concussions in sport information and presentation materials courtesy of dr. victor lun, ccfp, dip...
TRANSCRIPT
Concussions in Sport
Information and Presentation Materials Courtesy OfDr. Victor Lun, CCFP, DIP Sport Med, Dr. Connie Lebrun, Medical Director – CSFDr. Bob Morell, Member FIS Medical Committee, Tara Fontenot – USSA ATC/PT
Outline
All Sports are subject to Concussion Exposure
• Mechanism of Injury
• Concussion Guidelines
• Clinical Evaluation
• Return to Play
Management
• Concussion Prevention
• Recurrent Concussions
Concussion - Mechanisms
•Rapid deceleration•Extension-flexion movement•Rotation•Skiing – fall on the back of the head
Concussion - Mechanisms
Old Concussion Guidelines
27+ different grading systems in
literature !!
No universal agreement with regards to injury definition and return to play guidelines
Old Concussion Guidelines
Common elements: memory, loss of consciousness, and symptoms
Used to assess severity of a concussion
Poor prognostic value
Varying return to play timelines
New Concussion Classification
Simple
Complex
Summary and Agreement Statement of the 2nd International Symposium on Concussion in Sport. Clin J Sports Med 15(2): 48-56 , 2005
What is a Simple Concussion?
Symptoms?Pattern of gradual resolutionWithout complicationResolution over 7-10 days
Memory dysfunction?Transient
Loss of Consciousness?Transient / “blacked out” < 15 Sec.
What is a Complex Concussion?
Symptoms?Convulsions> 10 days
Loss of Consciousness?> 1 minute
Referral to sports concussion specialist recommended
Simple or Complex??
History
Physical exam
Serial assessment-SCAT
Retrospective Diagnosis
Evaluation - History
Circumstances of injurySymptoms immediate post injury Current symptomsAsk patient, family member, coach etc.
to corroborateCheck video if available
Evaluation – Symptoms
Note: > 90% of sport-related concussion have no L.O.C.
Any sports
Sport Concussion Assessment Tool (SCAT)
• Provides an easy to use tool
•Standardized tool
•Patient education and physician assessment of sport concussion
•Combination of existing tools
Sport Concussion Sport Concussion Assessment Tool (SCAT)Assessment Tool (SCAT)
SCAT – Symptom Scale
SCAT Evaluation - Examination
NeurocognitiveModified Maddocks questions5 word recall (immediate & delayed)months of year in reversereverse digits (string of 5 or 6)
Neurological examSpeechEye motionPronator DriftGait/ Balance Assessment
Return-to-Play Management
If concussion is suspected:
Remove from activity and observe
If prolonged LOC or neurological concerns, C-spine precautions and hospital assessment
Return-to-Play ManagementPhysical RestPhysical Rest
• No “light” exercise or cross training
• No weight training
• No physical activity until symptom free!
• Rest - Rest - RestRest - Rest - Rest
Return-to-Play Management
Cognitive RestCognitive Rest
• Limited School, computer work,
• No !!! - Video games
• Rest - Rest - RestRest - Rest - Rest
Return-to-Play Management
Rest for how long?Rest for how long?
If rapid and full recovery, then 24-48 hours – this is not the return to
physical activity time frame.
For the same amount of time as it took to become asymptomatic ( no symptoms i.e headaches etc.)
Return-to-Play Management
Neuropsychological Testing Detecting cognitive abnormalities
Memory, concentration, “information processing”
Best when compared to baseline data – many teams are now doing baseline testing to establish a norm for each competitor
Return-to-Play Management Neuropsychological TestingWeb-based Types: Traditional 6
hour battery programs
www.cogsport.com www.impacttest.com
Return-to-Play Management Graded Exercise Challenge
Exercise
Aerobic x 10 min HR<130 bpm Aerobic x 30 min with intervals
Protected sport-specific practiceFull sport-specific practice
Return to sport
Return-to-Play Management Graded Exercise Challenge
24 hours per step24 hours per step If there is recurrence of symptoms at If there is recurrence of symptoms at
any stage, return to step 1any stage, return to step 1
Return to Play Management
Other factors Ready to return (confidence) Equipment
Helmet and Mouthguard
How Many ConcussionsAre Too Many?
Lack of agreement on number of concussions “allowed” before termination of season or career
Evidence of cumulative effectWith each successive concussion:
Lower threshold for injuryMore severe symptomsLonger lasting symptomsRisk of subsequent injury higher
Managing Recurrent Concussion ● Longer period of asymptomatic rest
before starting graded exercise challenge
● Extend the time for each stage of exercise protocol
● Take period of time/season off if showing lower threshold / longer recovery
● More conservative with younger patient (“susceptibility”?)
Operative Words For Technical Delegates
When In Doubt When In Doubt
Keep The Athlete Out Of CompetitionKeep The Athlete Out Of Competition
Utilize The Medical Release FormUtilize The Medical Release Form
-HELMETS-All Helmets
Are Not Created Equal
No Matter How They May Look