Lecture: Sport related concussions Flashcards
Concussion definition
sport-related concussion is a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities
athletes are very vulnerable within the first – hours
10
Residual effects: second impact syndrome (SIS)
- the second injury is usually more severe and can lead to brain swelling
- SIS is preventable by preventing the second blow to the Brian
Recognize/Remove/Re-evaluate/Rest
- SRC is caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain
- its not the magnitude of the hit that we worry about, it’s the direction
acute medical management
- the appropriate disposition of the palyer must be determined in a timely manner.
- standard orientation questions (i.e. time, place, person) used in isolation are unreliable in the sporting situation when compared with memory assessment.
- diagnosis of concussion should be based on a combination of subjective symptom reports and clinical examination
signs that warrant immediate removal
- just know that you would refer to the SCAT for this
multimodal evaluation should include: symptoms
somatic, cognitive and emotional, headache, fog, mood swings
multimodal evaluation should include: physical signs
Loss of consciousness, amnesia, neurological deficits, watch out for red flags
multimodal evaluation should include: Balance impairment
modified balance error scoring system (BESS) double leg, tandem stance and single leg
multimodal evaluation should include: Gait changes
gait unsteadiness/ slowed testing with tandem gait
multimodal evaluation should include: Cognitive impairment
immediate memory - word lists
concentration - digits backwards and months in reverse order
Acute medical management tests: postural stability
modified balance error scoring system (mBESS)
Acute medical management tests: oculomotor functions
vestibular/ ocular motor screening (VOMS)
Acute medical management tests: Neurocognitive functions
standard assessment of concussion (SAC) of the sport concussion assessment tool-5th edition (SCAT5)
Acute medical management tests: symptoms
post concussion symptom scale (PCSS) of the sport concussion assessment tool-5th edition (SCAT5)
SCAT 6/Child SCAT 6
- SCAT6 utility appears have optimal utility in the first 72 hours up to 1 week
- if greater than 7 days - use the SCOAT (sport concussion office assessment tool)
Concussion red flags
- neck pain or tenderness
- seizure or convulsion
- double vision
- loss of consciousness
- weakness or tingling/burning in more than arm or in the leg
- deteriorating conscious state
- vomiting
- severe or increasing headache
- increasingly restless, agitated or combative
- GCS < 15
- visible dormitory of the skull
not to be missed for concusions:
- remember to re-evaluate
- athlete should not be left alone after the injury
- send the athlete home with a responsible adult
- serial monitoring for deterioration/red flags is essential over the initial few hours after injury
- Red flag = immediate emergency medical referral
refine paediatrics (child 5-12 and adolescents 13-18)
- brain development in young athletes necessitate paradigm shifts
- more focus needed on
prevention - rule changes and contact
limitations have
decreased concussion
rates
- more focus needed on
- use child SCAT 6 8-12 and SCAT 6 13+
- NEVER RETURN TO PLAY ON SAME DAY!!
- full return to learn is recommended before full return to sport, but the two can progress in parallel
para sport athletes
1: this population may benefit from baseline testing, due to potential varying nature of presentation
2. those with history of CNS injury (CP stroke etc) may require longer initial rest period, following concussion
3. testing may require use of alternate or specialized equipment (UBE)
4. RTP must be tailored to include the individal’s adaptive equipment
practical sideline tips
know your athlets
- take time to find out their daily baseline
- ask how they are
be prepared
- assess
- communicate
- idealize the environment
Multimodal evaluation should include:
1: symptoms
2: physical signs
3: balance impairment
4: gait changes
5: cognitive impairment
A safe an effective RTP
1: athlete
2: parent
3: medical
4: coach
rest and exercise
- recommending strict rest until complete recovery is NOT beneficial
- recommend early return to PA as tolerated
- reduce screen time for the first 48 hrs
stage 1 of return to play
- active rest
- things that do not make your symptoms worse (i.e. walking)
- this stage is where you will be reintroduced to school
- symptoms will go between 5-2 as long as it does not go above 5 your okay
step 2 of return to play
- doing some type of training
- walk bike
- light exercise
- will be on bike for 20 minutes and then you take them off and see how they feel
- wait 24 hours then bump them up to 70%
step 3 of return to play
- day 4 or so
- individual sport specific exercise
- but not where there will be any type of contact
step 4 of return to play
- introduce them back in with other people or teams (where theres open space and other people)
- non contract training drills
- drills with no defender
- want them moving in space with others
- now in space with moving things, light etc
step 5 of return to play
- introduce them into a full practice
- might be contact
- move them in slowly
- get them ready to return to sport
how many hours between each stage of return to play? what if they fail a stage?
24 hours between each phase.
if they fail between staged 2-3 then you should stop and they can try again 24 hours later.
if they fail stages 4-6 you stop, wait 24 hours and then they must return to stage 3
