Management of ConcussionsBy: Michael Cox

Technology and Assessment

Management of ConcussionsBy: Michael Cox

Technology and Assessment

What is a Concussion?What is a Concussion?

•Concussions are injuries that transiently impair the way your brain normally functions•They can be caused by a direct blow to your head or by a force that causes your brain to shake within your skull•Not all concussions include loss of consciousness

•Concussions are injuries that transiently impair the way your brain normally functions•They can be caused by a direct blow to your head or by a force that causes your brain to shake within your skull•Not all concussions include loss of consciousness

What to Do if There is a Suspected Concussion

What to Do if There is a Suspected Concussion

If there is an athletic trainer at the location where the injury took place, call him/her for immediate evaluation

Contact your primary physician If they are not available

Contact emergency services

If there is an athletic trainer at the location where the injury took place, call him/her for immediate evaluation

Contact your primary physician If they are not available

Contact emergency services

Concussion SymptomsConcussion Symptoms Headache Dizziness Nausea Ringing in the ears Blurred vision Dazed or confusion Amnesia Balance and coordination problems Aniscoria (pupil size)

Headache Dizziness Nausea Ringing in the ears Blurred vision Dazed or confusion Amnesia Balance and coordination problems Aniscoria (pupil size)

Evaluating A ConcussionEvaluating A Concussion Determine their consciousness and what symptoms the athlete is

experiencing Signs and Symptoms

Memory Testing Determine what they remember before the injury (antrograde

amnesia) and what they remember after the injury (retrograde amnesia)

SAC test Balance Testing

Have athlete balance on both feet with their eyes closed Then perform same test with one foot in front of the other and

vies versa Neurological Testing

Test dermatome (sensitivity to touch) and myotome (strength test) to specific nerve roots

Determine their consciousness and what symptoms the athlete is experiencing Signs and Symptoms

Memory Testing Determine what they remember before the injury (antrograde

amnesia) and what they remember after the injury (retrograde amnesia)

SAC test Balance Testing

Have athlete balance on both feet with their eyes closed Then perform same test with one foot in front of the other and

vies versa Neurological Testing

Test dermatome (sensitivity to touch) and myotome (strength test) to specific nerve roots

Cranial Nerve TestingCranial Nerve Testing

Olfactory- Sense of smell Optic- vision, reading a text at close proximity and distant proximity Oculomotor- PEARL, pupil dilation Trochlear- Eye trackign up and down Trigeminal- Facial sensations Abducens- Lateral eye tracking Facial- facial movements Vestibulocochlear- Balance and hearing Glossopharyngeal- Swallowing reflex Vagus- Gauge reflex Accessory- Shoulder shrug Hypoglossal- Tongue lag

Olfactory- Sense of smell Optic- vision, reading a text at close proximity and distant proximity Oculomotor- PEARL, pupil dilation Trochlear- Eye trackign up and down Trigeminal- Facial sensations Abducens- Lateral eye tracking Facial- facial movements Vestibulocochlear- Balance and hearing Glossopharyngeal- Swallowing reflex Vagus- Gauge reflex Accessory- Shoulder shrug Hypoglossal- Tongue lag

Determining the Severity of a Concussion

Determining the Severity of a Concussion

• Grade 1• No loss of consciousness• Memory loss lasting < 30 minutes• Symptoms lasting < 24 hours

• Grade 2• Loss of consciousness lasting < 1 minute• Memory loss lasting 30 minutes to 24 hours, OR• Symptoms lasting > 24 hours but < 7 days

• Grade 3• Loss of consciousness lasting > 1 minute OR• Memory loss lasting > 24 hours OR• Symptoms lasting > 7 days

• Grade 1• No loss of consciousness• Memory loss lasting < 30 minutes• Symptoms lasting < 24 hours

• Grade 2• Loss of consciousness lasting < 1 minute• Memory loss lasting 30 minutes to 24 hours, OR• Symptoms lasting > 24 hours but < 7 days

• Grade 3• Loss of consciousness lasting > 1 minute OR• Memory loss lasting > 24 hours OR• Symptoms lasting > 7 days

Post-concussion SymptomsPost-concussion Symptoms

Photophobia (sensitivity to light) Seeing stars Difficulty concentrating Irritability Depression Anxiety Fatigue Headache Trouble sleeping

Photophobia (sensitivity to light) Seeing stars Difficulty concentrating Irritability Depression Anxiety Fatigue Headache Trouble sleeping

RehabilitationRehabilitation

Once an athlete has been diagnosed with a concussion they are not aloud to start rehabilitation until they are symptom free

Once symptom free, a 7 day progressive rehab program can begin focusing on cardiovascular exertion, strengthening, and sport-specific activites

If at any time an athlete develops symptoms as a result of their rehab, they are to stop activity until symptoms are gone and start over

Once an athlete has been diagnosed with a concussion they are not aloud to start rehabilitation until they are symptom free

Once symptom free, a 7 day progressive rehab program can begin focusing on cardiovascular exertion, strengthening, and sport-specific activites

If at any time an athlete develops symptoms as a result of their rehab, they are to stop activity until symptoms are gone and start over

DAY 1DAY 1

10 minute elliptical/bike session Moderate intensity

Impact test- cognitive functioning

SAC test- memory

No participation during practice/game

Goal: Increase heart rate

10 minute elliptical/bike session Moderate intensity

Impact test- cognitive functioning

SAC test- memory

No participation during practice/game

Goal: Increase heart rate

20-25 minute elliptical/bike session Higher intensity

No participation during practice/game

Goal: Increase heart rate

20-25 minute elliptical/bike session Higher intensity

No participation during practice/game

Goal: Increase heart rate

DAY 2DAY 2

20-25 minute elliptical/bike session Begin full-body lifting

Leg extension/curls Chest press Bicep curls Triceps pull-downs Seated rows

No participation in practice/game

Goal: Get person moving

20-25 minute elliptical/bike session Begin full-body lifting

Leg extension/curls Chest press Bicep curls Triceps pull-downs Seated rows

No participation in practice/game

Goal: Get person moving

DAY 3DAY 3

Warm-up on elliptical/bike 10-15 minutes

Full-body workout Sprinting

10-15 sprints ranging from short to long distances

No participation in practice/games

Goal: increase athletes heart rate close to max

Warm-up on elliptical/bike 10-15 minutes

Full-body workout Sprinting

10-15 sprints ranging from short to long distances

No participation in practice/games

Goal: increase athletes heart rate close to max

DAY 4DAY 4

Warm-up on elliptical/bike 10-15 minutes Sport specific activities

i.e- shooting, throwing, hitting, kicking Minimal participation in practice No participation in game

Goal: get them back to sport-specific training

Warm-up on elliptical/bike 10-15 minutes Sport specific activities

i.e- shooting, throwing, hitting, kicking Minimal participation in practice No participation in game

Goal: get them back to sport-specific training

DAY 5DAY 5

Return to practice with no contact

Goal: Return to all sports activity restraining from contact

Return to practice with no contact

Goal: Return to all sports activity restraining from contact

DAY 6DAY 6

Full return to participation including contact Able to play in games

Goal: Contact drills being aware of any symptoms that may return

Full return to participation including contact Able to play in games

Goal: Contact drills being aware of any symptoms that may return

DAY 7DAY 7

Returning from a Concussion to Soon

Returning from a Concussion to Soon

Returning from a concussion before someone is ready can not only lead to an increase in symptoms, but it can cause further damage

Secondary Impact Syndrome This occurs when an athlete sustains a secondary head injury while

still experiencing symptoms from the first concussion The secondary injury can be very minor It will cause rapid swelling and disruption of the brain possibly

leading to respiratory failure and possibly death

Returning from a concussion before someone is ready can not only lead to an increase in symptoms, but it can cause further damage

Secondary Impact Syndrome This occurs when an athlete sustains a secondary head injury while

still experiencing symptoms from the first concussion The secondary injury can be very minor It will cause rapid swelling and disruption of the brain possibly

leading to respiratory failure and possibly death

What to Avoid What to Avoid Athletes who sustain a concussion should avoid certain behaviors until

instructed otherwise. Such behaviors include: Drinking coffee or other stimulants

Consuming alcohol

Consuming foods in excess that will upset the stomach

Weight lifting or exercise

Taking medications that contain ibuprofen such as advil or Aleve because they are blood thinners and can cause further problems

Athletes who sustain a concussion should avoid certain behaviors until instructed otherwise. Such behaviors include: Drinking coffee or other stimulants

Consuming alcohol

Consuming foods in excess that will upset the stomach

Weight lifting or exercise

Taking medications that contain ibuprofen such as advil or Aleve because they are blood thinners and can cause further problems

Some Ways to Help Treat a Concussion

Some Ways to Help Treat a Concussion

• There is no cure or specific medication for a concussion but there are some ways to help treat the symptoms:• REST- the most important thing a person can do is rest the body

and get a good nights sleep• Taking tylenol (acetaminophen)

for minor headaches• Avoid strenuous activity• Try not to watch TV or use the

computer to much• If doing homework or reading is bothersome, stop doing it

• There is no cure or specific medication for a concussion but there are some ways to help treat the symptoms:• REST- the most important thing a person can do is rest the body

and get a good nights sleep• Taking tylenol (acetaminophen)

for minor headaches• Avoid strenuous activity• Try not to watch TV or use the

computer to much• If doing homework or reading is bothersome, stop doing it

Summary Summary If an athlete sustains any type of headache or “not feeling right” after

being hit in the head, it is very important to have a certified health professional evaluate the injury

Do not lie about symptoms

Most important thing to do is

rest the body and refrain from

strenuous activity

A doctor must clear the athlete

before returning to activity

If an athlete sustains any type of headache or “not feeling right” after being hit in the head, it is very important to have a certified health professional evaluate the injury

Do not lie about symptoms

Most important thing to do is

rest the body and refrain from

strenuous activity

A doctor must clear the athlete

before returning to activity