keith eggleston, at/l, atc16yo male football player no relevant health issues; no hx of concussion...
TRANSCRIPT
Keith Eggleston, AT/L, ATC
Sports Medicine Coordinator – Rockwood Clinic
Sports Medicine Instructor – Spokane Valley Tech
Athletic Trainer – Central Valley High School
Assuming you know the basics about concussion, so taking different approach:
Discuss trends and directions
Research areas re: diagnosis and assessment
Touch on a lot of different aspects of sports-related concussion
16yo male football player
No relevant health issues; no hx of concussion
3rd quarter, head first into group tackle in V game
Immediately: Grasped head in obvious pain & goes to ground
HA; Several other typical concussive S/S
Delayed responsiveness but alert and oriented x3
Brief (seconds) spasmodic episode, ended before AT got to him
Transported to hospital via EMS
Was stable, no findings on imaging, released to home that night
Uneventful recovery, passed neurocognitive assessment and went thru gradual RTP program
Returned to play and participated in last 2 games of the season, no other sports for senior year
“Case closed” – just the way we want them all to end!
Direct/indirect blow to the head + some form of change in cognitive function = CONCUSSION
They aren’t on the decline
They aren’t getting any easier to treat
We are still learning about how to fully assess them
Still learning about ST & LT implications
They are prevalent in all sports
Do not need to exhibit significant symptoms
Even just having a headache, if not explained by other reason, is consistent w/concussion
Athletes must get written clearance for RTP
Schools should have policy and plan for these injuries
Talking about concussion, not subdural hematomas and bleed/fracture injuries
APOE4 (apolipoprotein epsilon4 allele) is the current target
Hockey siblings: Eric/Brett Lindros; Sidney/Taylor Crosby
Testing is cheap and it is not predictive
What does it test? Repeat concussion vs initial concussion vs healing issue, etc?
Clearance if you have it? Liability and insurance?
Everything goes through neural system or vessels, likely we will find indicators
Military research work
Concussion markers in blood concussion
Tau Proteins found post-bout in boxers
Goal: define active/ongoing concussion
Long ways to go (thresholds)
Expensive pictures but diagnosis, prognosis
fMRI interesting but not established clinically
DTI-MRI available but not established clinically
CT and MRI not effective for concussion
Goal: images direct treatment, care, or prognosis.
MRI
fMRI
MRI
DTI-MRI
Q: how do we know what is going on?
Professional, college, and HS (ROI) tracking
Establishing data for further evaluation
Findings: Concussions “on the rise”
Who has them, where, and when
Frequency
Duration of S/S
Seeking an A + B = C predictive modeling
Seattle Children’s (n=1412): Risk factors for concussion S/S 1 week
4+ symptoms = double risk 1 week
Hx of prior concussion =double risk in FB only 1 week
Drowsiness, nausea, difficulty concentrating = increased risk 1 week
Amnesia 1 week in males only
Used to think brain didn’t heal
Now we know lifelong changes occur
Peds = changes found in white matter 1 month after symptoms “resolved”
Will there be residual tissue changes similar to scar tissue after an ankle sprain, or will brain heal/adapt around that area?
Need to ID methods to encourage healing & know when/how to do so
Ongoing research
Repetitive blows to the head are bad
How many? Unknown
How often? Unknown
Time between contact? Unknown
What is the threshold for trauma & timeline for healing? 150N hit to head 1 time
3 x 50N hits to head in 1 day =/worse?
6 x 50N hits to head in 3 days =/worse?
Concussion is a metabolic issue
Exertion = controlled ↑ to HR, BP, etc
Evaluation: Used as progressive assessment in RTP
If S/S return during progression, not healed
Potential FUTURE treatment? Threshold below S/S to encourage healing
Research needs to ID ‘Goldilocks’ guidelines
Avoid contact to head while symptomatic
Avoid cognitive stressors that increase S/S
Avoid emotional stressors that increase S/S
Avoid alcohol, tobacco, caffeine
Avoid any meds not recommended by provider
Some medications used via skilled provider direction
‘ST’ injuries: sports-related concussion
‘Lifelong’ injuries: MVA, significant head trauma and disability
Opposite ends of the spectrum
Recent decades experts bridging gaps between opposite ends.
Sharing research/care paradigms shows promise in sports-related TBI/concussion
Lots of research, lots of promotions
Sales more marketing driven than proof-driven
Additional equipment may encourage more contact
No data defining prevention of concussion via equipment
Tissue damage more extensive than previously understood.
We underappreciated both effects and FQ
We underappreciated LT implications
We don’t know how much brain can heal
We don’t know how to influence healing
No RTP while symptomatic
When in doubt – they are out
Graduated RTP is the standard (S/S clear)
Coaches are eyes/ears, but should only be decision-makers in a conservative direction
Imaging is largely un-useful for concussion
No mild/moderate/severe classifications
They are STUDENT-athletes
Athlete presents to UCC, girlfriend reports seizure
No family hx, no hx of seizure prior to brief seizure episode in fall football
Dx: epilepsy
Tx: probable LT (lifelong?) care & meds
Did initial focal injury to area of brain never heal, leading to electrical issue/epilepsy?
Did symptoms manifest weeks/months later?
Is there any treatment that would have altered outcome?
Why Odd & Unpredictable Symptoms?
