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.
Overview
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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
Brain Care Centre
Edmonton, Alberta, Canada
About Brain Care Centre
Registered non-profit assisting individuals (18 and over)
and families affected by brain injury in the community
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Service Coordination
Occupational Therapy
Computer and Device Training
Counseling Services
Education and Community Capacity Building
Events and Fundraising
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!
Concussions, Why get Involved?
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
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.
Prevention
• Engage in Prevention Efforts - Prevention of PCSS
(Post Concussion Syndrome Symptoms) through
education and proper treatment at the time of injury
What is a Concussion?
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)
What is a Concussion?
Typically resolves within 7 – 10 days
(Harmon et al, CJSM 2013)
So why all the fuss?
The Challenges of Concussions
The Risks
Second Impact Syndrome
• Brain swells rapidly after a second
concussion sustained
• Extremely rare
• Affecting those < 21 years
The Risks
Chronic Traumatic Encephalopathy
• Progressive, degenerative disease in
people with a history of repetitive
concussions
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
The Challenges of Concussions
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)
The Challenges of Concussions
• The Culture of
Sport
• Failure to report
• Difficult to
recognize
• Misconceptions
The Challenges of Concussions
Mrazik, Perra, Brooks & Naidu, 2013
What would you do?
Stop playing and tell the
coach or trainer
What did you do?
Stopped playing and told my
coach or trainer
Total
Male
Female
143 (78.6) 124 (80.1) 19 (70.4)
Total
Male
28 (43.8) 22 (42.3)
Female
6 (50.0)
The Challenges of Concussions in Sport
Or if an athlete has sustained a concussion
The Challenges of Concussions in Sport
The Solution
The Solution: Engage in Prevention
Research, Partnerships and a unified message
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 preseason baseline testing
• Coaches packages
• Parent information sheets
Engage in Prevention
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
Age Appropriate
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
Concussion Physiology
Presentation Overview
• Concussion physiology,
prevalence, and
challenges
• What to do if a
concussion is suspected
• Protocol when returning
back to play
• ImPACT™ Assessment
What to do
What to do
What to do
Presentation Overview
• Concussion physiology,
prevalence, and
challenges
• What to do if a
concussion is suspected
• Protocol when returning
back to play
• ImPACT™ Assessment
Return to Play
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
SCAT and ImPACT
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
Prevention Presentation Summary
Entire program takes 1.5 hours
Challenges
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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
The Support
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.
The Support: What We Offer
• One-on-one counselling to develop coping
strategies, address any co-morbid disorders,
and improve quality of life
• Occupational therapy to develop
compensatory strategies and increase
independence.
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
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.
Comper P, Bisschop SM, Carndine N, Tricco A. A systematic review of treatments for mild traumatic brain injury. Brain Injury.
2005;19:863-880.
Paniak C, 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