Concussions

1
Concussions

• A parents guide to understanding

2
Concussion

• What is it?
• A concussion is a common brain injury that can be
  caused by a bump, blow, or jolt to the head. It
  changes how the brain normally functions and can
  range from mild to severe. It can be serious even
  if its just a ding or a bell rung incident.

3
Additional Information

• A concussion is not necessarily a structural
  injury to the brain. Most often it is a
  metabolic injury, meaning the injury disrupts
  how brain cells themselves function.
• CAT scans MRIs only show structural changes in
  the brain. They will not show metabolic changes.
  So it is possible to have a concussion and a
  negative CAT scan or MRI.

4
Signs Symptoms

• You cant see a concussion. You may notice signs
  and symptoms right away or you may notice them
  hours, days, or weeks later.
• If you notice any signs or symptoms or your child
  reports any signs or symptoms, seek medical
  attention immediately.

5
Signs Symptoms

• Signs
• Appears dazed or stunned
• Is confused about assignment
• Forgets plays
• Unsure of game score or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness
• Show behavior/personality changes
• Cant recall events prior to hit
• Cant recall events after hit

• Symptoms
• Headache
• Nausea
• Balance problems or dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish
• Feeling foggy or groggy
• Concentration or memory problems
• Confusion
• Change in sleep patterns

6
Variability of Symptoms
7
Other Pieces of Information

• Football Helmets
• No one type of helmet will prevent a concussion.
  Helmets reduce the risk of concussion, but do not
  eliminate it.
• Mouthguards
• Current research has shown that mouthguards do
  not reduce the risk of concussion. They only
  prevent dental injuries.
• Recovery Time compared to NCAA Professional
• Current research shows that younger athletes take
  longer to recover from a concussion than college
  and professional age athletes. Therefore,
  treatment needs to be more conservative.

8
What to do

• Seek medical attention. Your Certified Athletic
  Trainer or Team Physician will be able to provide
  the appropriate treatment protocol.
• Not all physicians are trained in concussions. It
  is NOT taught in medical school so most doctors
  know very little about concussion management.
• Keep your child out of play. The brain needs time
  to heal. If an athlete returns to play too soon,
  he or she has a greater risk of sustaining a
  second concussion. Second or later concussions
  can cause permanent brain damage and in some
  cases cause immediate death.

9
Treatment Timeline

• Step 1 Complete rest, no activity
• Step 2 Light exercise such as free play, walking
  or stationary cycling for 10-15 minutes
• Step 3 Sport-specific activity for 20 min to 30
  min (ie, skating in hockey, running in soccer)
• Step 4 On field practice with no contact
• Step 5 On field practice with body contact,
  after
• medical clearance
• Step 6 Game Day
• NOTE Each step should take a minimum of 24 hours
  to complete.

10
Newest Information

• It is now recommended that any athlete suspected
  of sustaining a concussion be removed from play
  for that day, even if signs and symptoms have
  resolved within 15 minutes.
• It is also recommended that athletes involved in
  contact sports undergo a baseline cognitive test.
  Cognitive testing is one of the best tools in
  evaluating a concussion.

11
ImPACT Test

• A computer based test developed to help
  clinicians evaluate an athletes recovery
  following a concussion
• It is a neuro-cognitive test that objectively
  evaluates an athletes cognitive status in an
  effort to prevent the cumulative effects of
  concussion
• Test results are compared to baseline testing
  done prior to the start of the season

12
ImPACT Test

• Pallotti began baseline testing athletes in the
  fall of 2008.
• Baseline tests are good for 2 years
• Athletes will be baseline tested if they are a
  member of any of the following teams

• Football
• Field Hockey
• Soccer
• Basketball
• Wrestling
• Lacrosse
• Baseball
• Softball

13
Pallottis Concussion Protocol

• Suspected Concussion?
• See list of symptoms
• ?
• Athlete does not return to that game
• ?
• ImPACT post test at 48-72 hours
• ?
• Normal Abnormal?
• ? ?
• Symptom free? Cortical rest 1-3 day?
• ? Retest at 10 days
• Exertional test (If normal, go
  to column 1)
• ? pass? ?
• Return to play Retest at 21 days
• If still abnormal, see next slide

14
Pallotti Concussion Protocol

• Cortical rest
• All students with a concussion and documented
  abnormal ImPACT results would benefit from
  several days of cortical rest. Cortical rest is
  achieved by staying home from school and resting.
  TV, Ipods, video games, etc. are strictly off
  limits. Sleep, quiet rest, quiet reading, etc.
  allow the brain to rest and shorten the overall
  duration of symptoms significantly. The athlete
  may return to school after a few days when the
  symptoms are significantly improved.
• Abnormal test results
• Abnormal ImPACT test scores indicate that a
  concussion has occurred. Follow up testing
  should be performed every week or two until
  normal.
• Symptoms last beyond 3 weeks
• Athletes with symptoms that last beyond 3 weeks
  may benefit from other forms of treatment
  (medications, physical therapy, etc.). We
  recommend that the athlete by evaluated at
  Childrens Hospital. Childrens has a concussion
  management program call SCORE. Call 202-884-2429
  and ask to make an appointment at the SCORE
  clinic. Be sure you bring copies of your ImPACT
  score results to your appointment.

15
References More Information

• USA. CDC. Health and Human Services. Heads Up.
  2005.
• www.cdc.gov/concussioninyouthsports
• www.cdc.gov/injury
• www.cdc.gov/ncipc
• www.biausa.org
• Lovell, Mark, Joseph Maroon, and Michael Collins.
  ImPACT Applications.
• www.impacttest.com
• Safe Concussion Outcome Recovery Education
  (SCORE) Program
• www.childrensnational.org
• Dr. Gerard Gioia, Pediatric Neuropsychologist,
  Director of SCORE Program, Childrens National
  Medical Center
• Dr. Amy Valasek, Primary Care Sports Medicine
  Fellow, University of Maryland
• Dr. Christopher Raffo, Board Certified Orthopedic
  Surgeon Sports Medicine Physician, Maryland
  Orthopedic Specialists Team Physician for St.
  Vincent Pallotti HS, Quince Orchard HS, and
  Catholic University.
• www.mdorthospecialists.com