Concussion Flashcards
Concussion
Traumatic brain injury induced by biomechanical forces
Typically results in impairment of neurological function
Acute clinical signs and symptoms that largely reflect functional disturbance rather than structural injury
No standard imaging can show concussion
Identifying Concussion
Sport Concussion Assessment Tool (SCAT)
Sport Concussion Assessment Tool (SCAT)
1 - Athlete background
2 - Symptom evaluation
3 - Cognitive screening
4 - Neurological screen
5 - Delayed recall
6 - Decision
Do assessment before the season. If score is worse after trauma, pretty clear indicator that there is a concussion
Crude because designed to be done in 10 mins pitchside
Diagnosis tool
The Concussion Journey - HIA Video Assessment
Convulsion
Tonic posturing - rigid extended upper limb
Loss of consciousness
- lying motionless for >5 secs
- falling with no protection
- failure to protect themselves on ground
- cervical hypotonia
- unusual postural reaction
Clearly dazed - vacant/blank stare
Ataxia - motor incoordination
- unsteady on rising
- unsteady on feet
- unusual postural reaction
5 Step Approach to Video Review
1 - Head impact - 0 secs
2 - Immediate response - 0-2 secs
3 - Delayed response - 3-7 secs
4 - Return to feet
5 - Return to play
Return to Play Pathway After Concussion - Community Level
1 - Initial rest - 24-48 hrs
2 - Rest
- -> relative rest - 2 weeks
- -> light aerobic exercise - 24 hrs min.
3 - Sport specific exercise - 24 hrs min
4 - Non-contact training drills - 24 hrs min
5 - Full contact practice - 24 hrs min, review by doctor
6 - Return to sport
Graduated Return to Play (GRTP) Protocol - Professional Level
1 - Player has no remaining symptoms after no activity over 24 hr period
2 - Light aerobic exercise
3 - Rugby-specific exercise - no head contact
4 - Non-contact training drills and CogSport
5 - Medical practitioner and doctor agrees that player may participate in full contact practice
Common progressions through GRTP protocol
Rapid linear progress - 25%
Delay for symptoms to settle then rapid progress - 35%
Symptoms re-provoked during stages 2-4 - 15%
Fail to match CogSport baseline - 25%
Risk of any injury after returning to play (Cross et al., 2015)
60% difference in injury risk after concussion
Median time to subsequent injury after returning from:
- concussion 53 days
- other injuries 114 days
Could be due to:
- motor dysfunction
- poorer rehab compared to physical injuries
Shown in rugby, football and US college sports
To prevent concussion
Modify and apply laws
Limit contact
- lower concussion rate in ice hockey in Ontario (no body checking) than Alberta (body checking) in 11-12 years
- Ivy League colleges limiting tackling in football practice
Prepare players - movement control
Protective equipment
- no evidence for concussion reduction
- potential for increased risk of concussion due to change in behaviour
