Concussions in Rugby

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Concussions in Rugby

• Michael Keating, MS, ATC, CSCS
• USA Rugby
• Coordinator of Medical Services

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What is a concussion?
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Concussion occurs when the brain is injured
following a blow to the head or face.Concussion
may occur without an apparent period of
unconsciousness. The signs andsymptoms of
concussion include any of the followingLoss of
consciousness , Giddiness or unsteadiness, Loss
of memory, Vomiting,Confusion and
disorientation, HeadacheDouble or blurred
vision,Being unaware of what happened, even for
a few moments at the time of the injury isthe
most consistent sign that the player is or has
been concussed.per IRB Regulation 10
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• Keys to Success
• Recognition
• Treatment
• Management and Return to Play

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• Recognition of the Head Injury
• Identify Signs and Symptoms
• On field assessment Maddocks ?s, Pocket SCAT
• Neurocognitive testing ImPACT
• MRI, CT, PET Scan

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• Treatment of the Head Injury
• Remove from Play IMMEDIATELY
• Evaluation by healthcare professional ATC is
  recommended
• Rest and monitor
• Refer to MD when appropriate

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No Silver Bullet
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• Management and Return to Play
• Continued rest until NO SYMPTOMS
• Gradual return to activity
• Follow IRB Regulation 10 as a MINIMUM
  REQUIREMENT!!

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Return to Play Guidelines
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IRB Regulation 10

• 10.1 Concussion1
• 10.1.1 A Player who has suffered concussion shall
  not participate in any Match
• or training session for a minimum period of three
  weeks from the time of
• injury, and may then only do so when symptom free
  and declared fit after
• proper medical examination. Such declaration must
  be recorded in a
• written report prepared by the person who carried
  out the medical
• examination of the Player.
• 10.1.2 Subject to sub-clause 10.1.3 below, the
  three week period may be reduced
• only if the Player is symptom free and declared
  fit to play after appropriate
• assessment by a properly qualified and recognised
  neurological specialist.
• Such declaration must be recorded in a written
  report prepared by the
• properly qualified and recognised neurological
  specialist who carried out
• the assessment of the Player.
• 10.1.3 In age grade. rugby the three week minimum
  period shall be mandatory

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• The Real Keys to Success
• Prevention
• Education
• Coaching
• Officiating - Rules

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• Prevention
• Scrum caps Nope
• Mouth guards - Nope

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• Education
• Players, Parents, Coaches and Staff
• Medical Staff ATCs, MDs, DOs, others

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• Coaching
• Proper Techniques tackle, ruck, maul
• Safe Play Aggressive play vs. Violence

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• Officiating - Rules
• Proper enforcement of existing rules
• Officials role in recognizing Concussions
• Proposed rule changes

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• Changes on the Horizon?
• Zurich Consensus Statement 2008 Enforced
• Return to play no longer required by neurological
  specialist
• If a player is removed from play with diagnosis
  of concussion they should NOT be allowed to
  return the same day
• Possible change of the 3 week rule

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• Resources
• ImPACT Applications www.impacttest.com
• CDC www.cdc.gov
• NATA www.nata.org

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Medical Services Needs and Design
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• What are your needs?
• Qualified and Reliable Staff
• PPE, Neurocognitive, Education
• EAP
• Reporting Mechanism
• Effective Communication
• Equipment and Supplies

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• Staff
• Guidelines and Standards from AAP, AAOSM, NATA
• ATC Certified Athletic Trainer (NATA)
• Team Physician (s)
• Physical Therapists, Chiropractors, Massage
  Therapists

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• Exams
• PPE
• Neurocognitive Testing (Baseline and Post)
• FMS/Mechanics assessment
• Education Programs
• Anti-Doping/Nutrition, Injury Recognition and
  Reporting, General Player Welfare

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• Injury Reporting/Tracking
• Record Keeping
• Injury/Accident Reports
• Coachs Report
• Pen and Paper
• Software applications
• Bottom line have to be prudent

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• Effective Communication
• Player to Medical Staff
• Medical Staff to Medical Staff
• Medical Staff to Coach(s)
• Medical Staff to Parent
• Coach to Media
• Player to Media and others (FB)

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• Equipment Supplies
• Basic First Aid supplies
• Emergency supplies
• AED
• Radios
• Transportation if appropriate