Concussions and Hockey

Sport-Related Concussions

Definition of ConcussionPost-traumatic impairment of neural status/brain is violently shook against the skullAlso called Mild Traumatic Brain Injury (MTBI)Defined also as he got his clock cleaned, bell rung; leveled, seeing stars

Symptoms of ConcussionsHeadacheConfusion/DisorientationTinnitusDizzinessNauseaAmnesiaPost-traumaticRetrogradeIrritabilityHyper-excitabilityLoss of ConsciousnessUnsteadinessVisual DisturbanceDifficulty ConcentratingLeading Sports for ConcussionsFootball, Ice Hockey, mens and womens soccerFootball is the leading sport for sport-related concussions in the US for men and soccer for womenStudy showed that female athletes are twice as susceptible to concussions as males

Second-Impact SyndromeCerebral edema: accumulation of excessive fluid in the substance of the brain.Sustaining a concussion before the first concussion has fully healedAbrupt increase in blood pressureAccompanied by post-traumatic systemic catecholamine surgeCreates intracranial pressure (ICP), resulting in cerebral blood expansion

SIS continuedUsually fatalNon-fatal: permanent severe functional disabilitySevere: no permanent functional disability, but severe injury

Head Fatalities in FootballTable 1Football Fatalities, 19451999*Head: 491Cervical Spine: 116Other: 105

Statistics65% of concussions occur during competition35% occur during practice90% of concussions occur without loss of consciousnessAccounts for 10% of all high school sports injuriesImpact on HockeyNHL Protocol for Concussion Evaluation and Management Protocol was revised Mar. 16, 2011

This revision takes players suspect of concussions to a quiet place to be evaluated

Traditionally, players were examined on the bench

e.g. Sydney Crosby, Eric Lindros, Scott Stevens, etc.

Problems with the ProtocolIt is up to the player himself/herself to report symptoms to team physiciansIf the player does not report symptoms, it will be assumed that there is no injurySymptoms may not always be immediate, some cases have been reported that it can be up to 3-4 days until symptoms occurOutside pressure/financial obligations

Return-to-Play Protocol

Concussion TestsConcussion testing have become mandatory for all sportsTake test before season starts when you arent concussedWhen concussed, you must match the score you got when first taking the testThe test includesLong-term ConsequencesLeads to chronic depression, Alzheimers Disease, and Parkinson's Diseasee.g. Mohammad AliSuffers dementia pugilistica, also known as Punch DrunkParanoia, rampant mood fluctuations, alcohol and drug abuse, major depression with suicidal ideation, suicide attempts or completed suicideConsequences cont.Onset usually occurs around the age of 42Keep Your Head Up