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eConcussions:

Prevention, Identification, & Management

Chris Franklin, M.Ed., ATC, AT/LAthletic Medicine Instructor/Director of Athletic Training

North Kitsap High Schoolcfranklin@nkschools.org

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eChris Franklin, M.Ed., ATC, AT/L

• Certified Athletic Trainer• Director of Athletic Training at North

Kitsap High School• Athletic Medicine Instructor at NKHS• WIAA Medical Aspects Committee• Played 3 years of football at Whitworth

University

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eWashington State Law

• Zachary Lystead Law• Youth athletes who are suspected of sustaining a

concussion or head injury be removed from play. "When in doubt, sit them out"

• School districts to work with the Washington Interscholastic Activities Association (WIAA) to develop information and policies on educating coaches, youth athletes and parents about the nature and risk of concussion, including the dangers of returning to practice or competition after a concussion or head injury.

• All student athletes and their parents/guardians sign an information sheet about concussion and head injury prior to the youth athlete's initiating practice at the start of each season.

• Youth athletes who have been removed from play receive written medical clearance prior to returning to play from a licensed health-care provider trained in the evaluation and management of concussion.

• Private, nonprofit youth sports associations wanting to use publicly owned playfields comply with this law.

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eWhat exactly is a concussion?

• Occurs when a blow to the head makes the brain shake in the skull causing injury to membranes of the brain cells.

• The shaking alters the way brain cells communicate with each other and the way the metabolize fuel and nutrients.• This brings a mismatch in fuel

supply and demand. • The injured brain cell needs more

glucose for energy to run, but the brain’s ability to bring glucose in is compromised.

• Brain can’t perform its usual functions.

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eHow to prevent concussions?

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eHow to prevent concussions?

• Regardless of the preventive steps taken to avert sports injuries, including concussions, some players will continue to be injured.

• Student-athletes that participate in soccer, basketball, wrestling, baseball, fastpitch, and volleyball should be encouraged by the coach to wear mouth guards to help prevent concussions.

• Football players must have their helmets fitted using the standards set forth by the National Football Foundation, once a week, preferably the night prior to a game.

• Playing facilities are free from inherent hazards (e.g. padded sideline equipment for collision games).

• Teach and enforce the proper techniques.• Strengthen neck muscles.

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eHow to recognize a concussion

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eHow to recognize a concussion

•Appears to be dazed or stunned•Vacant stare (befuddled facial expression)•Is confused about time, date, location•Disorientation (walking in the wrong direction)•Is unable to remember what he/she did prior to or after the injury •Has altered balance (stumbling, inability to walk tandem/straight line)

• Slurred or incoherent speech (making disjointed or incomprehensible statements)

• Is slow to answer questions• Displays a personality change-

emotions out of proportion to circumstances (distraut, crying for no apparent reason)

• Has altered sleep patterns: is unable to fall asleep or feels like he/she always wants to sleep

• Is vomiting• Experiences loss of

consciousness (not present in all concussions)

Signs (observable behaviors) that may be present with concussions:

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eHow to recognize a concussion

•Headache •Nausea•Dizziness•Double or fuzzy vision or any other visual alteration •Sensitivity to light and/or noise

• Feeling sluggish or slow• Feeling “foggy” or in a

“funk” • Difficulty in

concentrating when reading, listening or speaking

• Extreme fatigue

Symptoms (experienced and reported by the athlete) that may be present with concussions:

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eManagement of Concussions

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eManagement of Concussions

• The proper management of concussions is the best form of prevention of a serious catastrophic injury resulting from a concussion.

• The prevention of Second Impact Syndrome – a catastrophic increase in intracranial pressure leading to massive brain swelling, herniation and death, is of utmost concern when dealing with concussions and return to play criteria.

• This syndrome occurs in athletes up to 14 days post-concussion and when an athlete returns to competition prior to the complete resolution of symptoms.

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eManagement of Concussions

• Any student-athlete diagnosed with a concussion is removed from competition for that day.

• No student-athletes with a concussion will be allowed to return to play in the current game.

• For any student-athlete who receives a concussion, the Certified Athletic Trainer and/or head coach must communicate with the parents/guardians

• All concussions are referred for medical evaluation by a licensed physician following the injury.

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eReturn to Play after a Concussion

Stepwise return to play policy: • No physical activity; rest until asymptomatic• Light aerobic exercise once the student-athlete has passed the neurocognitive testing

(ImPACT Software), along with a licensed medical doctor’s clearance and once student-athlete is asymptomatic. Light aerobic exercise must be supervised by the Certified Athletic Trainer and must follow the following schedule.

• Day One: Increase in heart rate for 20 minutes (Stationary bike, jog, elliptical, ect). If symptoms occur, stop immediately.

• Day Two: No symptoms from Day One, increase in heart rate for 30 minutes (quicker, higher stress, Sport specific drills-[non-contact]). If symptoms occur stop immediately.

• Day Three: No symptoms from Day Two, practice in NON-CONTACT drills (conditioning, shooting, etc.) If symptoms occur, stop immediately.

• Day Four: No symptoms from Day Three, practice in non-contact drills, one on one drills. If symptoms occur, stop immediately.

• Day Five: No symptoms from Day Four, Practice in full contact and non-contact drills. If symptoms occur, stop immediately.

• Day Six: No symptoms from Day Five, Practice normally. If symptoms occur, stop immediately.

• Day Seven: No Symptoms from Day Six, return to game play.• Any recurrence of concussive symptoms should lead to the athlete dropping back to

the beginning.

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eQuestions

• Any Questions?• Contact Information:

• Chris Franklin, M.Ed., ATC, AT/L• cfranklin@nkschools.org• 360-598-8476