Concussion Education
• Tragedy opens the door for education,
increased awareness, and law
• In North Carolina…
– Gfeller-Waller Law passed in June 2011
• Three components
– Mandatory education for public middle & high
school student-athletes & parents
– Return to play decisions made by qualified
medical personnel
– Emergency action plan in place
Objectives
• What is a concussion?
– How does a concussion occur?
– What are the signs & symptoms?
– How should a concussion be treated?
– What if my child isn’t getting better?
– Is there any way to prevent these injuries?
Definition of Concussion
• “A complex pathophysiological
process affecting the brain, induced
by traumatic biomechanical forces”
– Sports Related Concussion in Pediatric
Athletes, Clinical Pediatrics Volume 47
Number 2 March 2008 106-113
5 Features Used to
Define Concussion
1. Trauma including a direct blow to the head,
neck or face, or a blow to another part of the
body which transmits an impulsive force to the
head
2. Rapid onset of short-lived neurological
impairment(s) which resolve over time
3. Acute clinical symptoms of concussion
reflecting a functional injury rather than a
structural abnormality
4. A graded set of clinical syndromes, which may
or may not involve loss of consciousness and
which resolve in a sequential course.
5. Typically normal structural neuro-imaging in
studies such as MRI or CT scan.
“Basic” Pathophysiology
Signs & Symptoms
• Some might be apparent right away, some
may take longer to develop
• Four categories of symptoms to keep in
mind
– PHYSICAL
– COGNITIVE
– EMOTIONAL
– SLEEP RELATED
PHYSICAL
• Headache
– Pressure??
•
•
•
•
Nausea
Vomiting
Balance difficulties
Dizziness
– Specifically with
position changes
• Fatigue
• Sensitivity to light
• Sensitivity to noise
• Feeling out of it or not
acting like self
• Hearing
problems/ringing in
ears
• Vision
changes/disturbances
COGNITIVE
• Feeling mentally
foggy
• Feeling slowed down
or slower than usual
• Difficulty
concentrating
• Difficulty
remembering
• Confusion
EMOTIONAL
•
•
•
•
Sadness
More emotional than usual
Irritability
Nervousness
• What is unusual for your child/player?
Compare their behavior to what his/her
NORMAL is.
SLEEP-RELATED
•
•
•
•
Excessive daytime drowsiness
Sleeping more than usual
Sleeping less than usual
Trouble falling asleep
RED FLAGS for Emergent Referral
• Loss of
consciousness
• Any suspected
cervical spine injury
• Repeated vomiting
• Disorientation
• Slurred speech
• Can’t recognize
people or places
• Headache that gets
progressively,
severely worse
• Increased lethargy
• Facial swelling,
significant bruising of
the face/head
• Fluid from ears and/or
nose
Emergency Action Plan
•
•
•
•
Know your organization’s requirements
Have a plan
Educate those involved in the plan
Practice the plan annually
Treatment
• When in doubt, sit them out
– Removal from activity once suspected
concussion is sustained IS THE STANDARD
OF CARE
– NFL, NCAA, NCHSAA, NC state law
• See a doctor!
• Cognitive Rest
– Stay home from school?
– Limit homework
– NO TV, computer usage, video games, texting
• Physical Rest
– No return to activity until no symptoms at rest
and with cognitive exertion
When is it safe to
return to play?
• Completely symptom free at rest & with
cognitive exertion
• Completely symptom free with physical
exertion
– GRADUAL!
– Walk, jog, light weightlifting or push-ups/situps, sport-specific non-contact agilities,
contact practice, return to competition
Second Impact Syndrome
• Occurs when a second impact is sustained
prior to the complete resolution of all
symptoms of concussion
– Loss of autoregulation of cerebral
vasculature; rapid, irreversible massive
swelling leading to lethal increased
intracranial pressure
• Always catastrophic, very often fatal
• Occurs in teenagers
– No documented cases in anyone over the age
of 18
Post-Concussion Syndrome
• Three weeks post-injury with little/no
resolution of symptoms
– Persistent headaches
– Inability to concentrate
– Any of those symptoms listed earlier that don’t
resolve or are exacerbated with any type of
cognitive or physical exertion
What if my child
isn’t getting better?
•
•
•
•
Medication?
Vestibular therapy?
Formal neuropsychological testing?
Gradual, very closely monitored physical
exertion?
• Counseling/psych intervention?
– Prolonged symptoms can greatly affect quality
of life
Are my players at risk?
• Previous history of concussion
– Once an individual has sustained a
concussion, he/she is FOUR TIMES as likely
to sustain another injury
– It will take less of a blow each time and
symptoms will take longer to resolve
• Diagnosis of ADD/ADHD
• History of headaches or migraines treated
by a physician
Prevention
•
•
•
•
•
•
Education
Awareness
Recognition
Appropriate management
Rules changes?
No research supports mouthguards,
specific helmets, headbands can prevent
this injury from occurring
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Education - Carolina Sports Concussion Clinic