Lecture 18 - Sport Related Concussions Flashcards
what is the definition of a concussion?
- sport-related concussion is a traumatic head injury induced by biomechanical forces
- may be linear or rotational
what is a linear concussion?
- injury at the impact site
- brain strikes skull on the opposite side
what is a rotational concussion?
- brain strikes skull on the other side
- brain rotates - stretches or tears structures/vessels as it shears itself
- CSF is not helpful here
what are common symptoms of a concussion in teenagers/adults?
- headache
- fatigue
- feeling slowed down
- difficulty concentrating
- fogginess
- dizziness
- light sensitivity
- visual blurring or double vision
what are the common symptoms of a concussion in children (ages 7-13)
- headaches
- fatigue
- dizziness
what are the 6 clinical domains of SRC?
- symptoms
- physical signs
- balance impairment (unsteadiness)
- behavioural changes (irritability)
- cognitive impairment (slowed reaction time)
- sleep/wake disturbances (somnolence)
what are the types of symptoms of a concussion?
- somatic (headache)
- cognitive (fog)
- emotional (mood swings)
what are the physical signs of a concussion?
- loss of consciousness
- amnesia
- neurological deficits
true or false: concussions only occur if someone hits their head
- false
- can be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head
true or false: concussions only occur if the head is hit hard
- false
- no agreed upon biomechanical threshold (60-168g)
- force does not factor in on symptom severity
true or false: you just need better equipment (and why?)
- false
- helmets reduce catastrophic head injuries (high energy impact forces) but not rotational forces (which usually cause concussions)
- limited evidence for most sports
true or false: concussions are getting worse
- false
- no scientifically validated concussion severity scales
- no such thing as a minor/severe concussion (until recovery is done, you can not say how bad it was)
- time missed is getting longer because we are getting better/smarter at dealing with concussions
what is the acute medical management for concussions?
- check ABC’s, consciousness, and C-spine/significant injury
- memory assessment (or other sideline tests) in combination with symptom report can lead to the diagnosis of a concussion
- these tests alone are not reliable (clinical examination is required)
What is the best test for the acute evaluation of SRCs?
- SCAT-5 (tests all 4 domains)
- tests postural stability, neurocognitive functions, and symptoms
- slightly tests oculomotor functions
- HAS A SCRIPT (easy to use and consistent)
- has a 10-word option (instead of just memorizing 5 words)
what should you do when sending a potentially concussed athlete home?
- re-evaluate
- send with someone (responsible adult)
- serial monitoring for deterioration (initial few hours)
- look for red flags (such as neck pain, unconscious, confusion, vomiting, seizure, double vision, weakness/tingling)
why is re-evaluation necessary?
- evolving and delayed-onset symptoms are common
- multidimensional testing is best (SCAT-5)
What is the timeline for return to play? (by age)
- teens = much longer than 10 days
- children = up to 4 weeks
- adults = as low as 6 days
why is recovery time longer for children under 13?
- developing brain is more vulnerable
- need to be clinically completely symptom-free before returning (never on the same day)
how long is recovery for a “very mild” concussion when on-field symptoms last >15 minutes?
- at least 7 days before full neurocognitive and symptom recovery
- short-term symptoms still need to be removed from play
how long does it take for the brain to metabolically return to normal?
- ~2 weeks
- period of vulnerability
- glucose, blood flow and metabolic rate for oxygen are not normal
what happens if another concussion occurs within 2 weeks of the first one?
- second impact syndrome
- up to 14 days post-injury
- occurs when athletes return to sport before the resolution of symptoms
- catastrophic increase in intracranial pressure (despite minor second impact)
- leads to much longer recovery time (if not death)
- common under the age of 21
how to check for concussions on the sideline
- know your athletes
- be prepared (educate, assess, communicate, idealize the environment (aka is it concussion or hunger/dehydration)
- re-evaluate!!! –> delayed or evolved symptoms are common
What is needed for a safe and effective return to play?
- athlete must be honest in subjective reports
- parent will be a liaison
- medical team must be a voice of reason (critical eye, communicate stages)
- coach must practice planning and team culture
- must work together to idealize environment
what are the 6 stages of return to play?
- symptom-limited activity (school/work)
- light aerobic exercise
- sport-specific exercise
- non-contact training drills
- full-contact practice
- return to sport
when do you transition through stages of RTP?
- once 24 hours symptom-free in one stage, can move up to the next stage
- if symptoms arise, move back a stage and wait until 24 hours symptom free again
