CC - CONCUSSION guest lecture Flashcards
Concussion Facts ?
CDC reveals 1.6-3.8 million concussions occur each year
Estimated 47%- 51% of athletes do report S/S after concussive blow
5-10% of athletes will experience a concussion in any given sports season
Fewer than 10% of sports related concussions involve loss of consciousness
Football is the most common sport with concussions.
Hockey ,boxing and lacrosse are very close.
Soccer is most common for females—50%,Hockey
78% of concussions occur during the game
Females are twice as likely to sustain a concussion and recover slower
Common complaints: Head/neck aches -85%,Dizziness 70-80%
What is a concussion ?
Defined as a mild traumatic brain injury
Sudden movement causing the brain to bounce, twisting inside the skull
Stretches and damages brain cells/synapse
Causes chemical changes in the brain
The primary elements of the pathophysiologic cascade following concussive brain injury include abrupt neuronal depolarization, release of excitatory neurotransmitters, ionic shifts, changes in glucose metabolism, altered cerebral blood flow, and impaired axonal function.
( brain cannot balance itself - always fighting one thing or another trying to defend itself and maintian homeostasis)
Causes of a concussion ?
Jolt, Bump, Blow to the head
Jolt/sudden stop to the body causing coup counter coup motion
**be specific when taking a Hx
females are more honest with sxs .**
Who can get a concussion ?
Toddler - inside cabinet, falls down stairs
Youth -
High school athlete
College athlete
Anyone, anyway, anywhere (regular people, slipping on ice )
0-2,3-5,6-13,14-18,19-40,41-60,60 + . It’s not a Bell shaped curve .
Dx of concussion athlete on field: To ER if ?
Loss of conscience >1 minute
Possible neck injury . C/O neck pain
stabilize it
Numbness or tingling persists or gets worse
Pupils are different sizes
Vision issues
HA that gets worse or will not go away
Siezures
Dx of concussion athlete on bench: To ER if ?
if vomiting starts , constant or gets worse
Headache worsens/starts
Numbness/tingling increases/starts
Neck pain develops
Seizures start
Slurred speech develops
Disoriented x2-3 begins
Review with parents symptoms to observe
Visit medical advise in the next 24-48 hours
-because of Possible hematoma
**these can start 10-15-20 minutes after the blow doesn’t have to be immediate
young kid - review with the parents**
What should parent look for in 1st 24-48 hours ?
Dizziness, clumsiness
Blurred vision, double vision, pupil sizes are different
Headache, numbness, tingling
Balance issues
Fatigue, drowsiness
Sensitivity to light
Altered sleep patterns
Concentration and comprehension decline
Fog (just not right) forgets plays and assignments. Coaches should be aware of this S/S
Any symptoms that get worse ,any ware ,bench ,field, home.
**some of these you wont get on the field right away they may come a day or two after ( some of these may start)
very insidious creature
when do they start and when do they end **
Children and toddler symptoms ?
Appears dazed
Listlessness and tires easily
-rely on the parent
Irritability and crankiness
Loss of balance and unsteadiness walking
Cry excessively, will not stop
Change in eating , nursing habits and sleeping pattern
Lack of interest in favorite toy
**mother bringing baby in
rely on the parent**
When does recovery start ?
Starts right away 85%-90% of concussions usually last 7-10 days (if everything goes will but there are outliers) ,in some cases longer.
When does recovery start: Physical rest ?
No running or jumping
Remove all activities that increase symptoms (triggers)
But don’t over do ,not doing enough can have adverse effects
When does recovery start: Mental rest ?
Limit study time
Limit any computer games or computer activities
Limit school time ,work ,physical or mental
Dont use what when recovering from concussion ?
Do not use Aleve or Ibuprophen as there is a chance of increasing bleeding
Acetaminophen is ok
No alcohol or other recreational drug that masks pain
blood thinning or reaction with anything
Other tips when recovering from a concussion ?
Watch neck position ( because of swelling and not in correct position can arrgivate sxs. ), chest out chin back ,military posture.
Take short naps 30-60 minutes ,keep a routine.
Avoid triggers
- Decrease symptoms faster
- Speeds up recovery
Testing for concussion ?
Do not DX concussions
MRI, CT, X-ray scans
Good for brain contusions, bruises
FX of vertebrae
Any other abnormality
Clinic has two categories: Testing for Athletes ?
Impact tool -Protects the athlete Measures symptoms Measures verbal, visual, memory, processes, reaction time Provide data for action plan Helps determine return to play criteria
Drop Test
-Reaction time test-5 minutes
Balance Testing
- Foot positions
- Hard/ soft surfaces
Clinic has two categories: Testing non-athletes ?
C3 APP combines above tests into a compact test
Balance testing
**compare the results and for progress every month
can have great recovery in 2 week and then a month of nothing but dont get discouraged **
Concussion Tx ?
Can be short or long. Depends on many factors
PT neck/vestibular issues
Exercise. Will be graded in nature
Cognition , memory training and processing
Medication ,Depends on how severe the concussion they have and time line
depending on when the entered the medical model
Balance and reaction times
Depends on grouping of S/S
CCF return to play guidelines
-Physical/mental rest
-Light aerobics/exertional activities 15-30 minutes
-Moderate aerobics 30 minutes
-Higher intensity aerobics 30 minutes
-Full contact practice
-Return to play symptoms free at rest and exertion 2-3 days
-24 hours symptom free to move up to next level if not move back one stage then start over.
assuming they are honest
**still in flux right now : they have many sxs. but there is one key or one master sxs. and if you get rid of these one or treat this one then the others go away **
Ramifications of concussion ?
Age plays roll
Estimates 50% of high school athletes have concussion prior to playing high school sports
38% of college athletes have multiple concussions
Frontal lobe does not develop until 25 years old
Must monitor younger athletes more closely
injury to the developing mind
Ramification of concussion cont’d ?
First concussion athletes are 1-2 times more likely to see a second
Second concussion athletes are 2-4 times more likely to see a third
Third concussion athletes are 3-4 times more likely to see a forth
Reasons are carelessness, and the brain is not balanced yet and may stress the damaged structures again
**lack of knowledge - coach putting child in to early
certian part of the brain get more malleable and not as flimsy as they used to be **
Second Impact Syndrome ?
rare condition.
Happens when a second concussion occurs prior to first healing.
-the first C is not healed yet
Causing rapid and severe brain swelling.
Can often result in catastrophic results.
Brain loses it’s ability to auto regulate. intracranial and cerebral profusion pressure.
Happen to younger athletes.
-because they want to play and they want to get in the game
**people can die from this ( later on from the first they are not as likely to have big issues , but sooner after the first then it is worse )
coachest are the worst
OHSAA guidelines 8**
Ramification of concussion , PCS ?
Post concussion syndrome symptoms
> 7 days to 3 months
Frustrating recovery.
Must break down triggers , what aggravates the Pt. and adjust or limit them
Inform patients, they may be Depressed.
15 % of patients with first concussion will get PCS.
The pt can recover from PCS.it just takes longer.
they need to follow the protocol
**these people fall outside the boundaries and they dont go to the doctor and they dont get checked up **
Chronic traumatic encephalopathy ?
Brain neuro degeneration
Unknown pathophysiology , unclear epidemiology
Progressive decline in memory
Cognitive dysarthria
Depression
Suicidal behavior
Poor impulse/aggressive behavior control
Dementia/Alzheimer’s
Parkinson’s
lasts a Life time
**these are the people that commit suicude and this is why we are tough on the kids cause this is where we dont want them to be **
CTE cont’d ?
White matter is most vulnerable due to if stretched to fast they get stiff ( during recover)
Microtubules /tracks break and drop the proteins ,then they build up as plaques
CTE is characterized by loss of neurons and build up of tau proteins
In 2012 a study showed 34 out of 35 postmortem brain samples show signs of CTE
**not just football players can be anyone , skateboarders and mountain bikers **
CTE facts ?
Six of the athletes most likely died from suicide.
Last year scans of 5 living players showed the tau proteins = CTE
No sure reliable way to diagnose in the living
Diagnosed for sure postmortem
Concussion type S/S , Differential diagnosis: Pots definition ?
Postural (orthostatic ) Tachycardia syndrome
“My heart rate increases when I stand up “
Adults > 19 years
1) Symptomatic heart rate increment > 30 bpm (or 120 bpm Total) within 10 minutes of tilt without drop in blood pressure .
Pots facts ?
Pediatric 19 years or younger
Symptomatic heart rate increments >40 bpm (or 130 bpm Total within 10 minutes of tilt with out drop in blood pressure .
Tilt table test
1 million in U.S. 3 million world wide are affected
Remember not all dizziness is vertigo
Benign paroxysmal positional vertigo ? what is it ?
One of the most common causes of vertigo
Feeling of spinning or inside head is spinning
Can be triggered by specific changes in head posture /position
Blow to head can dislodge crystals
s/s varies among people
BPPV facts ?
Vestibular labyrinth
three looped shaped structures ( semicircular canals)
Contain fluid and small hairs
Crystals (Otoconia) become dislodged
Most common in the posterior canal
BPPV dx ?
Goggles, enlarges, see eye better
Computer records and slows down the eye motion .
The maneuvers themselves are used to diagnose and treat the issue.
BPPV tx ?
Epley maneuver and the Dix-hall pike
Head and body positioning
Ohio concussion law ?
Effective April 26, 2013
Coaches, officials, medical support staff review their responsibilities
any coach, official, referee during a game or practice can remove a player if a concussion is suspected
Once removed. The player must get a clearance letter from a medical M.D. to return to play.
Concussion Prevention ?
Use gates on stairs
Keep doors locked
Use cabinet locks
Know athletes ability
Use up to date equipment
Use proper fitting equipment
Make sure all coaches are up to date on tackling tech
Officials are up to date
Slow down,
know your surroundings
Use proper foot wear for the weather
