CONCUSSION AND MARTIAL ARTS TRAINING

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CONCUSSION AND MARTIAL ARTS TRAINING

• Arnold E. Cuenca
• MS-III
• Western University of Health Sciences

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VIDEO PRESENTATION
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Case study

• A 21 year old college student prepared for an
  unofficial boxing match held by his fraternity by
  training with an experienced boxer. The student
  suffered several head blows and other hits that
  were of considerable force. Afterward, the
  student developed a headache.

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Concussion Definition

• Immediate and transient post-traumatic impairment
  of neuronal function
• Alterations of consciousness
• Disturbance of vision equilibrium
• Trauma-induced alteration in mental status
• Loss of consciousness is NOT an essential feature
• Fewer than 10 of concussions result in loss of
  consciousness
• A major impact injury results from a blow to the
  head at 80-90X the force of gravity for at least
  .004 seconds

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Concussion Symptoms

• Dizziness
• Headache
• Difficulty in concentrating
• Disturbances of vision and equilibrium
• Post-traumatic amnesia
• Loss of consciousness

Due to swelling of the brain
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Concussion Functional Impairment

• Ability to process information is reduced
  immediately after the injury
• Repeated insults are cumulative
• Once a concussion has occurred, the player
  becomes as much as 4-6X more likely to suffer a
  second concussion

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Concussion Evaluation

• Begin with basic life support
• Determine whether loss of consciousness has
  occurred
• Once it is determined that LOC has not occurred,
  stabilize the C-spine and move the player to the
  sideline.
• Assess for severity

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Concussion Grading

• According to the Quality Standards Subcommittee
  of the American Academy of Neurology
• Grade I transient confusion (inattention,
  inability to maintain a coherent stream of
  thought and carry out goal-directed movements),
  no LOC, symptoms resolve in lt 15 minutes
• Grade II same as Grade I but symptoms last gt 15
  minutes
• Grade III Any loss of consciousness

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Concussion Evaluation

• Neurologic exam
• Test short-term memory ask about what was the
  last technique they executed, events following
  the injury, what the score is, who scored the
  last point
• Ask player if they are experiencing any symptoms
  of concussion
• Rapid alternating test, balance test, heel to
  shin test
• If Dr. on the field, a thorough neurological
  examination should be performed
• Re-evaluate every 10 minutes to monitor any
  deterioration or continuation of symptoms
• Have them perform exertional maneuvers 5
  push-ups, 5 sit-ups, 5 jumping jacks, 5 knee
  bends

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Concussion Evaluation

• If there is loss of consciousness
• The Colorado and American Academy of Neurology
  guidelines recommend that athletes with any loss
  of consciousness be transported to a hospital for
  further evaluation.

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Case Study (continued)

• The student visited a physician at the student
  health center. He downplayed the severity of the
  pain and failed to keep a follow-up appointment.
  Two days later he sparred again without coaching
  or corner supervision. After 2 minutes of a light
  workout he collapsed in the ring, lapsed into a
  coma, and died before medical attention could be
  obtained

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Second Impact Syndrome

• Occurs when an athlete who has sustained an
  initial head injury (most often a concussion)
  sustains a second head injury before symptoms
  associated with the first have fully cleared.
• Second blow may be remarkably minor, perhaps a
  blow to the chest, side, or back that can snap an
  athletes head and impart accelerative forces to
  the brain

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Second Impact Syndrome

• Athlete may appear stunned, but usually does not
  lose consciousness and often completes the play.
• In the next 15 seconds to several minutes of the
  second impact, the athlete collapses with rapidly
  dilating pupils, loss of eye movement, and
  respiratory failure.

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Concussion Management

• According to the Quality Standards Subcommittee
  of the American Academy of Neurology
• Grade I remove from contest, examine at 5 minute
  intervals both at rest and during exertion, may
  return to contest if symptoms clear within 15
  minutes
• Grade II remove from contest and disallow return
  that day, examine frequently, follow-up with
  physician for return to play
• Grade III transport to nearest emergency
  department

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Conclusion

• Often times a physician is not present during
  classes or sporting events. As an instructor or
  senior student, it is your responsibility to
  ensure the safety of all students in your studio.

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Bibliography

• Anderson, K Concussion Lecture
• Cantu R, Voy R Second Impact Syndrome-A Risk in
  Any Contact Sport. The Physician and Sports
  Medicine 1995 23 27-34
• Harmon K Assessment and Management of Concussion
  in Sports. American Family Physician 1999 60
  887-892
• Kelly J, Nichols J, Filley C, Lillehei K,
  Rubinstein D, Kleinschmidt-Demasters B
  Concussion in Sports-Guidelines for the
  Prevention of Catastrophic Outcome. JAMA 1991
  (November) 266 2867-2869