Concussion & Post-Traumatic Headache in the Female Athlete
|
|
- Jason Mills
- 8 years ago
- Views:
Transcription
1 Concussion & Post-Traumatic Headache in the Female Athlete American Headache Society 2012 Scottsdale Headache Symposium Migraine Co-morbidities in Women Heidi Blume, MD, MPH Div. Pediatric Neurology Seattle Children s Hospital & Research Institute Univ. of Washington Seattle, WA Nov. 15, 2012 Case: Sports Concussion - Soccer 14 yo girl with no history of headache Was asked to head balls shot out from a machine for photo op Machine set too high, after heading 10 balls, triggered severe headache, but she recovered in time for the tournament games. During a game, ball was kicked into the side of her head: immediate pain, dizziness, nausea, vomiting 10 days later she had recovered 3 weeks later, bonked heads with her sister Next day sister elbowed her head triggering severe headache & dizziness Case: Sports Concussion Young Goalie 11 yo girl, premiere soccer goalie 1 year ago sustained 1 st concussion Headache, balance & memory problems 6 weeks later, asymptomatic, back to play 2 nd Concussion 16 months later Severe headache, balance & memory problems Headache decreased, but increased again with stress Daily headache continues 4 months after injury 1
2 Case: Sports Concussion Basketball Sophomore on women s basketball team at Ivy League College Elbowed in head during a game no LOC, immediate headache 2 nd or 3 rd lifetime concussion Personal and family history of migraine High achiever MRI, neuropsych testing, and exam all normal Two years later: chronic daily headaches and mental fogginess affecting ability to work and affecting her career and academic choices Concussion A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. A concussion is a violent jarring or shaking that results in a disturbance of brain function Sports Concussion 1-3 million sports related concussions/yr Many do not seek treatment with a medical care provider 46 states have pending or active legislation regarding concussion / head trauma Require education of coaches, parents and players After concussion player must be evaluated by a trained provider 2
3 Sports Concussion 38 million youth participate in organized sports in the U.S. In high school > 3 million girls and 4 million boys participate in sports High school athletes take longer to recover from concussion than college athletes Risks for Concussion: Female Sex Prior Concussion Game > Practice Sport & position Daneshvar et al. Rates of High School Sports Concussion Sport Rate per 10,000 Game AEs Rate per 10,000 Total AEs Rank Total # Concussions Football Girls Hockey 9.0 Boys Hockey Boys Lacrosse Girls Soccer Girls Lacrosse Girls Basketball Boys Soccer Boys Wrestling Girls Field Hockey Boys Basketball Cheerleading AE: Athlete-exposure Mara et al 2012 based on High School Database Why do girls & women have more concussions? 1. Decreased head-neck segment mass in females Could lead to greater angular acceleration after impact Females have a larger ball:head ratio in soccer 2. Lower neck strength and girth in females Although it is unclear if neck strengthening affects concussion risk 3. Estrogen: May be helpful or detrimental Few studies on estrogen and concussion 4. Females report more concussion symptoms Social macho pressures in male sports Females athletes are more concerned about future health than males 3
4 Post- Concussion Syndrome Somatic Symptoms: headache, nausea, photophobia, phonophobia, fatigue and balance deficits Emotional Disturbance: irritability, apathy, depression and anxiety Cognitive Symptoms: slow processing speed, attention deficits, impaired concentration, foggy thinking, and poor performance on neuropsychological testing Sleep Disturbance: insomnia, hypersomnia, too much or too little sleep Post- Concussion Syndrome Acute Headache is reported immediately after concussion by > 97% of all athletes Other very common acute symptoms include: dizziness & balance deficits, confusion, difficulty concentrating, nausea, photophobia More female athletes reported drowsiness and phonophobia More males reported confusion and amnesia Some studies find females report higher number of symptoms Frommer et al, Covassin 2011 Post- Concussion Syndrome Acute Time to return to play and resolution of symptoms is similar between males and females Age: Cognitive recovery is prolonged in high school vs. college athletes Sex related differences in cognitive recovery: Girls had higher risk of cognitive deficits after concussion than boys in similar sports Recovery of reaction time may be longer for females However, males and females have differences in strengths and weaknesses on baseline testing Frommer et al, 2011, Broshek 4
5 Post- Concussion Syndrome Chronic 3 months after mild TBI 11% of children remained symptomatic, only 0.5% were symptomatic after other injury 1 year after mild TBI 2.3% were symptomatic vs. 0.01% in control group Barlow et al Posttraumatic Headache Post Traumatic Headache Headache that develops within 7 days of head trauma or regaining consciousness Criteria are based on severity of injury, latency from injury and duration of the headache. BUT No description of headache localization, characterization or accompanying features are used Some question 7 day rule Adult Posttraumatic Headache Headache is one of the most common complaints following traumatic brain injury (TBI) > 90% report headache acutely after mild TBI/concussion Headaches may be more common following mild TBI than moderate or severe TBI. Women have higher risk of chronic headache after mild TBI than men OR: 4.45 ( ) headache increased compared with baseline men vs. women 18-46% of those with TBI report headaches 1 year following the injury 5
6 Adult Posttraumatic Headache Headache after Moderate/Severe TBI Lucas et al Baseline Acute 3 Months 6 Months 12 Months % with HA 18% 46% 48% 44% 46% Risk Factors for Chronic Headache Pre-Injury Headache: 48% vs. 23% Female Sex: Females were more likely to report any headaches over time (74% versus 63%) and Were more likely to report headache at all time points (37%) compared to males (18%) ~ 50% Classified as migraine Pediatric Posttraumatic Headaches Mild TBI in the ED (< 18 years old) 1 month after injury 32-58% report headache 1.3% had chronic headache 12 months after injury Sports Concussion - High School Database > 90% report headache after concussion Most (83%) had resolution of their symptoms in <1 week Only 1.5% had symptoms last longer than 1 month Field et al, Barlow et al, Blinman et al, Meehan et al Child Health After Injury Study Prospective Case Controlled Study of TBI Children Ages 5-17 with TBI or Arm injury evaluated in the ER and/or hospital Headache was more common after mild TBI than arm injury 3 months after injury 43% vs. 26%, RR 1.7 ( ) This risk was most pronounced in teens and girls Teens: 46% vs. 25%, RR:1.8 (95% CI: ) Girls: 59% vs. 24%, RR: 2.4 (95% CI: ) Headache was not more common 3 mo after mod/severe TBI and at 12 mo after injury was not different between mtbi and control groups Blume et al
7 Mild TBI & Headache: CHAI Study Girls with > 5/10 HA 3 months After Injury mtbi Boys with > 5/10 HA 3 Months After Injury 40 Arm 30 % mtbi 20 % 15 Arm Age, years Age, years Teen Girls Report of Headache 12 mo Increased headache after mild TBI in teen girls 12 months after injury compared to arm injury 43% vs. 14% 5/10 headache 26% vs. 7 % bothered a lot by headache Trend for increased headache after mod/severe TBI in girls 33% vs. 14% 5/10 headache 41% vs. 7% bothered a lot by headache However, these differences were not significant in this study Risk Factors for Headache 3 Months After Mild TBI 7
8 Why do females have more headaches after concussions than males? 1. Neuroanatomical Differences Higher cerebral blood flow and basal rate of glucose metabolism may lead to more pronounced metabolic derangements after concussion Differences in neuronal structure 2. Higher rates of migraine at baseline in women and teens 3. Hormonal Differences Estrogen may be helpful or detrimental after TBI, still a matter of debate 4. Females report more concussion symptoms Social macho pressures in male sports Females athletes are more concerned about future health than males Post-Traumatic Headaches in the Female Athlete Summary Women and teenaged girls are more likely to have a concussion than males in similar sports Women and teenaged girls are more likely to have chronic headaches following the concussion than males There is concern that women and girls have a higher risk for cognitive dysfunction and prolonged recovery following concussion The reasons for these differences are likely multifactorial, and remain unclear Zurich 2009 Guidelines 8
9 Return To Play Guidelines 1. No Activity - Cognitive and physical rest 2. Light aerobic exercise walking, swimming keep HR < 70% of predicted for age 3. Sport-specific exercise running drills 4. Non-contact training drills, progress to more complex training drills 5. Full Contact Practice after medical clearance 6. Return to play in game Each step takes at least 24 hours - in the acute period the athlete should return to previous step with increase in symptoms due to exercise Acute Headache Management Rule out neurological emergency, intracranial hemorrhage, and other acute injury No NSAIDs until evident there is no bleed Rest, acetaminophen, cool packs to head, heat to neck, possibly triptans Avoid exacerbating factors Hydration Then NSAIDs, possibly triptans, hydration, rest Management of Headache No Data Manage headache based on the patients headache and other symptoms Sub-threshold exercise Physical Therapy/Massage Supplements: Magnesium, B2/Riboflavin, CoQ10, Omega-3s Medications Counseling Autonomic symptoms Acupuncture, biofeedback Avoid Medication overuse & opiates 9
10 Management of Headache Sleep Meals & hydration Activity manage appropriately Sub-threshold exercise Relaxation/rest Trigger avoidance Management of Headache Medications used for acute post-traumatic headaches Acetaminophen Ibuprofen Naproxen Sumatriptan Ketorolac IV Fluids Depakote IV Magnesium Avoid medication overuse Management of Headache Preventive medications used for chronic post-traumatic headaches: Amitriptyline Topiramate Propranolol Depakote Magnesium Omega-3 Fatty Acids Gabapentin SSRIs Steroids.. 10
11 Acute Headaches after Concussion Summary Evaluate to ensure there is no life threatening or progressive injury or other secondary cause of headache Manage with rest, hydration, acetaminophen or NSAIDs, and conservative measures if possible Severe headaches should be treated to try to prevent conversion to chronic headache and to minimize disability, consider triptans for acute migrainous headache Follow Return to Play guidelines Most headaches will resolve within 1-2 weeks Chronic Headaches after Pediatric TBI Summary Chronic headaches affect a minority of children and teens with TBI/concussion Risk factors may include: female sex, prior TBI/concussion, prior headaches, family history of migraine, age Optimal treatment is not clear, but may involve: Sub-threshold exercise Massage or Physical Therapy Supplements and/or Complementary therapies Sub-threshold exercise Preventive prescription medications in appropriate situations Counseling Thank You 11
12 CHAI Study Group Frederick Rivara, Principle investigator Jin Wang Nancy Tempkin Thomas Koepsell Monica Vavilala Ken Jaffe Daniel Durbin Andrea Dorsch Case: Sports Concussion - Soccer 14 yo female soccer player Seen in local ER Stopped soccer Headaches and other symptoms resolved after about 2-3 weeks 4 months later cleared for gymnastics OK for 3-4 practices Severe migrainous headache after one practice w/o obvious head trauma ER, headache resolved with IV meds No further headaches or symptoms at rest or with activity in gymnastics, exam normal Case: Sports Concussion - Soccer 14 yo female soccer player Emerging common migraine or migraine triggered by concussion? Maternal Aunt with migraine, but no one else Should she go back to soccer? Advised early treatment of any future migrainous headaches with ibuprofen (if no evidence of ICH), +/- caffeine, and/or sumatriptan 12
13 References McCrory, P., et al., Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November Br J Sports Med, Suppl 1: p. i Lucas, S., et al. Natural history of headache in the first year after traumatic brain injury. in Amereican Neurological Association Honolulu, HI. Bazarian JJ, McClung J, Shah MN, Cheng YT, Flesher W, Kraus J. Mild traumatic brain injury in the United States, Brain Inj. Feb 2005;19(2): Preiss-Farzanegan SJ, Chapman B, Wong TM, Wu J, Bazarian JJ. The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. Pm R. Mar 2009;1(3): Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D. Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics. Aug 2010;126(2):e Blinman TA, Houseknecht E, Snyder C, Wiebe DJ, Nance ML. Postconcussive symptoms in hospitalized pediatric patients after mild traumatic brain injury. J Pediatr Surg. Jun 2009;44(6): Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. May 2003;142(5): Giza, C.C. and D.A. Hovda, The Neurometabolic Cascade of Concussion. J Athl Train, (3): p Giza, C.C., R.B. Mink, and A. Madikians, Pediatric traumatic brain injury: not just little adults. Curr Opin Crit Care, (2): p Post Concussion Scale Directions: After reading each symptom, please circle the number that best describes the way you have been feeling today. A rating of 6 means you have experienced severe problems with this symptom today. Subjects check a box if they are "not experiencing the symptom." Symptom Minor Moderate Severe Headache Nausea Vomiting Balance Problems Dizziness Fatigue Trouble Falling Asleep Sleeping More Than Usual Sleeping Less Than Usual Drowsiness Sensitivity to Light Sensitivity to Noise Irritability Sadness Nervousness Feeling More Emotional Numbness or Tingling Feeling Slowed Down Feeling Mentally "Foggy" Difficulty Concentrating Difficulty Remembering Visual Problems Total Score: 13
14 Mild TBI & Headache: CHAI Study Headache 3 months after Injury mtbi is associated with headache overall compared to children with arm injury 43% vs. 26%, RR 1.7 (95% C.I: ) This effect is most notable in girls and teens Girls: 59% vs. 24%, RR: 2.4 (95% C.I: ) Teens: 46% vs. 25%, RR: 1.8 (95% C.I: ) Teen Girls w/ > 5/10 HA: 55% vs. 23%, RR: 2.5 ( ) Risk of headache after mtbi appears to increase with age in girls but not boys Mild TBI & Headache: CHAI Study Headache 12 months after Injury Association between mtbi and headache 12 months after injury is suggested in girls but not boys Girls: 26% vs. 10% with > 5/10 headache RR: 2.2 (95% C.I.: ) Particularly in teenaged girls 44% vs. 14%, RR: 3.1 ( ) Mod./Severe TBI & Headache: CHAI Study 12 months After Injury Headache not significantly associated with pediatric moderate/severe TBI BUT Trend for teen girls to report more headache at 12 months following moderate/severe TBI than girls with arm injury Teen Girls Bothered a lot by headache : 42% vs. 7%, RR: 5.8 (95% C.I.: ) 14
15 CHAI Study Child Health After Injury Study Large, prospective, population-based CDC funded study of function of children and families after pediatric TBI compared to children with an arm injury Fred Rivara et al. at Harborview Injury Prevention & Research Center Children age 5 17 years at the time of injury: n=649 Mild TBI: n=441 Moderate/Severe TBI: n=71 Orthopedic Arm Injury: n=137 Analysis of data obtained at baseline, 3 and 12 months 15
Objectives. Definition. Epidemiology. The journey of an athlete
Sport Concussion Chantel Debert MD MSc FRCPC CSCN Physical Medicine and Rehabilitation Department of Clinical Neurosciences Hotchkiss Brain Institute, University of Calgary Objectives Definition Epidemiology
More informationDefined as a complex process affecting the brain, induced by traumatic biomechanical forces.
Concussion Protocol Defined as a complex process affecting the brain, induced by traumatic biomechanical forces. May be caused by a direct blow to the head, face, neck or elsewhere on the body with force
More informationTraumatic Brain Injury in Young Athletes. Andrea Halliday, M.D. Oregon Neurosurgery Specialists
Traumatic Brain Injury in Young Athletes Andrea Halliday, M.D. Oregon Neurosurgery Specialists Variability in defining concussion Lack of reliable biomarkers for concussions Reliance on subjective system
More informationRevised 10-4-10 Bethel Park s Sports Concussion and Closed Head Injury Protocol and Procedures for Student-Athletes
Bethel Park s Sports Concussion and Closed Head Injury Protocol and Procedures for Student-Athletes If the Certified Athletic Trainer of Bethel Park School District has a concern that a student-athlete
More informationConcussion Management Return to Play Protocol
Concussion Management Return to Play Protocol Returning to play following a concussion involves a stepwise progression once the individual is symptom free. There are many risks to premature return to play
More informationSOUTHWEST FOOTBALL LEAGUE CONCUSSION MANAGEMENT PROTOCOL
SOUTHWEST FOOTBALL LEAGUE CONCUSSION MANAGEMENT PROTOCOL NOTE: Revisions to the guidelines recommended in this Concussion Management Protocol will be made on an annual basis based upon current legislation.
More informationConcussion: Sideline Assessment
Concussion: Sideline Assessment Damion A. Martins, MD Director, Orthopedics & Sports Medicine Program Director, Sports Medicine Fellowship - Atlantic Health System Director of Internal Medicine - New York
More informationRecognition and Care of Concussion
Recognition and Care of Concussion Seattle Sport Concussion Program: Philip D. Heywood MS, ATC, AT/L Enter department name here Objectives: Definition and Pathophysiology Concussion facts Recognizing Concussions
More informationA GUIDE TO IN RUGBY UNION
A GUIDE TO The aim of this brochure is to provide information on concussion to those involved in rugby union in Ireland. Concussion MUST be taken extremely seriously. Any player with a suspected concussion
More informationTHE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL
THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL AFL Research board AFL MEDICAL OFFICERS' ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL This document has been published by the AFL
More informationNEW ZEALAND RUGBY LEAGUE CONCUSSION / HEAD INJURY POLICY
NEW ZEALAND RUGBY LEAGUE CONCUSSION / HEAD INJURY POLICY February 2015 New Zealand Rugby League Medical panel The aim of the policy is to provide information on concussion to all those involved in rugby
More informationConcussion Management Program for Red Bank Catholic High School Athletic Department
Concussion Management Program for Red Bank Catholic High School Athletic Department *This document should be used as a framework for a successful concussion management program but is not intended to replace
More informationA Parent s Guide to Choosing a Sports Concussion Specialist Brain Injury Alliance of New Jersey Concussion in Youth Sports Committee
A Parent s Guide to Choosing a Sports Concussion Specialist Brain Injury Alliance of New Jersey Concussion in Youth Sports Committee The following is a guideline for parents to use when choosing a sports
More informationConcussion in Sports
PSAL: Concussion in Sports and the Concussion Management and Awareness Act Dennis A. Cardone, DO Associate Professor Concussion Overview Concussion accounts for 1 of 10 sports injuries CDC: Estimated 2,651,581
More informationIHSA Sports Medicine Acknowledgement & Consent Form. Concussion Information Sheet
Concussion Information Sheet A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force
More informationSport Concussion in New Zealand ACC National Guidelines
Sport Concussion in New Zealand ACC National Guidelines This guideline document has been produced to inform National Sports Organisations (NSOs), and recreation, education and health sectors in their development
More informationWhat is a concussion? What are the symptoms of a concussion? What happens to the brain during a concussion?
What is a concussion? The working definition used today for concussion is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces (developed by the consensus
More informationMichael J. Sileo, MD. Orthopedic Associates of Long Island (OALI)
Michael J. Sileo, MD Orthopedic Associates of Long Island (OALI) ! Jeremy Thode, AD! Center Moriches BOE ! Safety of our student-athletes is our Number 1 concern! NYS is now forcing our hand " Referees
More informationSkate Australia Concussion Guidelines
Skate Australia Concussion Guidelines Introduction Forces strong enough to cause concussion are common in all roller sports. Even though helmets are worn in most disciplines, the risk of concussion is
More informationLIBERTY UNIVERSITY CONCUSSION PROTOCOL Page 1
Liberty University Sports Medicine Concussion / Traumatic Brain Injury Protocol The Liberty University Sports Medicine Department recognizes that head injuries, particularly sportinduced concussions, pose
More informationConcussion Guidance for the General Public
CONCUSSION FACTS A concussion is a brain injury. All concussions are serious. Concussions can occur without loss of consciousness. All athletes with any symptoms following a head injury must be removed
More informationNeuropsychological Assessment in Sports-Related Concussion: Part of a Complex Puzzle
Neuropsychological Assessment in Sports-Related Concussion: Part of a Complex Puzzle Jillian Schuh, PhD 1, 2, John Oestreicher, PhD 1, & Linda Steffen, PsyD 1 1 Catalpa Health 2 Department of Neurology,
More informationIF IN DOUBT, SIT THEM OUT.
IF IN DOUBT, SIT THEM OUT. Scottish Sports Concussion Guidance: Grassroots sport and general public Modified from World Rugby s Guidelines on Concussion Management for the General Public Introduction The
More informationSport Concussion in New Zealand:
Sport Concussion in New Zealand: ACC National Guidelines January 2015 Developed with our partners: This guideline document has been produced to inform National Sports Organisations (NSOs), and recreation,
More informationConcussion Rates per Sport
PSE4U UNIT 1: SPORTS-RELATED HEAD INJURIES DUE DATE: LATE PENALTY (-5% PER WEEK): K/U T/I C A FINAL MARK 10 10 10 32 62 PART A: BRAINSTORMING [T/I /10] [C /10] 1.) Construct a mind-map: research the amount
More informationCONCUSSION DEFINITION
Return to Learn and Return to Physical Activity Plan: Information for Parents and Student s CONTEXT Recent research has made it clear that a concussion can have a significant impact on a student'ss cognitive
More informationOutline. What is a concussion? A brief history of concussion. Neurometabolic Cascade 4/27/2016
Outline Challenges in Managing Concussed Adolescents: The Biopsychosocial Balancing Act Luke C. Henry, PhD Clinical Neuropsychologist UPMC Sports Concussion Clinic 05.16.2014 Concussions Brief history
More informationCONCUSSION PROTOCOL PARENT/GUARDIAN INFORMATION PACKAGE
CONCUSSION PROTOCOL PARENT/GUARDIAN INFORMATION PACKAGE November 2014 INTRODUCTION: PARENT/GUARDIAN CONCUSSION PACKAGE The parent/guardian concussion package has been developed to: Assist parent/guardians
More informationCONCUSSION AND HEAD INJURY AWARENESS POLICY TRAINING C I T Y O F S O U T H J O R D A N 9 / 2 0 1 1
CONCUSSION AND HEAD INJURY AWARENESS POLICY TRAINING C I T Y O F S O U T H J O R D A N 9 / 2 0 1 1 UTAH STATE LEGISLATION 2011 General Legislative Session House Bill 204: Enacts the Protection of Athletes
More informationModel Policy and Guidance for Pennsylvania Schools for Sports-Related Concussion/Mild Traumatic Brain Injury
INTRODUCTION This document is designed to provide guidance to Pennsylvania school boards of education in the development, establishment, and implementation of policies, protocols and programs for the prevention,
More informationLaurel School Sports Medicine Traumatic Brain Injury (TBI)/Concussion Management Document
Laurel School Sports Medicine Traumatic Brain Injury (TBI)/Concussion Management Document Baseline Testing Laurel School Sports Medicine utilizes ImPACT neurocognitive testing as part of our concussion
More informationSports Concussion Management Plan
Chesapeake Public Schools Sports Concussion Management Plan Developed in collaboration with The Children s Hospital of The King s Daughters Sports Medicine Program. CHKD Sports Medicine The official athletic
More informationManagement of Sports-Related Concussions Smallville School District
Management of Sports-Related Concussions Smallville School District Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding
More informationConcussion Information Sheet
Concussion Information Sheet A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force
More informationThe FacTs: * All concussions are serious. A Fact Sheet for School Nurses
A Fact Sheet for School Nurses Assess the situation Be alert for signs and symptoms Contact a health care professional The FacTs: * All concussions are serious. * Most concussions occur without loss of
More informationA patient guide to mild traumatic brain injury
A patient guide to mild traumatic brain injury Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
More informationTBI TRAUMATIC BRAIN INJURY WITHIN THE MILITARY/VETERAN POPULATION
TBI TRAUMATIC BRAIN INJURY WITHIN THE MILITARY/VETERAN POPULATION What is TBI? An external force that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The
More informationPOLICY TO ADDRESS SUSPECTED SPORTS RELATED HEAD INJURY/CONCUSSION
POLICY TO ADDRESS SUSPECTED SPORTS RELATED HEAD INJURY/CONCUSSION The Easton Public Schools has adopted this policy to address the identification and proper handling of suspected head injury for students
More informationNeuropsychological Assessment in Sports- Related Concussion: Part of a Complex Puzzle
Neuropsychological Assessment in Sports- Related Concussion: Part of a Complex Puzzle Jillian Schuh, PhD 1, 2, John Oestreicher, PhD 1, & Linda Steffen, PsyD 1 1 Catalpa Health 2 Department of Neurology,
More informationINTERNATIONAL RUGBY BOARD Putting players first
Summary Principles Concussion must be taken extremely seriously to safeguard the long term welfare of Players. Players suspected of having concussion must be removed from play and must not resume play
More informationUniversity of Notre Dame Sports Medicine Department Intercollegiate Athletics Concussion Management Plan
Purpose: University of Notre Dame Sports Medicine Department Intercollegiate Athletics Concussion Management Plan Head injuries can pose a significant health risk for student-athletes competing in intercollegiate
More informationAdolescent Sports Medicine Update
Adolescent Sports Medicine Update AARON GRAY, MD DEPARTMENTS OF FAMILY MEDICINE & ORTHOPAEDICS UNIVERSITY OF MISSOURI. Objectives Understand unique diagnostic and management considerations of concussions
More informationMontreal Cognitive Assessment (MoCA) as Screening tool for cognitive impairment in mtbi.
Montreal Cognitive Assessment (MoCA) as Screening tool for cognitive impairment in mtbi. Suresh Kumar, M.D. AUTHOR Director of: Neurology & Headaches Center Inc. Neurocognitve &TBI Rehabilitation Center
More informationImmediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Normative Data
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Normative Data Version 2.0 Only 2003 Grant L. Iverson, Ph.D. University of British Columbia & Riverview Hospital Mark R. Lovell, Ph.D.
More informationHEADACHES IN CHILDREN AND ADOLESCENTS. Brian D. Ryals, M.D.
HEADACHES IN CHILDREN AND ADOLESCENTS Brian D. Ryals, M.D. Frequency and Type of Headaches in Schoolchildren 8993 children age 7-15 in Sweden Migraine in 4% Frequent Nonmigrainous in 7% Infrequent Nonmigrainous
More informationConcussion (Mild Traumatic Brain Injury)
Teachers Desk Reference: Practical Information for Pennsylvania s Teachers Concussion (Mild Traumatic Brain Injury) This Teachers Desk Reference provides information about traumatic brain injury (TBI),
More informationNFL Head, Neck and Spine Committee s Protocols Regarding Diagnosis and Management of Concussion
NFL Head, Neck and Spine Committee s Protocols Regarding Diagnosis and Management of Concussion Introduction Concussion is an important injury for the professional football player, and the diagnosis, prevention,
More informationConcussion Education. Sports Medicine. ohsusportsmedicine.com 503 494-4000
Concussion Education What is a concussion? A concussion is a common, yet mild traumatic brain injury resulting from a force or impact to the head. Examples of such forces include: Head to Head Head to
More informationRecovering from a Mild Traumatic Brain Injury (MTBI)
Recovering from a Mild Traumatic Brain Injury (MTBI) What happened? You have a Mild Traumatic Brain Injury (MTBI), which is a very common injury. Some common ways people acquire this type of injury are
More informationUHSAA Sports Concussion Management Policy (Updated and Revised 8/17/2011)
1. Overview UHSAA Sports Concussion Management Policy 1.1. In response to the growing concern over concussion in athletics there is a need for High Schools to develop and utilize a Concussion Management
More informationCONCUSSION CHECKLIST FOR COACHES
Sports Medicine CONCUSSION CHECKLIST FOR COACHES 1. Read through the material included in the Concussion Packet for Coaches 2. Know the signs and symptoms of a concussion 3. Send the following forms home
More informationRainy River District School Board SECTION 4
Rainy River District School Board SECTION 4 Students STUDENT CONCUSSION PROTOCOL PROCEDURE PURPOSE 4.74 The Rainy River District School Board is committed to the safety of all students. In the interests
More informationConcussion Management The Team Plan
Concussion Management The Team Plan Joseph F. Waeckerle M.D., FACEP Concussion Management The Team Plan Joseph F. Waeckerle M.D., FACEP Clinical Professor of Emergency Medicine, University of Missouri
More informationBrain Injury Litigation. Peter W. Burg Burg Simpson Eldredge Hersh & Jardine, P.C. www.burgsimpson.com
Brain Injury Litigation Peter W. Burg Burg Simpson Eldredge Hersh & Jardine, P.C. www.burgsimpson.com Some General Facts About Traumatic Brain Injury TBIs contribute to a substantial number of deaths and
More informationConcussions in Children and Adolescents
Concussions in Children and Adolescents 17 November 2012 Christina L. Master, MD, CAQSM There are no conflicts of interest to disclose Objectives Definition/Pathophysiology Incidence/Epidemiology Myths/Facts
More informationConcussion in Athletes: Identification, Evaluation and Educational Considerations Mary Ann Dugan, MSN, CRNP, FNP-BC
Concussion in Athletes: Identification, Evaluation and Educational Considerations Mary Ann Dugan, MSN, CRNP, FNP-BC Pediatric Nursing 30 th Annual Conference Saturday, August 2, 2014 Objectives: 1. Definition
More informationPost-Concussion Syndrome
Post-Concussion Syndrome Anatomy of the injury: The brain is a soft delicate structure encased in our skull, which protects it from external damage. It is suspended within the skull in a liquid called
More informationTexas A&M Sports Medicine Concussion Policy
Texas A&M Sports Medicine Concussion Policy 1. All Texas A&M student-athletes must read the NCAA Concussion Fact Sheet and sign the attached student athlete statement acknowledging that: a. They have read
More informationTraumatic Brain Injury for VR Counselors Margaret A. Struchen, Ph.D. and Laura M. Ritter, Ph.D., M.P.H.
Training Session 1c: Understanding Recovery Courses and Outcomes after TBI What is the typical recovery course after a mild or moderate/severe TBI? What are the effects of personal and environmental factors,
More informationCOMPREHENSIVE CHILDREN S INJURY CENTER (CCIC) Head Injury Clinic A GUIDE TO CONCUSSIONS & MILD TRAUMATIC BRAIN INJURIES
COMPREHENSIVE CHILDREN S INJURY CENTER (CCIC) Head Injury Clinic A GUIDE TO CONCUSSIONS & MILD TRAUMATIC BRAIN INJURIES Concussions and What is a concussion? DIAGNOSIS Traumatic Brain Injuries A concussion
More informationGeneral Information Regarding Sports-Related Concussions & Head Injuries
Date Adopted: December 13, 2011 Date Revised Page 1 of 7 The Board of Education recognizes that head injuries pose a serious health risk to the students of this district and in particular to student athletes
More informationTraumatic brain injury (TBI), caused either by blunt force or acceleration/
Traumatic Brain Injury (TBI) Carol A. Waldmann, MD Traumatic brain injury (TBI), caused either by blunt force or acceleration/ deceleration forces, is common in the general population. Homeless persons
More informationSan Diego Sports Medicine Sport Concussion Policy Developed by the SDSM Committee on Sports Concussion Updated 2/11
San Diego Sports Medicine Sport Concussion Policy Developed by the SDSM Committee on Sports Concussion Updated 2/11 San Diego Sports Medicine (SDSM) has been a leader in the evaluation and treatment of
More informationHeadaches and Kids. Jennifer Bickel, MD Assistant Professor of Neurology Co-Director of Headache Clinic Children s Mercy Hospital
Headaches and Kids Jennifer Bickel, MD Assistant Professor of Neurology Co-Director of Headache Clinic Children s Mercy Hospital Overview Headache classifications and diagnosis Address common headache
More informationTraumatic Brain Injury and Incarceration. Objectives. Traumatic Brain Injury. Which came first, the injury or the behavior?
Traumatic Brain Injury and Incarceration Which came first, the injury or the behavior? Barbara Burchell Curtis RN, MSN Objectives Upon completion of discussion, participants should be able to Describe
More informationCreating an Academic Concussion Management Plan
Sports Medicine A School Administrator s Guide to Academic Concussion Management Nationwide Children s Hospital Sports Medicine wants you to understand the impact concussions can have on a student s ability
More informationHEADS UP ONCUSSION IN HIGH SCHOOL SPORTS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
HEADS UP C ONCUSSION GUIDE FOR COACHES IN HIGH SCHOOL SPORTS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION mthe Facts 1 mrecognizing a Possible Concussion 4 mwhen
More informationConcussion in Sports. Joaquin Wong, M.D. LSUHSC-NO/Children s Hospital New Orleans, LA
Joaquin Wong, M.D. LSUHSC-NO/Children s Hospital New Orleans, LA NFL: 53 concussions by the middle of October 2010 Week 6 of 2010 NFL season: 3 players fined a total of $175,000 New rules regarding helmet
More informationAttention & Memory Deficits in TBI Patients. An Overview
Attention & Memory Deficits in TBI Patients An Overview References Chan, R., et.al.. (2003). Are there sub-types of attentional deficits in patients with persisting post- concussive symptoms? A cluster
More informationNHCS CONCUSSION & TRAUMATIC BRAIN INJURY EDUCATION REVIEW
NHCS CONCUSSION & TRAUMATIC BRAIN INJURY EDUCATION REVIEW A brief discussion about concussions based on the most current data The New NC Law & what it means The practices & procedures New Hanover County
More informationMenomonee Falls School District
Concussion Management Plan For: Menomonee Falls School District W156 N8480 Pilgrim Road Menomonee Falls, WI 53051 May 17, 2012 Prepared by: Julie Italiano-Thomas, RN School District Nurse Gary Kiltz High
More informationMIGRAINE. Denise Cambier M.D. Delaware Neurology, Ohio Health March 2013
MIGRAINE Denise Cambier M.D. Delaware Neurology, Ohio Health March 2013 HISTORY: Graham and Wolff 1938: decreased amplitude of arterial pulsations coincided with reduction of headache with IV ergotamine.
More informationmtbi Concussion, Post Concussion Syndrome and mtbi
mtbi Concussion, Post Concussion Syndrome and mtbi Barry Willer PhD bswiller@buffalo.edu Immediate Symptoms Secondary Symptoms Cognitive Issues Ideally with Baseline Understanding Persistent Symptoms
More informationComputerized Neurocognitive Testing for the Management of Sport-Related Concussions
Computerized Neurocognitive Testing for the Management of Sport-Related Concussions WHAT S KNOWN ON THIS SUBJECT: Neurocognitive testing is recommended for the assessment of sport-related concussions.
More informationSUMMARY OF THE WHO COLLABORATING CENTRE FOR NEUROTRAUMA TASK FORCE ON MILD TRAUMATIC BRAIN INJURY
J Rehabil Med 2005; 37: 137 141 SPECIAL REPORT SUMMARY OF THE WHO COLLABORATING CENTRE FOR NEUROTRAUMA TASK FORCE ON MILD TRAUMATIC BRAIN INJURY Lena Holm, 1,2 J. David Cassidy, 3 Linda J. Carroll 4 and
More informationHow To Treat A Concussion
Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding sports-related concussions in high school athletes, including
More informationPost Traumatic and other Headache Syndromes. Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA
Post Traumatic and other Headache Syndromes Danielle L. Erb, MD Brain Rehabilitation Medicine, LLC Brain Injury Rehab Center, PRA Over 45 million Americans have chronic, recurring headaches 62% of these
More informationStaff, please note that the Head Injury Routine is included on page 3.
Staff, please note that the Head Injury Routine is included on page 3. This booklet explains what can happen after a concussion, how to get better and where to go for more information and help if needed.
More informationConcussion Update 2016 Managing Return to Activities
Concussion Update 2016 Managing Return to Activities New Horizons in Pediatrics April 16-17, 2016 David L, Marshall, MD Medical Director, Sports Medicine Overview of Concussion Acute (immediate) recognition
More informationAR159 February 9, 2015
AR159 February 9, 2015 1.0 PURPOSE AR CONCUSSION PROTOCOL The purpose of this protocol is to provide information regarding the prevention, identification and management of concussions. Everyone has a role
More informationRisk Management Policy
Inspiring all girls to be strong, smart and bold.sm Risk Management Policy Girls Incorporated of York Region 80 George Street, Newmarket, L3Y4V3 p. 905-830-0776 f. 905-830-4480 info@girlsincyork.org www.girlsincyork.org
More informationIn-Office Evaluation of Sports Concussion: Components of Assessment, Treatment and Rehabilitation
In-Office Evaluation of Sports Concussion: Components of Assessment, Treatment and Rehabilitation Micky Collins, PhD University of Pittsburgh Medical Center Department of Orthopaedic Surgery Department
More informationConcussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement *
SPECIAL COMMUNICATIONS Team Physician Consensus Statement Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement * DEFINITION Concussion or mild traumatic brain injury (MTBI)
More informationHeadaches in Children
Children s s Hospital Headaches in Children Manikum Moodley, MD, FRCP Section of Pediatric Neurology The Cleveland Clinic Foundation Introduction Headaches are common in children Most headaches are benign
More informationCognitive Assessment and Rehabilitation in mtbi Patients. Shannon E. Auxier, MS CCC-SLP Judy M. Mikola, PhD CCC-SLP
Cognitive Assessment and Rehabilitation in mtbi Patients Shannon E. Auxier, MS CCC-SLP Judy M. Mikola, PhD CCC-SLP Disclaimer The views expressed in this presentation are those of the presenters and do
More informationConcussion Management Protocol for Kansas State University Sports Medicine Prior to participation in any athletic activity for Kansas State
Concussion Management Protocol for Kansas State University Sports Medicine Prior to participation in any athletic activity for Kansas State University, a student-athlete will have a pre-participation medical
More informationMedical-School Partnerships in Concussion Management: Promoting Successful Return to School and Life
Medical-School Partnerships in Concussion Management: Promoting Successful Return to School and Life Gerard A. Gioia, PhD Division of Pediatric Neuropsychology Safe Concussion Outcome, Recovery & Education
More informationMild head injury and concussion
Mild head injury and concussion This teaching sheet contains general information only. Talk with your child s doctor or a member of your child s health care team about specific care for your child. What
More informationParents calling should use this number if they need to set up an appointment: 484-526-3884
IMPACT TESTING CONCUSSION MANAGEMENT ALL coaches on the Palmerton staff are now required to take a course once a year to complete the concussion management certification-training course offered by the
More informationConcussion Information for Parents/Guardians
Concussion Information for Parents/Guardians What is a concussion and what causes a concussion? A concussion is a brain injury that causes changes in how the brain cells function, leading to symptoms that
More informationConcussion Training for Coaches
Concussion Training for Coaches INTRODUCTION Each day in our nation, hundreds of thousands of young athletes head out to fields, ice and gymnasiums to practice and compete in a wide variety of sports.
More informationTHE PROTESTANT SEPARATE SCHOOL BOARD OF THE TOWN OF PENETANGUISHENE POLICY MANUAL. Student Concussion Protocol School Operations D 26
March 9, 2015 New Page 1 of 21 POLICY STATEMENT The Ministry of Education expects all school boards in Ontario to develop and maintain a policy on concussion as outlined in Policy/Program Memorandum No.
More informationTraumatic brain injury (TBI)
Traumatic brain injury (TBI) A topic in the Alzheimer s Association series on understanding dementia. About dementia Dementia is a condition in which a person has significant difficulty with daily functioning
More informationReturn to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition
Assessment Skills of the Spine on the Field and in the Clinic Ron Burke, MD Cervical Spine Injuries Sprains and strains Stingers Transient quadriparesis Cervical Spine Injuries Result in critical loss
More informationA PEEK INSIDE A CLOSED HEAD INJURY CLAIM... 1
A PEEK INSIDE A CLOSED HEAD INJURY CLAIM By: Douglas Fletcher Fernando Fred Arias Dr. Jim Hom April 11, 2014 CONTENTS A PEEK INSIDE A CLOSED HEAD INJURY CLAIM... 1 SYMPTOMATOLOGY... 2 CRITICAL INFORMATION...
More information8 th Annual W/C Spine Summit. Ted A. Lennard, MD Feb. 12, 2015
8 th Annual W/C Spine Summit Ted A. Lennard, MD Feb. 12, 2015 Case Study 45 y.o. male Truck Accident on 1/15/12 Slid on ice and crossed median. Case Study Taken by ambulance to ER in Texas +Loss of consciousness
More informationHeadaches in Children How to Manage Difficult Headaches
Headaches in Children How to Manage Difficult Headaches Peter Procopis Childhood headaches Differential diagnosis Migraine Psychological Raised Pressure Childhood headaches Other causes: Constitutional
More informationGet a Heads Up on Concussion in Sports Policies
Get a Heads Up on Concussion in Sports Policies Information for Parents, Coaches, and School & Sports Professionals National Center for Injury Prevention and Control Division of Unintentional Injury Prevention
More information1. Dislocations along with strains/sprains account for percent of musculoskeletal injury episodes. A. 0 B. 40 C. 50 D. 60
QUESTIONS Musculoskeletal Hour 1 Multiple Choice Questions 1. Dislocations along with strains/sprains account for percent of musculoskeletal injury episodes. A. 0 B. 40 C. 50 D. 60 2. Regarding high school
More informationReturning to School After a Concussion: A Fact Sheet for School Professionals
Returning to School After a Concussion: A Fact Sheet for School Professionals Assess the situation Be alert for signs and symptoms Contact a health care professional What is a Concussion? A concussion
More information