concussions in youth football - brain injury...
TRANSCRIPT
Concussions in Youth Football Educating Trainers & Coaches in Sideline Management
Presented by: Mona B. Allan, RN, MScN BIAC September 26, 2012
About Me Mona B. Allan
About Me Mona B. Allan
About Me Mona B. Allan
Clinical Setting
The Issue
Needs Assessment
Project Goals & Objectives
• Awareness Campaign
• Presentation based on N.A.
• Concussion Notice Form
Evaluation Process & Outcomes
Conclusion & Future Recommendations
Outline
Clinical Setting Myers Riders
Ottawa Myers Riders Football Club Non-profit community organization that promotes
amateur tackle football and the development of players aged 6 to 19 years
OVFL (provincial level) NCAFA (local level) 8 Teams
Sandy Ruckstuhl, President
The Issue
The failure to recognize, report, and effectively manage concussions in youth football is due to the lack of knowledge among coaches and trainers.
Football accounted for 11.3% of team sports injuries with 13% being skull & brain injuries (CHIRPP, 2002)*. * does not include concussions treated in community and those not treated at all.
0
5
10
15
20
25
Hockey
Soccer
Basketball
Football
Baseball
The Issue
11.3%
Concussions 13%
Fractures Sprains
Other
Unreported Concussions
Why Concussion not Reported %
Did not think it was serious enough 66.4
Did not want to leave the game 41.0
Did not know it was a concussion 36.1
Did not want to let down teammates 22.1
Other reasons 9.8
Complications for Youth Athletes Complications Short-Term: PTHA, SIS, PCS Long-Term: Alzheimer’s, Parkinson’s, CTE Complications on Academic Performance
Fatigue Difficulty with concentration & attention Difficulty with comprehension & memory Slower processing of new and old information Difficulty converting new learning into memory Problems with processing visual & auditory information Emotional, behavioural, or social symptoms
Best Practice Guideline Consensus Statement on Concussion in Sport
Consensus Statement
Paul McCrory, MBBS, PhD
Willem Meeuwisse, MD, PhD
Karen Johnston, MD, PhD
Jiri Dvorak, MD
Mark Aubry, MD
Mick Molloy, MB
Robert Cantu, MA, MD
2009 Panel Experts
Conceptual Framework W.K. Kellogg Foundation Logic Model
Logic Model Program Planning
Needs Assessment
To identify gaps in knowledge related to the identification and management of concussions. Questionnaire based on current literature 20 true, false, or uncertain formal 1 open-ended question to identify information
that participants wanted included in the educational seminar.
Coach Trainer
Please answer TRUE (T) or FALSE (F). HOWEVER, if you are UNSURE in any way, please select (U). The sole purpose of the questionnaire is for the development of a presentation on concussions.
1. Most concussions involve a loss of consciousness of 1 second or more.
U T F
2. All concussions are traumatic brain injuries. U T F
3. People who get repeated concussions can have permanent brain damage if they try to resume their normal routine too quickly.
U T F
4. Kids who have concussions can feel irritable for no apparent reason but it will not affect their sleeping pattern.
U T F
5. Concussions are less dangerous to youth under the age of 18 because their brain is able to heal more quickly than adults.
U T F
6. There are five grades of concussions that are based on the severity of the blow to the head.
U T F
7. A person who experiences a concussion can “see stars” but won’t get blurred vision.
U T F
8. Players usually recover from a concussion in 7 to 10 days. U T F
9. Studying soon after having a concussion can slow the healing process. U T F
10. A young athlete can safely return to the game right after suffering a concussion
U T F
11. A single blow to the head causes more damage than many smaller ones. U T F
12. There are specific guidelines that allow a player to practice or play a game after a concussion.
U T F
13. A mild jolt to the head can cause the brain to rotate suddenly. U T F
14. Studies show that it usually takes brain cells 24 hours to regain normal function after a concussion.
U T F
15. It is okay to return a young player to the game after having feeling dinged as long as the player’s pupils are not dilated.
U T F
16. Players who have a concussion are not likely to get another one because it only happens by chance during the game.
U T F
17. Concussions produce both mental and emotional symptoms. U T F
18. Concussion symptoms are usually the same for everyone so they are easy to identify.
U T F
19. It is alright for a player to return to play after a mild jolt to the head if they can identify how many fingers the trainer is holding up.
U T F
20. A player who was removed from a game due to a possible concussion may go to practice like everyone else the following day if all the signs and symptoms are gone.
U T F
What would you like to know about concussions?
Survey aspects definition characteristics signs & symptoms managing
Needs Assessment
Results of the Needs Assessment 14 completed surveys [10 coaches, 4 trainers] Gaps included:
Defining concussion Grading concussions Recognizing signs and symptoms Recognizing medical emergencies Identifying steps for safe return to play Prevention of concussions
Project Goals & Objectives
Goal To increase concussion knowledge of coaches and trainers through an educational seminar. Objectives 1. To create awareness about concussions in youth
football & awareness of the educational sessions 2. To develop & implement and educational session 3. To develop a sideline concussion reporting card
Logic Model Program Implementation
Awareness Campaign
Participant Recruitment
1. Emails – kickoff October 21, 2011
2. Poster on the Club website – December 21, 2011
3. Announcement at Club’s AGM – January 26, 2012
Educational Intervention
PowerPoint Presentation Based on gaps identified in Needs
Assessment Endorsed by ThinkFirst, Ottawa Given on 2 different days Interactive forum Evaluation: pre- & post- questionnaire
Concussion Reporting Card
Behavioural Change Cueing for sidelines assessment Inform parents that the athlete has
potentially sustained a concussion Identifies actual symptoms experienced
by the athlete (assist with medical evaluation)
Identify medical emergencies Inform the athletes teachers of
academic repercussions Includes RTP protocols
Evaluation Process
Logic Model
Program
Evaluation
Logic Model
Program
Evaluation
Evaluation Outcomes Trainers Coaches
Logic Model
Program
Evaluation
Evaluation Questionnaires
Pre-seminar Questionnaire 5 questions on existing concussion
knowledge 5 case scenarios to examine
behavioural intention to assess & manage concussions on the sideline
(evaluation of behaviour)
Pre-test Questionnaire
Concussion Clinic Presented to Myers Riders Football Club
Background Information
Coach Trainer Other:
Have a healthcare background
Number of years as a coach or trainer yrs
QUIZ
1. Resting after a concussion is critical because it helps the brain recover.
TRUE or FALSE 2. If the symptoms of a concussion last for weeks, this is called: a) Concussion complication disorder b) Second Impact Syndrome c) Concussive edema d) Post concussion Syndrome e) Chronic Traumatic Encephalopathy (Punch Drunk Syndrome) 3. After sustaining a concussion, a healthcare professional has determined that the athlete can
return to play. What is the second step in this process? a) Start football-specific training activities to increase the athlete’s heart rate b) Start light resistance training c) Start aerobic exercise to increase an athlete’s heart rate d) Begin non-contact physical activity – running, weightlifting routine and football drills e) Reintegrate the athlete in controlled practice sessions
4. Amnesia is a rare side effect of a concussion.
TRUE or FALSE 5. Which of the following would be considered danger signs of a concussion and require taking
an athlete to the emergency department immediately? a) The athlete seems slightly off balance, complains of a headache, did not lose
consciousness, but just “isn’t feeling right” b) The athlete complains of a headache and cannot remember what happened before or
after his hit c) The athlete has slightly slurred speech, and seems to become increasing more confused
and restless d) The athlete complains of a headache and appears dazed or stunned e) Any of the above
Evaluation Outcomes
Concussion Knowledge Years of Experience and Pre-seminar Questionnaire Score
Negative association
Evaluation Outcomes
Concussion Knowledge Pre-seminar and Post-seminar Scores
Pre-seminar mean = 3.02
Post-seminar mean = 4.33
Logic Model
Program
Evaluation
Evaluation Questionnaires
Post-seminar Questionnaire
Same knowledge questionnaire
Same scenarios
Plus self-assessment of perceived
knowledge gained
Post-test Questionnaire
Concussion Clinic Presented to Myers Riders Football Club
Background Information
Coach Trainer Other:
Have a healthcare background
Number of years as a coach or trainer yrs
Learning Self-Assessment Please review the following list of knowledge statements. Give some thought to what you knew before this training and what you learned here today. Circle the number that best represents your knowledge before then after this training.
RATING SCALE: 1 = LOW 3 = MEDIUM 5 = HIGH
BEFORE TRAINING Self-Assessment of Knowledge Related to: AFTER TRAINING
1 2 3 4 5 The definition of concussion and how they can be sustained.
1 2 3 4 5
1 2 3 4 5 How to identify a concussion on the sidelines. 1 2 3 4 5
1 2 3 4 5 Why it is important to recognize and respond properly to a concussion.
1 2 3 4 5
1 2 3 4 5 When to remove a player from the game/practice. 1 2 3 4 5
1 2 3 4 5 When a concussion is a medical emergency. 1 2 3 4 5
1 2 3 4 5 The steps for returning an athlete to play. 1 2 3 4 5
1 2 3 4 5 Overall concussion knowledge 1 2 3 4 5
QUIZ
1. Resting after a concussion is critical because it helps the brain recover.
TRUE or FALSE 2. If the symptoms of a concussion last for weeks, this is called: a) Concussion complication disorder b) Second Impact Syndrome c) Concussive edema d) Post Concussion Syndrome e) Chronic Traumatic Encephalopathy (Punch Drunk Syndrome) 3. After sustaining a concussion, a healthcare professional has determined that the athlete can return to
play. What is the second step in this process? a) Start football-specific training activities to increase the athlete’s heart rate b) Start light resistance training c) Start aerobic exercise to increase an athlete’s heart rate d) Begin non-contact physical activity – running, weightlifting routine and football drills e) Reintegrate the athlete in controlled practice sessions See OVER for page 2
Evaluation Outcomes
Perceived Knowledge Overall
Positive shift in
knowledge gained
Logic Model
Program
Evaluation
Evaluation Questionnaires Pre- & Post- Questionnaire 5 case scenarios to examine
behavioural intentions for managing a suspected concussion on the sidelines
Theory of Planned Behaviour Constructs that predicts intention to perform a behaviour:
Attitudes Subjective norms Perceived behavioural control
Pre-test Questionnaire
QUIZ (page 2)
Each question in this section refers to a game situation. Please circle the number that best represents your intentions. 1. A 17-year old high school football player was tackled in the first half of a varsity game and struck his
head on the ground. When he returns to the sideline, I would ask the player if he has any concussion symptoms.
Disagree 1 2 3 4 5 6 7 Agree
2. A 17-year old high school football player was tackled in the first half of a varsity game and struck his
head on the ground. He clumsily walked back to the huddle unassisted. I am confident that I would call out to the player to take a knee and remove him from play.
Disagree 1 2 3 4 5 6 7 Agree
3. A 17-year old high school football player was tackled in the first half of a varsity game and struck his
head on the ground. He complains of dizziness and a headache. The player’s symptoms completely resolve in 10 minutes. It is expected of me that I remove and keep the player from returning to the game.
Disagree 1 2 3 4 5 6 7 Agree
4. A 17-year old high school football player was tackled in the first half of a varsity game and struck his head on the ground. During half-time intermission, he tells you that he has a headache. Benching the player with a possible concussion is:
Worthless 1 2 3 4 5 6 7 Useful
5. I intend to be proactive in assessing players for concussions on the sidelines.
Disagree 1 2 3 4 5 6 7 Agree
Evaluation Outcomes
Behavioural Intention Overall
Positive shift in intention
to use new knowledge on
the sideline assessment &
management of
suspected concussions
Study Conclusion &
Next Steps
Conclusion
Concussion education is an effective intervention for increasing knowledge acquisition related to: 1) The definition of concussion and how they can be sustained 2) How to identify a concussion on the sidelines 3) Why it is important to recognize and respond to a concussion 4) When to remove a player from the game/practice 5) When a concussion is a medical emergency 6) Steps for returning an athlete to play
Next Steps
1. Evaluating educational programs on sports-related concussions 2. Examining actual behaviour changes following knowledge translation programs. 3. Evaluating the effects of the concussion notice form.
• Assists in facilitating sideline assessment and management? • Provides valuable information of medical evaluation in diagnosis? • Assists parents following a suspected concussion? • Assists school teachers in helping athletes optimize education during their
symptomatic period? • Assists trainers/coaches to reintegrate the athlete into play?
Thank You.
Questions?