overview of ‘concussion in sport’ symposium · overview of ‘concussion in sport’ symposium...
Post on 05-Jul-2018
219 Views
Preview:
TRANSCRIPT
Overview of ‘Concussion In Sport’
SymposiumSymposium
Margo Mountjoy M.D.Sports Medicine
Health and Performance Centre
January 17, 2013
Statistics
Incidence of sport-related concussion in
Canada estimated to be 30, 000 per year.
Likelihood of an athlete in a contact sport Likelihood of an athlete in a contact sport
sustaining a concussion
Up to 19% per season
Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
What is a Concussion?
“... a complex
pathophysiological process
affecting the brain, affecting the brain,
induced by traumatic
biomechanical forces”
McCrory et. Clin J Sports Med 19(3): 185-195, 2009
•Concussion may be caused either by a direct blow to the
head, face, neck or elsewhere on the body with an
“impulsive” force transmitted to the head
•Most concussions have a quick onset of symptoms that
resolve almost immediately
•Most changes that happen with the brain affect how it
functions, rather then its structure.
•As a result tests like MRI, CT Scans, X-ray do not show
findings
Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
Clinical Diagnosis of Exclusion
Symptoms
•Headache
•Dizziness
•Nausea
Physical signs • Loss of consciousness
• Balance difficulties
• Seizure
• Sleep disturbance•Nausea
•Blurred vision
•Ringing in the ears
•Slurred speech
• Sleep disturbance
Behavioural changes• Irritablity
• Emotional lability
• Personality changes
Clinical Diagnosis of Exclusion
Cognitive impairment
Slowed reaction times
Impaired calculation
Memory disturbance
Field of Play Assessment
1.Standard emergency clinical assessment
2. Cervical spine injury
3. Intracranial injury 3. Intracranial injury
4. Loss of consciousness
5. Serial assessments over first few hours
Under no circumstances should the athlete return to play on the same day!!!
Remove from field of play
Field of Play: Management
Medical assessment
Monitor for signs of deterioration
Office AssessmentHistory
Mechanism of injury
Early symptoms and signs
History of previous concussions
Co-morbidities
Current symptomatology
Physical Examination
Neurological examination
BESS testing
SCAT2 (to be renamed SCAT3 plus a new Child SCAT!)
“Concussion Recognition Tool –CRT”
Investigations: Current and Future
•Neuropsychological testing
•Genetic testing
•F MRI
•King Devick (eye tracking)
Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
Treatment
• Physical Rest
• No sport
•Cognitive Rest
•Minimize screen time
•Time from school • Avoid active play
• No gym at school
•Time from school
•Regular sleep
•Avoidance of ETOH/drugs
Clinical Treatment
First address if any….
•Cervical spine injury•Cervical spine injury
•Headache
•Depression
Symposium Overview
Definition
Diagnosis
Treatment
Return to play
Special populations
Prevention
Return to Play
Return to Play
•Must pass the graded exertion (previous slide)
•Must feel confident to RTP
•New helmet if needed•New helmet if needed
•Other behaviours/ factors
•Other multiple/ recent injuries
Symposium OverviewDefinition
Diagnosis
Treatment
Return to play
Special populations
Prevention
Special Population: Pediatric
•Age specific physical and cognitive rest issues
•Symptom resolution may take longer
•Extend symptom free period before starting RTP protocol
•Extend length of the graded exertion protocol
Special Population: Elite vs. Non-Elite
No difference in treatment!
An athlete is a person/ patient first!An athlete is a person/ patient first!
Symposium Overview
Definition
Diagnosis
TreatmentTreatment
Return to play
Special populations
Prevention
Prevention: Pre-Event Screening
•Number of prior concussions
•Non-sport head injuries
•Previous facial/ dental injuries
•Type of player (aggressive)
•Ability to take a hit•Ability to take a hit
•Baseline SCAT taken?
•Protective equipment
Helmet age
Helmet fitting
Mouth guard
Full face mask
Prevention: Athlete Skills and Education
�Be a good skaterWork on balance and agility
�Keep your head upPractice stick handling
�Keep your arms upWhen going into boards use hands & arms to absorb shock
�Approach boards on an angle�Approach boards on an angle
�Know the Danger Zone3-4 feet from boards
�Neck Strengthening� May help reduce concussions
Prevention: Athlete Skills
•Don’t hit from behind
•If you see the numbers, don’t hit
• Control your stick responsibly
• Do not make suicide passes
•Don’t hit to the head
•Hit with shoulders, not elbows, hands, or stick
• Communicate with teammates
• RESPECT YOUR OPPONENTS!!!!
Prevention: Sport Rule Changes
�Federation rule changes
�Implementation & monitoring
�“Zero” tolerance head checking�“Zero” tolerance head checking
�Body checking – pee wee hockey
�Political Legislation- Lystedt Law
top related