concussions in sports - juan ronderos m.d

7/29/2019 Concussions in Sports - Juan Ronderos M.D.

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Concussions in SportsDr. Juan Ronderos, M.D.


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Financial

DisclosureConsultant for Orthofix Spine receive consulting fees and royaltiesInvestigator Zimmer Spine receive consulting fees

Investigator Globus Medical Receive consulting feesInvestigator Integra Medical receive consulting fees

Owner NMS medical solutions receive profitsOwn JNJ and Medtronic stock on open market


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This is

what aconcussion

looks like...


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Long term effects

Dementia Pugilistica


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I object to violence because when it

appears to do good, the good is only

temporary; the evil it does is

permanent.

Mahatma Gandhi


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Concussion

Recently described as the Silent

Epidemic

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Concussion

A stunning, damaging, or shattering

effect from a hard blow; especially: a

jarring injury of the brain resulting in

disturbance of cerebral function

Synonyms: bump, collision, impact,

crash, jar, jolt, slam, smash, strike,

wallop Merriam-Webster


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Silent

Making no mention: unspoken (condition)

Merriam-Webster


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Prevalence

Until very recently Concussion orMild

Traumatic Brain Injury (MTBI) has been

a silent epidemic

Synonyms or MTBI have helped to

disguise the overall incidence and

effect on our society

Lack of definitive testing has helped

disguise the impact as well


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Prevalence - Synonyms

Name

Shaken Baby

Syndrome

Concussion

Sports Concussion

Dementia

Pugilistica Alzheimer's disease

Senile Dementia

Age Group

Infants to age 4

Ages 5 and above

Limited to sports

Limited to Boxing?

Early Dementia Elderly


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Epidemic

Affecting or tending to affect a

disproportionately large number of

individuals within a population,

community, or region

Merriam-Webster


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Prevalence

38 million children and adolescents

participate in organized sports

170 million adults participate in

physical activity not related to work

1.1 million persons are treated and

released from ED following treatment

for TBI

235,000 are hospitalizedSource: MMWR, July 27, 2007


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Sports TBI 2001-05

5.1% of all SR ED visits were for TBI

70.5% male

Highest rate age 10

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2nd highest age 15 19

Most common activities Bicycling

Football

Playground

Basketball

Riding ATVs

Source: MMWR, July 27, 2007


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Diagnosis

Symptoms reported by injured

Based on Observation

Observed Signs

Initial Physicians role is to rule out more

serious injury (Hematomas and Contusions)

Secondary Physicians role is to monitor and

control back to activity decisions Future Functional MRI and/or PET


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Diagnosis

Observed

Vacant stare/befuddled expression

Delayed verbal/motor responses

Easy distractibility

Difficulty focusing attention

Inability to perform normalfunctions

Disorientation

Walking in wrong direction

Unaware of date, time, place

Slurred/incoherent speech

Incomprehensible statements

LOC (Rare


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Common Findings

Vacant stare/befuddledexpression

Delayed verbal/motor

responses

Easy distractibility

Difficulty focusing attention

Inability to perform normal

functions

Disorientation

Walking in wrong direction

Unaware of date, time, place

Slurred/incoherent speech

Incomprehensible

statements

Lack of coordination

Inability to tandem walk

Exaggerated emotionality

Inappropriate crying

Distraught appearance Memory deficits

Cannot name 3 out of 3

objects after 5 minutes

Repeatedly asking same

question which has beenanswered already

Any period of LOC

Paralytic coma

Unresponsive to stimuli


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Diagnosis

CT and MRI are usually negative

Metabolic rather than structural

disruption Accurate diagnosis aimed at

preventing cumulative effects of

concussion

Preventing SIS (second impact

syndrome)


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Initial Treatment

Removal from current game oractivity

No return to play that day until

evaluation Preventing SIS (second impact

syndrome)


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SCAT-2


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SECOND IMPACT SYNDROME

Occurs in athletes with prior concussion following relativelyminor second impact

- Second impact has been shown to occur up to 14 days post-injury- Athlete returns to competition before resolution of symptoms

Catastrophic increase in intracranial pressure- Vasomotor paralysis, edema, massive swelling, herniation, death

Most often occurs in athletes


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Treatment

Widely used in

athletes

Baseline

normative data

Used as a

adjuvant to

clinical

observation and

reporting


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ImPACT: A TOOL FOR EVALUATING CONCUSSION

(Immediate Post-Concussion Assessment and Cognitive Testing)

Computerized test developed by clinical researchers at the University of

Pittsburgh Medical Center (UPMC)

Developed to allow for a more objective assessment of concussion and

recoveryAccounts for individual differences in cognitive ability and symptom

reporting through the use of baseline testingProvides a common metric which allows for effective collaborationbetween athletic trainers, coaches, physicians, and neuropsychologists

in concussion managementUtilized throughout professional and amateur sports across the countryand internationally


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Treatment

Throughout all phases look for signs of

deterioration

Look for signs of post concussion

syndrome

Neurocognitive testing


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Consensus statement on concussion in sport: the 4th International

Conference on Concussion in Sport held in Zurich, November 2012Graduated return to play protocolRehabilitation stage Functional exercise at each stage of rehabilitation

Objective of each stage

1. No activitySymptom limited physical and cognitive restRecovery

2. Light aerobic exerciseWalking, swimming or stationary cycling keeping intensity


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Study 1

How Long Does It Take The AthleteTo Recover from Concussion?

Lovell MR, Collins MW, Maroon et al. Medicine and Science

in Sports Exercise, 34:5;2002


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STUDY 2

Do Athletes Underreport Symptoms?

Lovell MR, Collins MW, Maroon et al. Medicine and Science inSports Exercise, 34:5;2002


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Long Term Effects

Mostly studied in athletes

Boxers and more recently football

injuries have brought issue to the

forefront

A few high profile cases

Recently Football players have become

high profile


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Famous boxers known to have

(or had) Dementia Pugilistica Muhammad Ali (1942 - )

Joe Louis (1914 1981)

Jack Dempsey (1895

1983) Floyd Patterson (1935 2006)

Sugar Ray Robinson (1921 1989)

Jerry Quarry (1943

1999) Mike Quarry (1951 2006)

Leon Spinks (1953 - )


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NFL prominent TBI

Jim McMahonbattling early

dementia, wishes

he'd playedbaseball

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NFL prominent TBI Junior Seaus family sues NFL claiming star linebackers suicide a result of

brain disease caused by violent hits

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NFL

(Reuters) - The National Football League and General Electric

Co are teaming up to improve the diagnosis and treatment of

brain injuries amid growing concerns about sports-related

concussions in youth and professional sports.

On Monday they announced a $60 million effort with leading neurologists to speed up researchinto brain injuries and the development of new technologies to help protect the brain from traumaticinjury to benefit athletes, the military and the broader public.

The initiative includes a $40 million research program into imaging technologies to improve

diagnoses and an additional $20 million pool of funds open to researchers andbusinesses trying to improve the prevention, identification and management of brain injuries.Mon Mar 11, 2013

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http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001http://www.reuters.com/finance/stocks/overview?symbol=GE.N&lc=int_mb_1001


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Awareness

Recent push by professional athletes

to treat and prevent injury

Manufacturers have responded by

having better testing of equipment and

certification of equipment

Trainers and all personnel are more

aware of the signs, symptoms, andtreatment of MTBI


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Awareness

Main stream media has reported issuesand problems

Health care providers are obtaining

certification to provide better care Governmental agencies are requiring

safety initiatives at the manufacturing,

public, and private sectors Foundations are promoting awareness

Education is becoming ubiquitous


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National Geographic

February 2011

New BrainScience onFootballConcussions


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New York Times

October 10, 2010

Front page

As ConcussionsRise, Scant

Oversight for

Football Helmet

Safety


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Resources

CDC

NIH

Impact concussion testing Think First Foundation

The Watson Neuroscience Foundation


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www.watsonresearch.org
http://www.watsonresearch.org/http://www.watsonresearch.org/

concussions in sports - juan ronderos m.d

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