1. Concussion 101 The Sports Medicine Podcast
SportsMedicinePodcast.com
2. Concussion Rules and Laws 50 states have concussion
laws
3. Concussion Rules and Laws 33 states have seat-belt use
laws
4. Concussion Rules and Laws California AB 25 - 2012 Mandates
removal of suspected concussion from play Concussion and head
injury info sheet signed yearly California AB 1451 - 2013 Training
for coaches every 2 years California AB 588 - 2014 Extends
requirements to private and charter schools
5. Concussion Rules and Laws CIF Rule 313 from 2010 A
student-athlete who is suspected of sustaining a concussion or head
injury in a practice or game shall be removed from competition at
that time for the remainder of the day. The student-athlete who has
been removed from play may not return to play until the athlete is
evaluated by a licensed health care provider trained in the
education and management of concussion and receives written
clearance to play from that health care provider.
6. Concussion Rules and Laws CIF Rule 313 from 2010 A
student-athlete who is suspected of sustaining a concussion or head
injury in a practice or game shall be removed from competition at
that time for the remainder of the day. The student-athlete who has
been removed from play may not return to play until the athlete is
evaluated by a licensed health care provider trained in the
education and management of concussion and receives written
clearance to play from that health care provider.
7. What is a concussion? Zurich 2012 Concussion is a brain
injury and is dened as a complex pathophysiological process
affecting the brain, induced by biomechanical forces. Several
common features that incorporate clinical, pathologic and
biomechanical injury constructs that may be utilized in dening the
nature of a concussive head injury include
8. 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 neurologic function that
resolves spontaneously. However in some cases symptoms and signs
may evolve over a number of minutes to hours. 3. Concussion may
result in neuropathological changes but the acute clinical symptoms
largely reect a functional disturbance rather than a structural
injury and as such, no abnormality is seen on standard structural
neuroimaging studies. 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 some cases, post-concussive symptoms may be prolonged.
What is a concussion? Zurich 2012
9. How Concussions Happen
10. What is a concussion? Direct blow to head or Blow to other
part of body with force transmitted to head
11. What is a concussion? Disturbance in brain function Brain
shaken back and forth Loss of consciousness NOT required
12. What is NOT a concussion? Bleeding in or around the brain
Stroke Skull fracture Seizure
13. Symptoms of Concussion Initial symptoms Headache Fatigue
Dizziness Difficulty thinking Loss of consciousness
14. Symptoms of Concussion Delayed symptoms Sleep disturbances
Frustration/agitation Forgetfulness Fatigue Symptoms of
Concussion
15. Sports at Risk of Concussions Sport Boys Girls Football
11.2 NA Lacrosse 6.9 5.2 Soccer 4.2 6.7 Wrestling 6.2 NA Basketball
2.8 5.6 Field Hockey NA 4.2 Softball NA 1.6 Baseball 1.2 NA Source:
National Academy of Sciences, Datalys Center (2010-12) PER 10,000
ATHLETIC EXPOSURES
16. Management of concussions Sideline management Exam by
medical staff SCAT3 form
17. Sport Concussion Assessment Tool SCAT3
18. Management of concussions Neuroimaging - CT or MRI Limited
use in concussions Used for ruling out other conditions with
specific findings on exam
19. Recovery from concussions CORNERSTONE = initial period of
rest until acute symptoms resolve Physical Rest No training,
playing, exercise, weights Beware of exertion with activities of
daily living Cognitive Rest No television, extensive reading, video
games? Caution re: daytime sleep
20. Recovery from concussions About 40% resolve in 1-3 days
Most 85% to 90% resolve in 7 -10 days Children and teens may take
longer.
21. Return to Play - Step #1 Physical and cognitive rest
Physical No training or practice Cognitive Limited reading,
studying Limit computers, phones Limit music, video games
22. Return to Play - Step #2 Light Aerobic Exercise Walking,
stationary bike No weight lifting Objective Increase heart
rate
23. Return to Play - Step #3 Sport Specific Exercise Add
running drills No heading -soccer Non contact Objective Add
Movement
24. Return to Play - Step #4 Non-contact Drills More complex
drills Passing drills in football and soccer No heading if soccer
Objective Exercise, coordination, cognitive load
25. Return to Play - Step #5 Full Practice Medical Clearance
Full contact practice Should not be on any medications for the
concussion
26. Return to Play - Step #6 Return To Game Play Should have 24
hours between each step If symptoms occur then return back to next
lower level
27. Neuropsych testing for concussions Should NOT be sole basis
of management decisions, but an aid to clinical decision making
Important component in overall assessment and RTP
28. Chronic Traumatic Encephalopathy CTE Neurodegenerative
disease First reported in 1928 Protein deposts in brain Repetitive
trauma to brain (maybe) Not related to number of concussions (lower
impacts?)
29. Prevention of concussions Mouthguards May decrease
biomechanical force but no studies show decrease in concussions
Helmets Probably no decrease in concussions May prevent head
trauma
30. Summary Many different causes Remove from practice or game
if suspected Medical Evaluation for full return to play Most
resolve in 7 to 10 days Gradual return to play and return to school
Difficult to prevent