we in?
How far into the half is it?
Which side scored the last points / try?
Which team did we play last week?
Did we win last week?
Management of Concussion
Age <18yrs: mandatory 3 week stand-down
(age is a concussion modifier as the
adolescent, young brain heals slower)
Medical Clearance prior to return to training
Use of ACC Funded Concussion Clinics if
medical clearance is not able to be attained
easily or prolonged symptoms
What Happens at the
Professional Level?
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SCAT II Testing Protocol
Symptom score testing
Cognitive testing – orientation, immediate memory,
concentration, delayed recall
Balance examination
Coordination exam
Physical examination – BP, neurological
examination, cervical spine, maxillo-facial
Computerized cognitive testing – CogSport or
ImPact
Once player has passed all of the above then proceed on
Return to Play Protocol under guidance
Graduated Return to Play Protocol
Consensus Statement of Concussion in Sport, Zurich 2008
Rehabilitation stage
Functional exercise at
each stage of rehabilitation
Objective of each stage
1. No activity
Complete physical and cognitive
rest
Recovery
2. Light aerobic exercise
Walking, swimming or stationary
cycling keeping intensity <70%
maximum predicted heart rate.
No resistance training
Increase heart rate
3. Sport-specific exercise
Skating drills in ice hockey,
running drills in soccer. No head
impact activities
Add movement
4. Non-contact training drills
Progression to more complex
training drills, eg. passing drills in
football and ice hockey
May start progressive resistance
training)
Exercise, coordination, and
cognitive load
5. Full contact practice
Following medical clearance
participate in normal training
activities
Restore confidence and assess
functional skills by coaching staff
6. Return to play
Normal game play
Thanks for Listening
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CONCUSSION - Auckland Rugby Referees Association