CONCUSSIONS A HEADACHE OF A PROBLEM OCTOBER 12

“CONCUSSIONS: A HEADACHE OF A PROBLEM” OCTOBER 12 2015 BRIAN SIDDALL, M. A. , ATC SUPERVISOR OF A. T. SERVICES

A. T. BACKGROUND • • 1976 -79 1979 -81 1981 -01 2001 -Present Ass’t. A. T. – Western Michigan U. Head A. T. – Hillsdale College (MI) Head A. T. - Ashland University Supervisor of A. T. Services

BASEBALL BACKGROUND YOUTH HIGH SCHOOL

RECENT HEADLINES • AAP: Don't Ban Tackle in Kids' Football — Go for Good Technique • NFL to Help Fund Search for New Concussion Therapy • Concussion Tests Won't Fix the Concussion Problem

REACTION TO HEADLINES

CONCUSSIONS • A concussion consists of clinical symptoms stemming from the brain being shaken by external forces. • Sometimes called a “Mild TBI”. • Highest concussion rates are found in football, wrestling, soccer and girl's basketball. • Approximately 10% of all high school athletic injuries were concussions. Roughly 80 to 90 percent of concussions resolve themselves in seven to 10 days, but a number of athletes have experienced symptoms for much longer.

What have we learned about concussions now that is our main focus? • The most important thing is that every concussion is different. • They all have similarities, but when it comes to treatment, there is no easy blueprint to follow; have to care for each athlete as an individual. • What each person brings to the table – such as anxiety or depression, their motivation level, or just their overall health – is another big part of the treatment process.

Ohio’s Return-to-Play Law • Now Ohio will join the bandwagon. Starting April 26, 2013 , House Bill 143, Ohio's Return-to-Play law for young athletes, will go into effect. This bill was formed to ensure the safety of young athletes suspected of a concussion, increase awareness and education, and make sure athletes are safely guided back to play after suffering a concussion

Ohio's House Bill 143 includes the following provisions for interscholastic sports: • • • Mandate that parents and athletes submit a signed letter stating they received and reviewed a concussion information sheet. Coaches and officials must undergo training focused on brain trauma and brain injury management. Coaches can complete online concussion education course through NFHS or CDC; and is free of charge. If an athlete displays signs and symptoms of a concussion during practice or a game, he or she must be removed from play by coaches, referees or officials. Student-athletes removed cannot return to play on same day. Athletes cannot return to play until evaluated and receive written clearance by a physician or other licensed health care provider approved by the school district.

MEDICAL AUTHORIZATION TO RETURN TO PLAY WHEN A STUDENT HAS BEEN REMOVED DUE TO A SUSPECTED CONCUSSION • PRESENT THIS FORM TO THE SCHOOL ADMINISTRATOR • Note: The school must retain this form indefinitely as a part of the student’s permanent record. [ Up-dated 6/2015 ]

THOUGHT • Allowing adequate time for the brain to heal is the best way to allow a safe return to play. Returning to sports before a concussion has resolved is dangerous. If another hit to the head occurs before an athlete has fully recovered, he or she risks suffering permanent neurologic damage. • www. healthy. ohio. gov/concussion

5 Things to do if You Think You Have a Concussion

1. Get OFF the Field • Get off the field of play and tell your coaches, parents, or athletic trainer. • S. I. S. Second Impact Syndrome

2. Do NOT Play Thru the Concussion • It will only make the injury worse. • The brain will use up all of it’s energy reserves while trying to heal - so it needs to borrow energy stores from muscles and other areas of the body. • By continuing to work out; you deprive the brain of energy it needs to recover and symptoms last longer.

3. Seek a Medical Evaluation • Select appropriate health care provider trained in concussion management. • State Law requires medical clearance before can RTP. • Concussions are difficult injuries to assess. Unfortunately we do not have one single test to diagnosis a concussion or predict the length of recovery.

4. Rest is Important • Rest is important for the reasons previously described. • Pacing your daily activities and modifying your academic requirements are important.

5. Follow the RTP Protocol • Following the recommended five step return to play protocol helps athletes know whether symptoms are completely gone before risking further injury. • 1. Light aerobic activity • 2. Moderate Activity • 3. Heavy, noncontact activity • 4. Practice and full contact • 5. Competition

INJURY ASSESSMENT • A detailed concussion history is an important part of the evaluation of the injured athlete. • Sports Concussion Assessment Tools include the SCAT 3 and Child SCAT 3 – easily searchable on the Internet. • Forms used in the assessment of possibly concussed athletes.

Sideline Assessment of Concussion

What You Should Do If Suspect a Concussion • Player should be safely removed from the practice or game for evaluation. • The player should not be left alone, and serial monitoring for deterioration is essential in the first few hours following a possible concussion. • Attention and Memory can be tested with some of the components in SCAT 3. (Maddock’s Score) Just asking about time, place and surrounding people has shown to be unreliable in the sports setting.

Sideline Assessment of Concussion When to transport to an emergency facility:

Concussion The Physician’s Role in Assessment and Return to Play

• • • Matthew C. Petznick, D. O. Specialties: Sports Medicine Family Practice Locations: 2500 W. Strub Rd. , Suite 230 Sandusky, OH 44870 419 -625 -1200 • • • Accreditations Board Certified Osteopathic Board of Family Medicine Board Certified American Osteopathic Association of Sports Medicine Specialty Description Sports Medicine - Ultrasound Guided Injections: Intra-articular hip, ankle, shoulder and various small joints, Sacro-iliac joint injection, Nerve hydrodissection: carpal tunnel, cubital tunnel, Joint/muscle/tendon examination, Viscosupplementation, Platelet rich plasma (PRP) injections for chronic tendinosis (future) - Injuries: Treatment of non-operative orthopedic problems both sport and non-sport related, Sport injury prevention, Specialized in keeping athletes competing while healing Education & Training Fellowship: Sports Medicine Fellow, University of Toledo, OH Residency: Firelands Regional Medical Center, Sandusky, OH Degree: Ohio University College of Osteopathic Medicine

Key Features of the First Medical Consult • Comprehensive history • Assessment of mental status, cognitive functioning, gait and balance. • Detailed neurological exam (Vestibular Screening)

Key Features of the First Medical Consult • Determination of clinical status of the athlete. • Improvement or deterioration since time of injury • Medications that maybe prescribed to address S/S • Modifications to D. L. A. and School Attendance

Key Features of the First Medical Consult • Determination for neuro-imaging to exclude the possibility of a more severe brain injury.

Concussion The Athletic Trainer’s Role in Assessment and Return to Play

ATHLETIC TRAINER - CHALLENGES

RETURN TO PLAY • The assessment of cognitive function should be an important component in any RTP protocol. • Cognitive recovery overlaps with symptom recovery and commonly follows symptom resolution. • See SAC (Standardized Assessment of Concussion) in SCAT 3 Forms.

Return to Play Following Concussion Normal testing (“at baseline”) and clinical impression determine beginning of return to play progression. No set time for completion. No set time period for completion

Return to Play • • • -INDIVIDUALIZED!! -Proceed to next level only if asymptomatic -Each step should take 24 hours -Start when asymptomatic at rest -If symptoms recur, drop back to last asymptomatic level after a 24 hour period of rest

Return to Learn: Transitioning students with head injuries back to class • Cognitive demands (e. g. , school) can exacerbate symptoms and prolong recovery • Simple accommodations to ease student’s transition back into the classroom. • If the student stays at home, s/he must avoid extensive computer use, texting, video games, television, loud music, and music via headphones. These activities make the brain work harder to process information and can exacerbate symptoms, thereby slowing down recovery.

SYMPTOMS – 10 DAYS + • Ten to 15 percent of concussed athletes go on to have persistent S/S post 10 days. • Need to consider other pathologies: ► Structural Damage ► Neuro-Transmitter ► Psychological Disorder

Concussion Management 3 LAYERS: • Game Rules • Coaching Technique • Equipment An once of prevention is worth a pound of cure” - Benjamin Franklin “

WHAT TO LOOK FOR • Program Essentials: Good Coaching - Enforcement of playing rules Proper Equipment - Practice conducted in safe manner Concussion protocol in place - Research

All education must be focused around the following statement from the CDC: • “All concussions are not created equally. Each player is different, each injury is different, and all injuries should be evaluated by the team medical staff”. • www. cdc. headsup • www. healthyohioprogram. org/concussion

What every parent should know about concussions • What makes a child’s brain unique • Recognizing signs and symptoms • Return to play and return to learn

What makes a child’s brain unique • Concussions are a type of mtbi and believed to result from a traumatic shaking of the brain. • Because child’s brain have less mass in relation to the skull, their brains experience more acceleration (brain can hit skull with more force) • A child’s brain also appears to be far more plastic or impressionable than an adult’s. Thus, less resistant to trauma.

Recognizing signs and symptoms • Research shows that parents have misconceptions regarding definition, symptoms, and treatment of concussions. • Parents are in prime position to recognize the signs and symptoms of a concussion in their child. • Parents can pick up the subtle signs of problems associated with a previous concussion.

Signs & Symptoms - Four Categories • Physical • Cognitive • Emotional • Sleep Patterns

Return to play and return to learn • Communication gaps in the medical community • Cornerstone initially is REST – physical & cognitive • Concussions are a metabolic crisis for the brain because blood flow and glucose delivery are impaired. The brain needs energy to function normally and heal itself. (If brain is over active-may not get as much energy as it normally needs to function normally).

Return - Continued • Children with concussions symptoms may have to modify classroom work and instruction. • Resuming physical activity should be progressive as well. • Following these guidelines can help parents to be protective of their children’s brains and potentially prevent long-term effects or tragic consequences.

TAKE HOME POINTS • We allow our children to engage in all types of activities that have inherent dangers/risks: ride a bike, play soccer, skate board, snow board, play ice hockey, self-defense, drive a car, etc. • Need to be educated – to make an informed decision. • Parents – Teammates – Coaches - Trainer

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EMAIL: bsiddall@ftmc. com

THANK YOU