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Whether playing football, soccer or just riding a bicycle, everyone is vulnerable to concussions. This webinar will provide the latest medical information on how to identify, treat and prevent sports concussions – and the mild traumatic brain injuries they result in.
Citation preview
Play It Smart: What you need to know about sports concussions
Cynthia L. Boyer, Ph.D. Executive Director, Brain Injury Services September 26, 2012
@2012 All rights reserved
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To ensure that every person is given opportunities for lifelong learning and fulfillment.
We do this by altering perceptions, and by supporting those with intellectual and developmental challenges and acquired brain injuries in achieving their life goals as valued and respected members of our world.
Our Core Values Responsible Empathetic Supportive Passionate Empowered Committed Trustworthy
R E S P E C T
By 2014 our distinct ability to deliver high quality individualized services in modern living, learning and working environments will exceed stakeholder expectations and secure Bancroft as the region’s elite provider of services to people with intellectual and developmental disabilities and brain injuries.
Our Vision
Our Mission
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Why the increased focus on sports-related concussions? Concussions are common in sports, and
their frequency appears to be increasing Although typically mild, sports
concussions have a high risk of recurrence and can have significant complications
Knowledge of the potential for long-term negative outcomes
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What is a Concussion? A concussion ( or mild traumatic brain injury) is a complex physiological process affecting the brain, induced by traumatic biochemical processes secondary to direct or indirect forces to the head.
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What is a Concussion? Disturbance of brain function is related to neurometabolic dysfunction rather than structural brain injury and is typically associated with normal structural imaging findings
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What is a Concussion? Concussion may or may not involve a loss of consciousness
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What is a Concussion? Results in a constellation of physical, cognitive, emotional, and sleep-related symptoms
Symptoms may last from several minutes to days, weeks, months, or longer in some cases
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Current Diagnosis of Concussion
Does not require LOC Does not require a direct blow to the head Does not require amnesia CT/MRI likely to be normal
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Sports and Concussions
In the United States there are over 3.8 million sports related concussions a year.
It is estimated that an athlete playing a contact sport has a 19% chance of suffering a concussion each year of play.
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Sports and Concussions
34% of college football players have suffered at least one concussion.
20% of college football players have suffered multiple concussions
Department of Neurosurgery, University of Pittsburgh
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Sports and Concussions
All sports and recreation-related concussion in U.S. 1.6-3.8 million/year
Concussion is COMMON in youth sports: 8.9% of high school athletes
Concussions appear to be increasing, especially among high school athletes
Meehan WP, et al. High School concussions in the 2008-2009 Academic Year: Mechanisms, Symptoms and Management. A J Sports Med.2010;38(12):2405-2409.
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Sports and Concussions
Commonly involve: Other players Falls on hard surfaces Equipment
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“Limited Contact” Sports Also Carry a Risk of Concussion Baseball Bicycling Cheerleading Fencing Flag Football Gymnastics Horseback Riding
Raquetball Ice Skating Skateboarding Snowboarding Softball Squash Volley ball
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Head Injuries Per Sport 2010 Cycling: 85,389 Football: 46,948 Baseball/softball: 38,394 Basketball: 34,692 Water sports: 28,716 Powered recreational
vehicles: 26,606 Soccer: 24,184
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Head Injuries Per Sport 2010 Skateboards/scooters:
23,114 Winter sports: 16,948 Horseback riding: 14,466
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Gender Differences
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Mechanism of Injury
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Mechanism of Injury
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Pathophysiology
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Metabolic Abnormalities Potassium, glutamate and glucose are
immediately released from affected brain cells Calcium enters these disturbed cells Neurotransmitter release occurs with loss of
autoregulation on the affected area Decreased cerebral blood flow
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Neurometabolic Changes and Concussion
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Injury Aftermath An energy crisis in the brain The brain is vulnerable to further damage
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Emergency Symptoms Changes in alertness and consciousness Seizures Muscle weakness on one or both sides Persistent confusion Remaining unconsciousness (coma) Repeated vomiting Unequal pupils Unusual eye movements Walking problems
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Concussion Symptoms Headache Nausea/Vomiting Balance Problems/
Dizziness Fatigue/Drowsiness Trouble sleeping Irritability/Sadness Nervousness/more
emotional
Feeling slowed down Foggy Difficulty with
memory/concentration Double vision Ringing in ears Sensitivity to light/noise
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Observed Signs of Concussion Appears dazed, stunned Confused about assignment/position Forgets an instruction Moves clumsily Answers questions slowly Loses consciousness (even briefly) Exhibits mood/ behavior/personality changes Can’t recall events before hit
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Cumulative Effects Increased severity of
symptoms with subsequent concussions
Unknown effects on the developing brain
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Second Impact Syndrome Experiencing a second
concussion before signs and symptoms of a first concussion have resolved may result in rapid and typically fatal brain swelling.
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Second Impact Syndrome Athletes should never to
return to sports while they're still experiencing symptoms of concussion.
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Post Concussion Syndrome 20-25% of patients who suffer a
concussion residual symptoms
Estimated < 5% of sports related concussions
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Post Concussion Syndrome Symptoms Headache Dizziness Sensitivity to light and sound Blurred vision Concentration, attention, and memory
problems
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Post Concussion Syndrome
Most people recover fully from post concussion syndrome within 3-6 months.
However, 7-15% of people will experience symptoms 1 year post injury.
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Long Term Effects of Concussions
Chronic Clinical Changes seen in NFL players - Increased risk of cognitive impairment - Increased risk of depression
Chronic Traumatic Encephalopathy (CTE) - Damaged Tau Protein as seen in AD - Diagnosed in a college football player
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Concussion Management
ANY Signs or Symptoms: NO RETURN TO ANY SPORTS ACTIVITY
Rest Gradual Return to Play
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Clinical Dilemma of Concussion
There is no proven treatment-the injury must run its course
The severity of the concussion is not fully known until it has resolved
Uncertainty about when it is safe to return to competition
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Concussion Management
REMOVE REFER REST RETURN Children’s Hospital, Boston, Sports Concussion Clinic
athlete from play to medical provider no sports, no texting, no tv only with medical clearance
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We Don’t Know……
How many concussions are too many? When the brain is really back to “normal”? If pharmocotherapy could help? Why are more injury prone?
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Prevention Teach safe techniques in
practice and play Encourage recognition
and reporting of concussion symptoms
Be aware that injuries are more common in younger athletes
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Prevention Use available assessment
tools Monitor developments
at advanced levels of play and legislative efforts
Head and spine injury prevention programs (Think First)
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Education
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Videos About Concussions Can Be Seen On
https://www.nanonline.org/NAN/_Research_Publications/Concussions_in_Sport.aspx
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Resources Mayo Clinic http://www.mayoclinic.com The Center for Sports Concussion at Idaho
State University www.knowconcussion.org Center for Disease Control www.cdc.gov Medicine Plus www.nlm.nih.gov Sports Concussion Center of NJ
http://www.sportsconcussionnj.com/?1f6c3100
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Resources
Concussion tear-off pad: a resource for coaches, physical education teachers, school nurses, community youth sports personnel, and emergency response professionals. It is a pad of 50 sheets which can be torn off and sent home with parents or students. http://www.sportsconcussion.com/pdf/resources/tear-off%20pad%202010.pdf
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Thank you!