concussion playbook - bellin health€¦ · 1. concussion is caused either by a direct blow to the...

ConCussion Playbook

A complete guide to concussion management

What is a Concussion?

As part of our mission to improve the health of the community, Bellin Health is working to educate the community on concussion prevention, safety, and the appropriate medical recommendations.

Bellin Health is committed to the health and safety of every athlete in the community. This commitment includes: • building awareness to the risk of concussion. • providing the community with a team of highly trained medical

professionals who specialize in ImPACT™ testing, interpretation and concussion management.

• providing valuable concussion resources to reference for athletes, coaches and parents. For more information on concussions, go to bellin.org/concussion, email [email protected], or call (920) 430-4800.

Concussion Readiness

Checklist:

Study your concussion

playbook (pages 1–7).

Establish preseason baseline

ImPACT™ Testing.

Go to bellin.org/concussion

for events and the latest

concussion information.

E-mail us at concussion@

bellin.org with any additional

questions about concussion

or ImPACT testing.

(920) 430-4800 | bellin.org/concussion 1

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What is a Concussion?

Any alteration of mental function following a blow to the head that may or may not involve a loss of consciousness. — American Academy of Neurology

A concussion is an injury to the function of the brain caused by a direct or indirect force to the head. It results in a variety of symptoms and may or may not involve memory problems or loss of consciousness.

1. Concussion is caused either by a direct blow to the head, face, neck, or body that transmits force to the head.

2. Concussion usually results in the rapid onset of temporary impairment of brain function that generally resolves on its own in the majority of cases.

3. Concussion is an electric stunning of the neuron networks in the brain; there is generally no bleeding or swelling in the brain.

4. Loss of consciousness in concussion only occurs in approximately 10% of cases.

5. Concussions may take up to several weeks or more to recover.

6. Concussion is typically not able to be diagnosed with neuroimaging tests such as MRI or CT Scans.


Signs and Symptoms

Confusion

Inability to remember events prior to the injury

Inability to remember events immediately following the injury

Headache

Loss of consciousness

Ringing in the ears

Drowsiness

Feeling sick (nausea)

Vomiting

Unequal pupil size

Convulsions

Unusual eye movements

Slurred speech

Irritability

Headaches

Depression

Sleep disturbances, inability to sleep, or difficulty waking

Feeling “run down” (fatigue)

Difficulty concentrating

Memory problems (forgetfulness)

Getting lost or becoming easily confused

Increased sensitivity to sounds, lights, and distractions

Loss of sense of taste or smell

Difficulty with walking or in coordinating use of the arms or legs

ImmedIAte SIgnS And SymptomS

delAyed SIgnS And SymptomS

The signs and symptoms of a concussion can be mild and may not appear immediately. Symptoms may last for several days. In some cases, symptoms may last weeks or longer.

the following signs and symptoms are commonly observed in the event of a concussion.


Signs and Symptoms

If A ConCuSSIon IS SuSpeCted

Keep careful watch over the athlete. Watch for delayed signs and symptoms.

Do NOT allow the athlete to take aspirin or ibuprofen products as these products thin the blood and may mask symptoms of a more severe injury!

AVOID alcoholic beverages.

Call (920) 430-4800 to schedule an appointment with a Bellin Health medical concussion specialist.

300,000 sports- and recreation-related concussions are diagnosed nationwide each year. It is estimated the actual number is seven times more because many concussions go undiagnosed. — American College of Sports Medicine


observationIf the athlete has suffered a concussion, they should NOT be left alone, and should be monitored for persistent or worsening symptoms. The athlete should NOT continue to play during this observation time unless released by a medical professional.

emergenCy SIgnS And SymptomS

Difficulty in waking the athlete

Increase in dizziness or disorientation

Increased frequency of nausea or vomiting

Severe headache, particularly at a specific location, which is continuing, increasing or changing in pattern

Blurred vision

Pupils which are dilated, unequal in size, or nonreactive to light

Poor balance or unsteadiness

Weakness or numbness in either arm or leg

Mental confusion such as difficulty in remembering recent events or meaningful facts.

Convulsions

Unusual or bizarre behavior

Persistent ringing of the ears

Any discharge from the ears or noseSlurring of speech

Take the athlete to the nearest Emergency Room IMMEDIATELY if any of the following symptoms persist or worsen.


observationAlthough there are currently no medically proven ways to prevent sports-related concussions, the athlete can help reduce their risk by using appropriate equipment, proper training techniques, and strengthening exercises.

equIpment

Concussion injuries occur inside the skull. No helmet or other device can completely prevent a concussion from occurring. • Wear safety equipment that is appropriate for the sport.

Soccer headgear has NOT been proven to be effective in preventing concussions. In fact, it may contribute to a more aggressive style of play which can actually increase the risk for concussion.Mouth guard’s role in preventing concussion is inconclusive at this time; however, there is certainly no harm in wearing one. If anything, it may help reduce dental trauma as well as lacerations to the mouth.

• Use equipment certified by the National Operating Committee on Standards for Athletic Equipment (NOCSAE).

• Ensure equipment fits properly in accordance to the requirements of the sport.

trAInIng

• Learn and practice proper techniques so they become second nature during a sporting event. For example, the head (or helmet) should never be used as the primary point of contact with another athlete. Avoid leading with the head and hit with the shoulder instead. Antispearing rules have significantly helped to reduce the number of cervical spine injuries when tackling in football.

StrengthenIng

• Strengthen the neck muscles. Studies show a stronger neck can absorb some of the shock of the blow to the head and decrease the force delivered to the brain lowering the rate of concussion. Evidence shows that female athletes may be at greater risk of concussion than males due to differences in neck musculature.

prevention

6

treatmentAllowing enough recovery time following a concussion

is crucial in preventing any further damage.

Researchers continue to study the effects of multiple concussions on athletes. Evidence demonstrates that once an athlete has sustained their first concussion, they may be at a greater risk of sustaining another. The cumulative effects of concussion are not fully known at this time, but studies indicate that the effects of multiple concussions over time can cause long-term effects on brain function.

Immediately following a concussion and until all symptoms are completely resolved, the brain is at greater risk for more severe and permanent injury.

estimated 47% of athletes do not

report feeling any symptoms after a concussive blow.


education – The first step to recovery is education. Understanding what a concussion is, how to identify it, and immediately activating the appropriate treatment options is key.

rest - The most important thing the athlete can do following a concussion is rest. Increasing the amount of sleep time and relative rest allows the brain to heal and return to normal function.

Assessment/ImpACt™ – Bellin Health’s medical concussion specialists utilize the ImPACT™ Computerized Concussion Test to help provide an objective measurement of how the brain is functioning. This tool assists the specialist in determining the severity of the injury and the most effective treatment for each individual. Bellin Health recommends taking the ImPACT test after they have been without symptoms for 24-48 hours.

Student Advocacy – Bellin Health’s medical concussion specialists will work with the athlete to ensure that their academic achievement does not suffer as a result of their injury. Guidelines regarding studying and test modifications will be discussed with the athlete and their family and the appropriate recommendation made to their teachers and school.

return to play – Once the athlete is symptom free at rest, their ImPACTTM test scores are back to normal, and they are symptom free with sports specific activity, their medical concussion specialists will allow them to return to sports participation. If at anytime during the athletes return to play they experience a concussion symptom, it is very important that they notify their coach, parent, licensed athletic trainer, or health care provider right away.

Relative Rest means the athlete should restrict physical and mental activity as much as possible. Limit participation in sports and physical education along with schoolwork, housework, computer use, video game playing, social media, texting, and other activities that can stimulate the brain.

treatment

Step one: About 15 minutes of light exercise: stationary biking

or jogging

Step tWo: More strenuous

running and sprinting in the gym or field without equipment

Step three: Begin noncontact

drills in full uniform. May also resume

weight lifting

Step fIVe: Full game clearance

Step four: Full practice with contact

8

wiaawi.org/Health/Concussions

frequently Asked questions

What is ImpACt™?

ImPACT™ (Immediate Post-Concussion Assessment and Cognitive Testing) is a scientifically proven, computer-based testing program used to diagnose concussion. This baseline test is used by medical specialists to treat injuries and safely returning athletes back to their sport.

the athlete suffered a concussion on Wednesday; will they be able to play in friday’s game?

The WIAA’s current recommendations are for a stepwise return-to-play program. To resume activity, the athlete must be symptom free and off any pain control or headache medications. The athlete should be carrying a full academic load without any significant accommodations. Finally, the athlete must have clearance from an appropriate health care provider.

The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often require a very different return-to-activity program and should be managed by a physician that has experience in treating concussion.

If your sport is not governed by the WIAA, best practices still recommend a 5-step, graduated return to play.

The following program allows for one step every 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and contact. If symptoms return, the athlete should stop activity and notify their health care provider before progressing to the next step.


frequently Asked questions What medications can the athlete take to help manage their symptoms?

Athletes should avoid taking any medications unless directed by a physician. Medications such as aspirin, Advil, Aleve, or ibuprofen should be avoided as they may mask the symptoms the athlete is experiencing and could also thin the blood placing the athlete at risk if there is a more substantial brain injury.

Can the athlete participate in school, physical education class, work, or sport activities?

Returning to these activities should be at the discretion of a medical professional. Cognitive and physical activity may increase concussion symptoms. Modification of these activities may need to occur in order to allow the athlete’s brain to heal. Seek the advice of the treating medical professional in order to help reduce prolonging the athlete’s symptoms.

the athlete looks fine, why can’t they go back to their sport?

The effects of a concussion can be subtle. While the athlete may “look ok,” they may still be mentally or neurologically impaired. In the event the athlete is allowed to return to the sport before their brain is completely healed, they may be at risk of significant injury. Second Impact Syndrome is a potentially fatal injury that occurs when an athlete sustains another concussion before the first one has completely healed.

Why are some athletes allowed to return to play sooner than others?

Concussions are unique to the individual. No two concussions are the same and each concussion should be managed individually. What part of the brain is affected, history of previous concussions, and severity of symptoms all factor into how soon an athlete will recover.

the athlete’s mrI results came back negative. does that mean they are okay to play?

No. MRIs and CT Scans are generally used to determine if there is a more traumatic injury. They help to see if there is a skull fracture or if there is bleeding within the brain. However, they are not able to detect physiological changes within the brain that are associated with concussion, so it is important to follow up with a concussion specialist.

ConCussion Playbook

A complete guide to concussion management

[email protected] | (920) 430-4800 | bellin.org/concussion

Ortho-13-16068 6/4/13

concussion playbook - bellin health€¦ · 1. concussion is caused either by a direct blow to the...

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