sports concussion Flashcards
how man concussions occur during sports/rec annually
CDC estimates 1.6-3.8 mil
12x more non sports concussions in ER
myths
concussions cause CTE
the evidence is clear
concussion caused CTE caused football players to kill themselves/others
facts
head impacts are related to CTE, it does not need to be a concussion
CTE is found in the brains of football players who killed
- all these players had significant neuro symptoms bfore death
- thousands of players have CTE not doing that
the evidence is associations and so far has only really looked at high risk people
clinical course of concussion
majority of symptoms resolve within 3 months
5-58% have persistent impairments/symptoms
post concussive syndrome = 3 months or greater
2x risk for MSK injury after concussion
ontario guidelines for diagnosis
any loss or decreased level of consciousness
any lack of memory immediately before or after injury
any alteration in mental state
any headache, vestibular, weakness, loss of balance, dizzy, visual changes
number 1 goal from a sports perspective
prevent second impact - can cause death
early dx, early intervention
red flags
Declining levels of consciousness, cognition, orientation, affect
NEW onset of pupillary asymmetry, seizures, vomiting (repeated), other focal neuro signs
Rapidly worsening headache or neuro deficits
Suspected cervical spine or skull fracture
Suspected cervical spine instability
assessment and management: cervical MSK
Assess for cervical spine instability
Assess for cervicogenic:
Dizziness
Imbalance
Headache
Post concussion (Morin 2016,Schneider 2018):
Impaired cervical flexor strength and endurance
Joint position errors
vestibulo-oculomotor
Assess for BPPV
Dix-Hallpike
VOMS
- Smooth pursuits
-Saccades
-Convergence
-VOR
-Visual motion sensitivity
autonomic/exertional
Undetected in resting vitals
Exertional tests (Buffalo Treadmill Test)
Monitor vitals
Symptom irritation?
Can also be used to promote brain health
If dizziness is a problem -> Bike
motor assessment/manage
Static/Dynamic Balance
Motor coordination/control
Dual/Multitasking
Identify and treat impairments
CDM to determine if impairments are contributory
Incorporate dual tasking
education
Earlier intervention, better outcomes (Collins 2016, Kenzie 2017, Lennon 2018)
24-48 hrs rest, then promote activity to tolerance (McCrory 2016, Lumba-Brown 2018)
Educate on Prognosis (1-3 months)
Be careful to avoid creating catastrophizing
May require referral to other professionals (e.g. Neuropsych, sleep)
May need access to a quiet room (and a bucket for vomit)
Screen/monitor for depression
prognosis
Factors related to prolonged recovery:
Pre-injury Risk Factors
Concussion and/or migraine history
Female sex, Younger
ADHD
Genetics
Injury-related Factors
Loss of consciousness
Amnesia (retrograde or anterograde)
Delayed removal from sports
Post-Injury Factors
Dizziness, headache, migraine or depressive symptoms
These are likely to change, many of these have conflicting evidence
