Concussions in Ice Hockey

Lauren ChurchSport, Health & Physical Education Vancouver Island University

Why Is This An Issue?

Previous Head Injuries or Concussions6

01234

57 individuals have dealt with a concussion

3 individuals with multiple concussions or head injuries

1102 man games missed in the NHL

Why Is This An Issue?

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2

267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)

25 percent of adults & 25 to 50 percent of players could not recall any concussion symptoms or only one symptom

Why Is This An Issue?

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2

267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)

50 percent of players & 20 percent of adults incorrectly stated that concussions are treated with medication or physical therapy

Why Is This An Issue?

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2

267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)

25 percent of players did not know if an athlete experiencing concussion symptoms should continue playing

Why Is This An Issue?

2009: Concussion knowledge questionnaire completed in the Greater Toronto Area2

267 players (atom, bantam, AA & HL competitive levels) 142 adults (coaches, parents & trainers)

66 percent of players did not know it was possible to sustain a concussion without losing consciousness

What Is a Concussion?

“A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”5

Clinical, pathological and biomechanical injury constructs may be used to define the nature

Signs and Symptoms

Signs Observed Signs Reported by Athlete

- Appears to be dazed or stunned - Is confused about assignment- Forgets plays - Is unsure of game, score or opponent - Moves clumsily - Answers questions slowly - Loses consciousness (even temporarily)- Shows behaviour or personality change - Forgets events prior to incident (retrograde amnesia)- Forgets events after incident (anterograde amnesia)

- Headache - Nausea- Balance problems or dizziness - Double or fuzzy vision- Sensitivity to light or noise- Feeling sluggish - Feeling “foggy”- Change in sleep pattern- Concentration or memory problems

Table 1. Common Signs and Symptoms of a Concussion4

Grading Scales

There are at least 27 systems proposed1 Typically the 3 systems used are:

Cantu American Academy of Neurology Colorado Medical Society

75% of concussions do not result in a loss of consciousness; therefore, new scales have been developed which address this3

Grading Scales

Grade McGill Scale3

1 No loss of consciousness (LOC) & No post-traumatic amnesia (PTA)

1A – No post-concussive symptoms (PCS), only seconds of confusion 1B – PCS and/or confusion resolved in 15 minutes

1C – PCS and/or confusion not resolved in 15 minutes

2 PTA < 30 minutes and/or LOC < 5 minutes

3 PTA > 30 minutes and/or LOC > 5 minutes

On Ice Assessment

Number of different tools available Hockey Canada – Sport Concussion Assessment Tool 2

(SCAT 2) 8 components ▪ Symptom evaluation ▪ Physical signs score ▪ Glasgow coma scale (GCS)▪ Sideline assessment – Maddocks score ▪ Cognitive assessment ▪ Balance examination▪ Coordination examination▪ Cognitive assessment

These combine for a total score

Return to Play

Step One: Rest

Step Two:Light Exercise

Step Three: Sport Specific

Activity

Step Four:Drills Without Body Contact

Step Five:Drills With

Body Contact

Step Six: Return to

Game Play

5

Risk Factors

Facial protection In-game fatigue Ice size Collision type &

frequency Chin strap &

mouthguard use Age Gender

References

1. Bender, S. D., Barth, J. T., & Irby, J. (2004). Historical perspectives. In M. R. Lovell, R. J. Echemendia, J. T. Barth & M. W. Collins (Eds.), Traumatic brain injury in sports: An international neuropsychological perspective (pp. 3-21). Lisse, the Netherlands: Swets & Zeitlinger.

2. Cusimano, M. D. (2009). Canadian minor hockey participants’ knowledge about concussion. Canadian Journal of Neurological Sciences, 36, 315-320.

3. Johnston, K. M., Lassonde, M., & Ptito, A. (2001). A contemporary neurosurgical approach to sport-related head injury: The McGill concussion protocol. Journal of the American College of Surgeons, 192(4), 515-524.

4. Lovell, M. R., Collins, M. W. & Maroon, J. C. (2011). Concussion resource center. Retrieved March 29, 2011, from http://impacttest.com/concussion/overview.

5. McCrory, P., et al. (2009). Consensus statement on concussion in sport – the 3rd international conference on concussion in sport, held in Zurich, November 2008. Journal of Clinical Neuroscience, 16, 755-763.

6. TSN. (2011). NHL injuries. Retrieved April 12, 2011, from http://tsn.ca/nhl/injuries/.